Cavity Distortion Research Articles

Thinking in context: Fibroids-to-uterine volume ratio in pre-surgical fertility evaluation for intramural fibroids

ObjectiveTo explore the utility of the total fibroids-to-uterine volume (FTUV) ratio as a simple, preoperative tool to assist in counseling patients seeking pregnancy who are undergoing myomectomy for intramural (IM) fibroids. Study designThis is an historical cohort study on reproductive-aged patients seeking pregnancy who underwent laparotomic myomectomy for intramural fibroids from January 2017 to December 2021. Only G3 to G5 fibroids, according to the 2011 International Federation of Gynecology and Obstetrics (FIGO) classification, were included. Pre-operative transvaginal ultrasound (TVUS) was performed to measure the volume of intramural myomas (diameter1*diameter2*diameter3*0.52) and to calculate their total volume. The total fibroids-to-uterine volume (FTUV) ratio was calculated as the proportion of the uterine volume occupied by the sum of IM fibroids volumes. ResultsA total of 166 women with pre-surgical TVUS evaluation of IM fibroids were included, with a mean age of 36.22 ± 5.15 years. The FTUV ratio was identified as a positive predictor of clinical pregnancy after surgery (adjOR, 1.04; 95 % CI, 1.02–1.06; p = 0.0001), whereas age showed a negative association (adjOR, 0.90; 95 % CI, 0.83–0.98; p = 0.012). Endometrial cavity distortion prior to surgery was also positively associated with pregnancy post-surgery (adjOR, 3.50; 95 % CI, 1.51–8.08; p = 0.003). Consistent results were found for live births, with the FTUV ratio being a significant positive predictor of live birth after surgery (adjOR, 1.03; 95 % CI, 1.01–1.05; p = 0.001) and age showing a negative association (adjOR, 0.88; 95 % CI, 0.80–0.96; p = 0.004). Parity prior to surgery also positively impacted live birth post-surgery (adjOR, 2.65; 95 % CI, 1.30–5.40; p = 0.007). An FTUV ratio threshold of 53.39 % accurately predicted clinical pregnancy in 68.46 % of cases (sensitivity of 71.70 % and specificity of 66.67 %). For live births, a higher FTUV ratio threshold of 59.21 % predicted outcomes accurately in 69.13 % of cases (sensitivity of 65.85 % and specificity of 70.37 %). ConclusionThe use of the FTUV ratio in pre-operative ultrasound evaluation of IM fibroids may improve counseling for patients desiring to conceive after myomectomy. By providing a personalized assessment of the amount of myometrial volume occupied by fibroids, the FTUV ratio can help predict fertility outcomes after surgery, enabling better-informed decisions and treatment planning.

Diagnostic accuracy of transvaginal ultrasonography and hysterosalpingography in the detection of uterine cavity pathologies among infertile women.

Uterine cavity pathology may affect the endometrium or myometrium, resulting in distortion of the uterine cavity, and is responsible for 2%-5% of infertility. The methods for its assessment usually involve imaging modalities like pelvic ultrasonography, often transvaginal-(TVS), and hysterosalpingography-(HSG), with hysteroscopy-(HSC) as the gold standard. However, HSC is not readily available in resource-poor-settings. To determine and compare the diagnostic accuracy of TVS and HSG in detecting uterine cavity pathology using HSC as a gold standard. A cross-sectional analytical study of consenting infertile women for evaluation of the uterine cavity using transvaginal-ultrasonography, hysterosalpingogram, and hysteroscopy. The primary-outcome-measures were the sensitivity, specificity, and accuracy of TVS and HSG in detecting uterine cavity abnormalities using HSG as the gold standard. Eighty-eight participants were analysed for this study. The lesions confirmed on HSC were intrauterine-adhesions (43.1%), endometrial polyps (14.8%), submucous fibroids (18.2%), intrauterine-septum (13.6%), and cavity distortion (14.8%). The overall sensitivity with TVS was 57.7%, with a specificity of 97.6%, a positive-predictive-value (PPV) of 88.2%, and a negative-predictive-value (NPV) of 88.2%, giving a percentage-accuracy of 88.2%. In comparison, HSG had a sensitivity of 72.1%, a specificity of 99.4%, a PPV of 97.4%, and an NPV of 92.0%, giving an overall accuracy of 92.9%. The detection rates of TVS and HSG in this category were: fibroids (97.7% vs 89.8%; p = .0004) and adhesions (73.9% vs 87.5%; p = .0002), respectively. HSG appears to be the superior modality for detection of obliterative uterine cavity pathologies, while TVS is better suited for myometrium and endometrial lesions.

