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STUDY QUESTION: Do women ≥40 years old without a male partner who utilize donor sperm have the same reproductive outcomes as those who utilize their partner's sperm? SUMMARY ANSWER: After controlling for relevant confounders, women ≥40 years old using donor sperm for IVF have significantly higher odds of having a live birth compared to those utilizing their partner's sperm. WHAT IS KNOWN ALREADY: Women who are unpartnered or in same-sex relationships are by definition not infertile, but may choose to conceive using donor sperm. It is not known how IVF outcomes are affected with the use of donor sperm compared to women utilizing their partner's sperm, particularly at very advanced maternal ages. STUDY DESIGN, SIZE, DURATION: This is a retrospective cohort study conducted at a university-affiliated center of women undergoing IVF with fresh embryo transfer between 2008 and 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS: Patients were divided into two groups based on the ejaculated sperm source utilized: donor or partner sperm. Live birth rate was the primary outcome. Pregnancy rate was the secondary outcome. Multivariable logistic regression was performed and adjusted for age, the developmental stage of the embryo, and the number of embryos transferred. Unadjusted odds ratio (OR) and adjusted OR (aOR) with 95% CI for pregnancy and live birth were estimated. Statistical significance was denoted by P < 0.05. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 3910 cycles in women ≥40 years old were analyzed, of which 307 utilized donor sperm and 3603 utilized their partner's sperm to conceive. In the univariate analysis, patients utilizing donor sperm were found to have similar pregnancy rates as those utilizing partner sperm (41.0 vs 39.8%, OR: 0.95, 95% CI: 0.75-1.20). After adjusting for age, the number of embryos transferred and the developmental stage of the embryos, the model estimates did not vary (aOR: 1.22, 95% CI: 0.95-1.56). Similarly, the univariate analysis for live birth did not demonstrate a difference between groups (19.2 vs 17.8%, OR: 0.91, 95% CI: 0.67-1.22). However, after a similar adjustment was made for confounders, the use of donor sperm was associated with statistically significant increased odds of live birth (aOR: 1.38, 95% CI: 1.01-1.88). LIMITATIONS, REASONS FOR CAUTION: As with any retrospective study, the potential for residual confounding exists, despite attempts to control for this with regression modeling. WIDER IMPLICATIONS OF THE FINDINGS: Women ≥40 years old who are unpartnered or in same-sex relationships can be counseled that their odds of a live birth are slightly better than women in heterosexual relationships utilizing their partner's sperm. These findings serve to further refine and individualize counseling on the expected IVF outcomes for women in this population. STUDY FUNDING/COMPETING INTEREST(S): No funding was sought for this study. The authors declare no competing interests. TRIAL REGISTRATION NUMBER: N/A.

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From the DNA sequences for N taxa, the (generally unknown) phylogenetic tree T that gave rise to them is to be reconstructed. Various methods give rise, for each quartet J consisting of exactly four taxa, to a predicted tree L(J) based only on the sequences in J, and these are then used to reconstruct T. The author defines an "error-correcting map" (Ec), which replaces each L(J) with a new tree, Ec(L)(J), which has been corrected using other trees, L(K), in the list L. The "quartet distance" between two trees is defined as the number of quartets J on which the two trees differ, and two distinct trees are shown to always have quartet distance of at least N - 3. If L has quartet distance at most (N - 4)/2 from T, then Ec(L) will coincide with the correct list for T; and this result cannot be improved. In general, Ec can correct many more errors in L. Iteration of the map Ec may produce still more accurate lists. Simulations are reported which often show improvement even when the quartet distance considerably exceeds (N - 4)/2. Moreover, the Buneman tree for Ec(L) is shown to refine the Buneman tree for L, so that strongly supported edges for L remain strongly supported for Ec(L). Simulations show that if methods such as the C-tree or hypercleaning are applied to Ec(L), the resulting trees often have more resolution than when the methods are applied only to L.

