Li, Yan

ABSTRACT Background Idiopathic subglottic stenosis (iSGS) occasionally affects women of childbearing age. Surgical intervention is the primary treatment, yet limited research exists on factors influencing disease severity. This study explores the impact of hormonal contraception on iSGS recurrence rates and surgery‐free intervals. Methods This retrospective study was conducted at a tertiary academic care center. Patients using hormonal birth control (e.g., estrogen‐progesterone pills, progesterone implants) during their first procedure were classified in “Birth Control (BC)” group, while those not using contraceptives were placed in “No Birth Control (NBC)” group. Poisson regression evaluated recurrence rates, and Mann–Whitney tests assessed surgery‐free intervals. Kaplan–Meier analysis estimated time to first recurrence, adjusting for age and follow‐up duration. Results Twenty‐six patients were in the NBC group and 12 in the BC group (average ages 37 and 34, respectively). Patients in the NBC group were 2.6 times more likely to experience recurrence compared to those in the BC group ( p = 0.001). The expected number of recurrences for the BC group was 0.4 times that of the NBC group (95% CI: 0.2–0.7; p = 0.001). Furthermore, patients taking birth control were significantly less likely to have a first recurrence (HR: 0.4; 95% CI: 0.2–0.9; p = 0.025) and had longer times to first recurrence (Figure 1; p = 0.031). Conclusions Birth control appears to protect against iSGS severity, potentially through hormonal mechanisms. Hormonal contraception may serve as a non‐surgical alternative for managing iSGS. Future prospective studies may evaluate outcomes in newly diagnosed iSGS patients started on birth control compared to those not using hormonal contraceptives. Level of Evidence 3.

Objectives The effect of ovarian reserve on expected in vitro fertilisation (IVF) attrition remains controversial. This study analyses IVF attrition rates based on ovarian reserve and stimulation protocol to create customised pre-treatment counselling tools for assisting clinicians in setting accurate patient expectations. Material and Methods We completed a retrospective chart review of 18–44-year-old patients who underwent IVF treatment at a single academic institution between January 1, 2013, and March 23, 2023. Cycle outcomes, number of retrieved oocytes, mature oocytes, fertilised embryos, and blastocysts were analysed for patients with polycystic ovary syndrome (PCOS), unexplained infertility, and diminished ovarian reserve (DOR). A Poisson regression model was used to compare oocyte maturation, fertilisation, and blastulation rates among groups, adjusted for age, body mass index, race, and insemination method. Results Three hundred and thirteen couples underwent a total of 385 IVF cycles analysed in this study. There were 109 patients who underwent 120 cycles in the unexplained infertility group (31% cycles), 133 patients with 143 cycles in the PCOS group (37% cycles), 40 patients with 45 cycles in the DOR antagonist stimulation group (12% cycles), and 39 patients with 77 cycles in the DOR minimal stimulation group (20% cycles). No differences in oocyte maturation, fertilisation, or blastulation rate were seen among PCOS or DOR antagonist cycle groups when compared to unexplained infertility. After adjusting for confounders, blastulation rate was higher for the DOR minimal stimulation group compared to unexplained infertility (1.37-fold change, p = 0.04). Conclusion Rates of oocyte maturation, fertilisation, and blastulation were similar among all antagonist protocol cycles regardless of ovarian reserve. However, patients with DOR who undergo minimal stimulation may have modestly higher blastulation rates compared to DOR patients who undergo the antagonist protocol.

Abstract Introduction Acoustic analysis of speech has discriminated decompensated acute heart failure (HF). Speech rate (SR) and cepstral peak prominence (CPP) variation are among features previously evaluated. However, the association between SR and CPP and chronic stable HF with and without pulmonary hypertension (PH) as well as PH alone have not been previously studied. Methods Patients evaluated for HF and/or PH in the outpatient setting recorded a standardized text read out loud from which a sentence was extracted and analysed to extract pre-specified acoustic features including SR and CPP calculated for voiced speech (CPP-V) and in all speech (CPP-All). Patients were grouped depending on the presence or absence of disease (HF and/or PH) and symptoms. Linear regression models were fitted to determine the association between each acoustic feature and disease status. Results In total, 2153 patients were included: age 65.32 ± 17.18 years; male n = 1246 (57.9%); 879 had HF (40.8%), 542 had PH (25.2%) and 777 had no disease and no symptoms (36.1%). After adjustment for age and sex, SR was significantly lower in patients with PH only [estimated coefficient, 95% confidence interval (CI): −0.14, −0.21 to −0.06, P = 0.0006], HF only (−0.11, −0.17 to −0.05, P = 0.0002) and HF with PH (−0.17, −0.24 to −0.10, P < 0.0001) compared with no disease. CPP-V differed in patients with PH only (0.37, 0.16–0.57, P = 0.0004) and CPP-All differed significantly compared with patients without disease (0.23, 0.08–0.38, P = 0.0025). Conclusions SR is significantly slower in patients with HF alone, PH alone and HF and PH combined compared with patients without disease. CPP also differs significantly in patients with PH compared with controls. These findings suggest that acoustic analysis may be useful in discriminating chronic stable HF and PH, offering promise for the development of non-invasive screening methods for HF and PH.

AbstractObjectiveThis study aims to evaluate the impact of parity on the severity and recurrence rates of idiopathic subglottic stenosis (iSGS) in premenopausal females.Study DesignA retrospective cohort study.SettingTwo tertiary care centers from 2002 to 2024.MethodsWe analyzed premenopausal iSGS patients under 40 years who underwent balloon dilation or laser wedge excision. Clinical features, including demographics and pregnancy history, were examined. Recurrence rates between nulliparous and parous patients were compared using Poisson regression, adjusting for age and follow‐up duration. Linear regression assessed the relationship between pregnancy and iSGS recurrence.ResultsForty‐eight patients were included, with 36 parous and 12 nulliparous. Adjusting for age and follow‐up, the mean recurrence rate was 2.6 times higher in parous patients (95% confidence interval [CI]: [1.5, 4.8], P = .0008). Each additional pregnancy was associated with 0.81 additional recurrences (95% CI: [0.05, 1.57], P = .0375). No significant differences in surgery‐free time were observed between groups.ConclusionParity and pregnancy significantly increase the risk of iSGS recurrence, although they do not accelerate subsequent recurrences. Health care providers should counsel women of childbearing age about these risks in family planning discussions, emphasizing shared decision‐making regarding potential surgical interventions.Level of evidence3.