Prognostic value of the location of submucosal uterine leiomyomas in infertility.

Submucosal fibroid location and size are predictive factors of impaired fertility. Submucosal fibroids cause infertility through several mechanisms including distortion of the endometrial cavity, increased uterine contractility, local inflammation and remodeling of the endometrial blood supply. This is a monocentric, retrospective, cross-sectional study, conducted in the Department of Obstetrics and Gynecology of 'Sf. Pantelimon' Clinical Emergency Hospital, analyzing patients from a 5-year period (January 2015-December 2019). In the present study, the relationship between different characteristics of the submucosal fibroids (among others, location and dimensions) and fertility (birth rates, early pregnancy loss rates) were investigated. This study identified that submucosal and intramural fibroids are risk factors for reduced birth rate compared with subserosal fibroids (P=0.02, RR=2.58, 95% CI 1.03-6.47; P=0.005, RR=1.18, 95% CI 1.02-1.35, respectively). In addition, G2 leiomyomas are risk factors for low birth rate compared with G0 and G1 fibroids (P=0.01, RR=1.95, 95% CI 1.05-3.60). Moreover, the presence of a subserosal fibroid was associated with an increased early pregnancy loss rate (P=0.01, RR=2.14, 95% CI 1.05-4.35). In conclusion, the location and degree of uterine cavity distortion are important factors that alter the normal development of a pregnancy and the birth rate.

Laparoscopic Myomectomy Assisted by Hysteroscopy: A Case Report

Study Objective To demonstrate the benefits of laparoscopic myomectomy assisted by hysteroscopy to minimize endometrium damage, therefore providing a better fertility outcome. Design Case report for surgical technique and description of the procedure using video. Setting Tertiary hospital. Patients or Participants A 30-year-old nulliparous woman presents with abnormal uterine bleeding and pelvic pain for a year and a half. She previously tried clinical treatment with Tranexamic Acid and Oral Progesterone without symptoms remission. In the physical examination there weren't any irregular findings. The MRI evidenced multiple nodular formations: a 2 cm submucous fibroid on the fundus with cavity distortion and 8mm of myometrial free margin and others intramural and subserous fibroids measuring up to 1.7cm. Interventions We performed a diagnostic hysteroscopy to locate the submucous fibroid and used the hysteroscope's pressure and light to guide de surgeon on the laparoscopy towards that fibroid. We did a vertical incision and proceeded to enucleate the fibroid. We also excised other subserous and intramural nodules along the surgery. Uterine suture was done with a 2-0 barbed suture in two layers. We finished the procedure with another diagnostic hysteroscopy to evaluate endometrium damage. Measurements and Main Results In the final hysteroscopy we could see little endometrium damage. The patient was discharged on the first postoperative day without significant pain. Conclusion We were able to achieve minimal endometrium damage in a Type 2 FIGO staging fibroid, which would not be possible if we had performed a hysteroscopic myomectomy. On the other hand, if we had done only a laparoscopic procedure, we would have had a significant higher degree of difficulty at finding the fibroid due to its deep placement. Therefore, we reached a favorable outcome regarding the surgical approach in resecting a submucous fibroid in a patient with intention of childbearing. To demonstrate the benefits of laparoscopic myomectomy assisted by hysteroscopy to minimize endometrium damage, therefore providing a better fertility outcome. Case report for surgical technique and description of the procedure using video. Tertiary hospital. A 30-year-old nulliparous woman presents with abnormal uterine bleeding and pelvic pain for a year and a half. She previously tried clinical treatment with Tranexamic Acid and Oral Progesterone without symptoms remission. In the physical examination there weren't any irregular findings. The MRI evidenced multiple nodular formations: a 2 cm submucous fibroid on the fundus with cavity distortion and 8mm of myometrial free margin and others intramural and subserous fibroids measuring up to 1.7cm. We performed a diagnostic hysteroscopy to locate the submucous fibroid and used the hysteroscope's pressure and light to guide de surgeon on the laparoscopy towards that fibroid. We did a vertical incision and proceeded to enucleate the fibroid. We also excised other subserous and intramural nodules along the surgery. Uterine suture was done with a 2-0 barbed suture in two layers. We finished the procedure with another diagnostic hysteroscopy to evaluate endometrium damage. In the final hysteroscopy we could see little endometrium damage. The patient was discharged on the first postoperative day without significant pain. We were able to achieve minimal endometrium damage in a Type 2 FIGO staging fibroid, which would not be possible if we had performed a hysteroscopic myomectomy. On the other hand, if we had done only a laparoscopic procedure, we would have had a significant higher degree of difficulty at finding the fibroid due to its deep placement. Therefore, we reached a favorable outcome regarding the surgical approach in resecting a submucous fibroid in a patient with intention of childbearing.