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Suppose that we seek a tree T giving the phylogenetic relationships among the species in a set S. A common method selects for such a tree a maximum parsimony tree using the genome of the species in S. Suppose that K is a proper subset of S. Then T induces a tree U which gives the same relationships among the species in K but omits the species of S which are not in K. Unfortunately, when T is a maximum parsimony tree for the species in S, then U need not be a maximum parsimony tree for the species in K. This phenomenon exhibits an inconsistency in the criterion of maximum parsimony-maximum parsimony trees for different groups of species may be "inconsistent". It implies that the addition of a new species scan change relationships already "established" for prior species if the trees are obtained by the criterion of maximum parsimony. The phenomenon occurs both in artificial examples and with real data. An alternative method for generating phylogenetic trees seeks to minimize such inconsistencies. For each group J consisting of four of the species, we find a tree T(J) describing the relationship only among the four species in J, for example by the use of maximum parsimony on those four species alone. In favorable cases one may combine all the trees T(J) into a single tree T that is consistent with all the trees T(J). If such a tree T exists, then it is unique, and there is a computationally efficient algorithm for finding the tree T. In unfavorable bases such a tree T does not exist, but there may still be a tree containing only "mild" inconsistencies with the trees T(J). A numerical measure is given for the inconsistency I(T) of a tree T in terms of the treelengths of the various trees with set J of leaves in comparison with the tree T. We may then seek a "minimally inconsistent tree T" that minimizes the inconsistency I(T). We describe procedures which find a tree T with low inconsistency I(T). Examples are provided using both artificial strings and data from the complete mitochondrial DNA sequences for 16 species. In particular, minimally inconsistent trees are identified for the 16 species. The definition permits a proof that the trees are in fact minimally inconsistent. The criterion can be applied in both a relative and an absolute sense.

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This survey assessed the prevalence and severity of difficult behaviour displayed by residents in a residential hospital for the mentally handicapped as reported by the direct-care staff. Of the hospital residents, 30.2% were reported as having at least one problematic behaviour. The men were generally more difficult than the women and those on the disturbed wards more difficult than those on residential wards. Men and women exhibited the same types of behaviours in both disturbed and residential wards. However, withdrawn/uncooperative behaviour, stealing and inappropriate sexual behaviour were more prevalent on disturbed wards; withdrawn and inappropriate sexual behaviour being exhibited by more men than women on disturbed wards. The factors most likely associated with being on a disturbed ward were sex and age; young men presenting with most management difficulty. Approximately 12% of the hospital population were defined as presenting with a 'severe' management difficulty. Difficult behaviour is the main reason for admission to and remaining in hospital. The concept of management difficulty and the implications on service provision are discussed.

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Obliteration of peripancreatic fat planes usually is considered an indicator of peripancreatic tumour infiltration in the presence of a malignant mass, or of inflammation of peripancreatic tissues in patients with pancreatitis. However, absence of peripancreatic fat planes also may be found in patients without evidence of pancreatic disease. Hence, CT scans of 125 patients without clinical or computed tomographic evidence of pancreatic disease were evaluated to assess normal variations in the anatomy of the pancreas and its relation to surrounding vessels and bowel loops. The fat plane separating the superior mesenteric artery from the pancreas was preserved in 100% of patients. Conversely, fat planes between the pancreas and the superior mesenteric vein, inferior vena cava, and adjacent bowel loops were partially or totally obliterated in 13% to 50% of patients. It is concluded that the absence of fat around the superior mesenteric artery is highly suggestive of pathologic changes of the pancreas, while the lack of fat planes between the pancreas and other splanchnic vessels or bowel loops frequently is normal, and therefore, is an unreliable sign of pancreatic disease. The applications of these findings to the assessment of tumour resectability by CT, and to CT scanning techniques, are discussed.

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From 1960 through 1978, a total of 274 patients who had a diagnosis of Scheuermann kyphosis were treated with a Milwaukee brace at the Twin Cities Scoliosis Center. We analyzed the long-term results in 120 patients who had used the Milwaukee brace and had been followed for at least five years after the completion of treatment. The average age of the patients at the initiation of treatment was twelve years and five months, the average age at the completion of treatment was sixteen years and one month, and the average age at the last follow-up examination was twenty-four years. Of the patients who wore the brace consistently, seventy-six showed improvement in the kyphosis between the initial evaluation and the evaluation at final follow-up, while twenty-four showed worsening and ten were unchanged. Seven of the twenty-four patients who were worse had had surgery before the review for this study. The indication for surgery was a kyphosis of more than 60 degrees that was increasing and was not controlled by the brace. Ten patients were inconsistent in their use of the brace. Two of the ten patients had improvement and eight had worsening of the kyphosis; three of the latter eight had a spinal fusion. This study showed that the Milwaukee brace is usually an effective method of treatment for patients who have Scheuermann kyphosis; however, four of fourteen patients who had an initial kyphosis of more than 74 degrees required a spinal fusion.

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Sonography, disappointing as a primary screening method, has emerged as the single most helpful adjunct to mammography in evaluation of the clinically and/or mammographically abnormal breast. Sonography can reliably diagnose simple cysts presenting as palpable masses or as indeterminate, nonpalpable lesions on mammography. However, differentiation of benign from malignant solid masses cannot be reliably accomplished by sonography. The expense of an automated breast sonographic scanner has deterred many radiologists from the purchase of such a unit. The authors have used both an automated breast scanner and a real-time 10-MHz hand-held unit. This paper describes their experience with the real-time unit, demonstrating both normal and pathologic anatomy. Special emphasis has been placed on the sonographic diagnosis of a simple cyst because this lesion was the cause of one-quarter of all palpable masses and nonpalpable, mammographically dominant masses. Cysts are sharply marginated and anechoic. Posterior enhancement visible in 78 of 80 cysts was not demonstrable on all images in 25% of cysts.

