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“Many strategies, including intraopera

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“Many strategies, including intraoperative acute normovolemic hemodilution (ANH) and pharmacologic agents, exist to minimize the use of allogeneic blood products in pediatric congenital heart surgery. Recombinant activated factor VIIa (rFVIIa) is a hemostatic agent approved for the treatment of bleeding episodes and prevention DMXAA mouse of bleeding in surgical interventions in patients with hemophilia A or B with inhibitors, acquired hemophilia, or congenital factor VII deficiency. Off-label use in nonhemophilic

patients for uncontrolled hemorrhage is increasing although still under investigation. We present our experience with ANH and rFVIIa in nine patients. All were < 16 months of age and underwent complex cardiac surgery with

the end point of achieving hemostasis while decreasing or eliminating buy SNX-5422 the need for allogeneic blood products. Clinically, we have observed rapid hemostasis in patients who underwent ANH and then had autologous blood reinfused after cardiopulmonary bypass, along with rFVIIa, without any time delay. The patients required no allogeneic blood products and therefore results suggested the potential utility of this practice. The study group consisted of nine patients < 16 months of age who received rFVIIa in the operating room after open-heart surgery. Amount of autologous blood removed preoperatively, blood product use, time from protamine to rFVIIa administration, platelet count, INR, and fibrinogen

level were retrospectively obtained. Of the nine patients, the three who underwent the most aggressive hemodilution received rFVIIa most rapidly and required no allogeneic blood products to achieve hemostasis although DZNeP mw they had an average lower fibrinogen level on admission to the cardiothoracic intensive care unit. These preliminary data suggest that hemodilution before surgical stimulation and the rapid administration of rFVIIa, along with the reintroduction of autologous blood, may decrease or potentially eliminate the need for allogeneic blood products. Prospective trials are warranted to further explore this technique.”
“Dehydroepiandrosterone (DHEA) has been reported to improve oocyte/embryo yields and oocyte/embryo quality in women with diminished ovarian reserve. Whether DHEA objectively improves ovarian reserve is, however, unknown. This study investigated 120 consecutive patients with diminished ovarian reserve, supplemented for 30-120 days (mean 73 +/- 27) with DHEA (25 mg three times daily). Anti-Mullerian hormone (AMH) concentrations were determined in relationship to DHEA supplementation using linear regression and, longitudinally, by examining interaction between days of DHEA treatment and pregnancy success in respect to changes in AMH. AMH concentrations significantly improved after DHEA supplementation over time (P = 0.002). Women under age 38 years demonstrated higher AMH concentrations and improved AMH concentrations more than older females.

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