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Clinically significant weight gain (CSWG) is associated with increased morbidity and mortality. This study describes CSWG and comorbidities observed in patients with bipolar I disorder (BD-I) and schizophrenia (SZ) after initiating select second-generation antipsychotics (SGAs).
Percent change in weight, CSWG (=7% weight increase), and incident comorbidities within 12 months of treatment were assessed among patients initiating oral SGAs of moderate-to-high weight gain risk using medical records/claims (OM1 Real-World Data Cloud; January 2013-February 2020). Oral SGAs included clozapine (SZ), iloperidone (SZ), paliperidone (SZ), olanzapine, olanzapine/fluoxetine (BD-I), quetiapine, and risperidone. Outcomes were stratified by baseline body mass index and reported descriptively.
Among patients with BD-I (N = 9142) and SZ (N = 8174), approximately three-quarters were overweight/obese at baseline. During treatment (mean duration = 30 weeks), average percent weight increase was 3.7% (BD-I) and 3.3% (SZ). Average percent weight increase was highest for underweight/normal weight patients (BD-I = 5.5%; SZ = 4.8%), followed by overweight (BD-I = 3.8%; SZ = 3.4%) and obese patients (BD-I = 2.7%; SZ = 2.3%). Within 3 months of treatment, 12% of all patients experienced CSWG. A total of 11.3% (BD-I) and 14.7% (SZ) of patients developed coronary artery disease, hypertension, dyslipidemia, or type 2 diabetes within 12 months of treatment; development of comorbidities was highest among overweight/obese patients and those with CSWG.
Patients who were underweight/normal weight at baseline had the greatest percent change in weight during treatment. Increased comorbidities were observed within 12 months of treatment, specifically among overweight/obese patients and those with CSWG. The magnitude of weight gain and development of comorbidities were similar for patients with BD-I and SZ.
Discusses the development, application and limitations of computer-aided sperm analysis (CASA) methods, including the deriation of kinematic measures of human sperm motility. Explains the technical and biological factors that limit CASA's functionality for human semen analysis and summarizes expert recommendations on the use of CASA for human semen analysis and sperm kinematics analysis (including sperm-mucus penetration and sperm hyperactivation). Issues related to the non-comparability of different CASA systems are considered, along with quality control for CASA. A strategy for validating a CASA system for human semen analysis, based on expectations of accuracy and precision, is also provided. Finally the use of CASA for analyzing sperm function tests, and new and future CASA technology (including the application of artificial intelligence technqiues) are surveyed.
The physiology and basic principles of sperm washing and other preparative techniques are described, including the limitations and even dangers posed by some methods. Optimized methods for sperm preparation using direct swim-up from semen and density gradient centrifugation are provided as standard operating procedures (SOPs) for easy use at the bench. Methods are focussed on standardization and robustness, and minimizing the risk iatrogenic damage to the spermatozoa and avoiding errors. There are sections on selecting which method to use, dealing with atypical semen specimens, processing multiple specimens, and potential new technology for preparing human spermatozoa for use in assisted conception treatment.
Provides methods for a range of common sperm function tests that are structured as standard operating procedures (SOPs) for easy use at the bench. Methods are focussed on objectivity, robustness, standardized reporting, controlling the risk of errors, and minimizing measurement uncertainty. Includes sperm hyperactivation, acrosome reaction testing, and sperm-zone pellucida binding tests (hemi-zona and competititve binding formats). A protocol for using the sperm survival test in also provided. Limitations of the hyaluronan bibding assay, and of sperm fertilizing ability testing using zona pellucida-free hanster oocytes, are summarized.
Discusses the origins and detection of sperm DNA fragmentation, including cliniCal indications for such testing. Provides methods for a range of common techniques for assessimg sperm DNA fragmentation that are structured as standard operating procedures (SOPs) for easy use at the bench, inclding the TUNEL assay, Comet assay, and the sperm chromatin dispersion test (Halosperm test).
Sampling of cervical mucus, its assessment, and the investigation of sperm-mucus interaction are described in detail. Methods are provided for a range of common tests that are structured as standard operating procedures (SOPs) for easy use at the bench. Methods are focussed on objectivity, robustness, standardized reporting, controlling the risk of errors, and minimizing measurement uncertainty. Includes the post-coital test, Kurzrok-Miller slide test, the Kremer capillary tube sperm penetration test, and the sperm-cervical mucus contact sldie test. An explanation of crosed hostility testing is also included, along with a discussion of complementary tests and the use of cervical mucus surrogates.
This chapter provides an overview of 20 primary recommendations for safe working in the andrology laboratory, along with sections on accident prevention, appropriate clothing and the proper use of personal protective equipment (PPE), fire safety, dealing with spills, use and disposal of biological materials, chemical hazards, compressed gases, and cryogenics.
The basic princples of cryobiology are described for both slow freezing and vitrification of spermatozoa. Specific aspects of cryopreserving human spermatozoa are discussed in detail, incluidng the formulation of cryopreservation media and their proper use. Alternative packaging devices are discussed in relation to the achievement of correct cooling and warming curves as well as effective biocontainment. High security straws are recommended as the best method to use from both perspectives, and a standard operating procedure (SOP) for easy use at the bench is provided. SOPs for human sperm vitrification techniques are also gven. Quality control and risk management aspects of sperm freezing and for cryobank organzation are described. Finally, there is a section on sperm donation.
Provides methods for a range of common additional assessments on semen that are structured as standard operating procedures (SOPs) for easy use at the bench. Methods are focussed on objectivity, robustness, standardized reporting, controlling the risk of errors, and minimizing measurement uncertainty. Includes anti-sperm antobodies (direct and indirect MAR test), immunocytochemical staining of leukocytes, meaaurement of reactive oxygen species and seminal plasma redox state, and biochemical tests on the seminal plasma to evaluate acessory gland function (zinc for the prostate, frutose for the seminal vesicles and alpha-glusidase for the epidiymis) and investigate abnormalities of the sequence of ejaculation. There is also a discussion on the microbiological examination of semen,.
Following an overview of Risk Management, tools such as Failure Modes and Effects Analysis (FMEA) and Root Cause Analysis (RCA) are described. The key role of risk management in laboratory accreditation and certification is discussed, and the main sources of risk in the andrology laboratory are considered. The specific areas of specimen provenance and sperm cryobanking / cryobank management are discussed, as well as the post-analytical phase of sperm testing in terms of results intepretation and diagnosis.