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Sonographic measurement of common bile duct caliber alone is insufficient to ascertain the presence of obstruction. Fatty meal stimulation significantly improves diagnostic accuracy. An increase in caliber of a normal or slightly dilated common duct after the subject has ingested a fatty meal is a strong indicator of biliary obstruction, while a decrease in caliber indicates normal dynamics and virtually excludes obstruction. This study determines the significance of no change in the caliber of the dilated common bile duct of subjects who have eaten a fatty meal. Further imaging studies and clinical/laboratory follow-up of 31 patients showed that in 84% of the cases no obstruction was present. A dilated common duct that does not decrease in size after a fatty meal is not a specific indicator of obstruction. The use of invasive diagnostic procedures in these patients is not advised unless there is other evidence of biliary obstruction.

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The utilization and effectiveness of a hospital preoperative autologous blood donation program were analyzed. Over 16 months, 180 donors, or 11.6 percent of eligible patients (those undergoing elective surgical procedures where blood was routinely crossmatched), were enrolled in the program. They donated an average of 2.2 units of red cells, or 59 percent of the mean order of 3.7 units. Donations were completed in 17.9 days, leaving 10.7 days between the last donation and hospitalization. Of all scheduled donations, 25.5 percent were cancelled due to deferrals; 47.8 percent of patients were deferred at least once. Most patients were able to donate a unit of blood weekly, with minimal drops in hematocrit (mean 3.2%). The reaction rate, 4.8 percent, was comparable to figures reported for homologous donors. Nearly two-thirds of participants used no homologous blood during their hospitalization: 28.6 percent used no blood whatsoever, and 36.9 percent used only autologous components. Including released autologous components subsequently administered to other recipients, transfused autologous red cells were 2.1 percent and fresh-frozen plasma (FFP) 7.2 percent of the hospital's blood supply. Although the high deferral rate complicated the administration of the program, this complication was offset by the demonstration of donor safety, reduction in the proportion of patients who used homologous blood, and the contribution of autologous blood components to the hospital's blood inventory.

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We describe an access technique that we have used in 150 nephrostomy and biliary drainage procedures and for access to some abscesses and viscera. The system provides safe coaxial access with a 22-gauge removable hub needle, which then acts as a guide wire and is replaced by an 18-gauge cannula. A major advantage is that only one guide wire is used (0.038-inch) for the entire drainage procedure. No significant complications have occurred to date with this method.

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Computerized tomography, isotope imaging and ultrasonography are available for the investigation of elderly patients at the Middlesex Hospital. Over a six-month period there were 360 acute admissions to the Geriatric Department and 100 specialist imaging techniques were used in their investigation. The pattern of presentation of these patients and results of specialist techniques are presented. Sick elderly patients should have ready access to modern non-invasive imaging techniques.

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A case of ileitis, clinically resembling regional enteritis, but almost certainly due to previous spinal irradiation for ankylosing spondylitis is described.

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The radiological appearances of necrotic colonic neoplasms have been described previously and their bad prognosis has been stressed. Four cases of carcinoma of the colon which exhibited characteristic radiological features are described. Survival following surgery in these cases was extremely variable.

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One hundred consecutive parotid sialograms were reviewed to assess the clinical usefulness of the technique. In 54 per cent of patients significant information was provided by the sialogram, and in 22 per cent the diagnosis was made on sialographic appearances alone or the findings altered subsequent management. The highest proportion of useful investigations was found in those presenting with bilateral parotid swelling. No significant information was obtained in patients with an isolated lump in the parotid region.

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1 The comparative antidepressant efficacy of 150 mg imipramine, 60 mg mianserin and 150 mg nomifensine was studied in 45 depressed patients in a six week double-blind investigation. 2 In the efficacy analysis of 41 patients completing the study there was no overall significant difference in efficacy between the groups. Individual group comparisons showed no significant difference in response between mianserin and nomifensine, and mianserin and imipramine. There was a significant (z = 1.99, P less than 0.05) improved response in the imipramine compared with the nomifensine treated group. The imipramine treated group were significantly older. 3 No significant plasma concentration/clinical response relationships were demonstrated with nomifensine, mianserin, imipramine or desipramine. 4 Plasma level monitoring of imipramine recommended by some investigators does not seem to be appropriate.

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