Evolution of laparoscopic myomectomy and description of two hemostatic techniques in a large teaching gynecological center

ObjectiveTo provide a description of laparoscopic myomectomy and the two hemostatic techniques performed over the last 11 years in a single reference center for gynecology and obstetrics and to evaluate the factors associated with favorable surgical outcomes. Study DesignWe retrospectively analyzed 625 who underwent laparoscopic myomectomy from January 2009 to December 2019. ResultsOf 625 patients, 437 (69.8%) were symptomatic. The most common symptoms were heavy uterine bleeding (33.2%). 188 patients (30.1%) were asymptomatic but were operated in 77 cases (12.3%) for rapid fibroid growth, 32 (5.1%) for uterine cavity distortion and, in 45 cases (8.6%), the myomectomy was indicated during a surgery for other medical reason due to its accessibility. In 173 cases (27.9%) intramyometrial adrenaline was injected and in 246 cases (39.7%) a temporary blockage of the uterus blood supply was performed.Only 35 (5.6%) patients presented complications, of which, 14 (40%) were hemorrhagic. These hemorrhagic complications were more frequent when intramyometrial adrenaline was used (5,8%) than after the temporary clipping of the uterine arteries and infundibulopelvic ligaments (0,8%; p < 0,001).In the multivariate logistic regression model, the only factor statistically associated with favorable surgical outcome was the use of temporary clipping of the uterine arteries at their origin and infundibulopelvic ligaments as hemostatic technique during the surgery. ConclusionLaparoscopic myomectomy was generally safe with a high level of favorable outcomes. The temporary clipping of uterine arteries and infundibulopelvic ligaments presented fewer intraoperative bleedings compared with injecting intramyometrial adrenaline.

The effectiveness of uterine parametrics measured by three-dimensional transvaginal sonography in the diagnosis of uterine cavity distortions.

BackgroundTo analyze the application values of quantitative parametrics measured by three-dimensional transvaginal sonography (3D-TVS) in the diagnosis of uterine cavity distortions.MethodsA retrospective analysis was performed on consecutive 113 patients with septate uteruses, as diagnosed consistently by both 3D-TVS and hysteroscopic surgery, between Jan 2016 and Jan 2018. The intrauterine quantitative parametrics were compared between an infertility group and a miscarriage group. Receiver operating characteristic (ROC) curve analysis and evaluation indicators of diagnostic tests were plotted to analyze the relationships between parametrics and uterine cavity distortions.ResultsThere were no significant differences in septum width, septum length, uterine angle, remaining uterine cavity length, and distortion rate between the infertility and miscarriage groups (P>0.05). The distortion rate was positively correlated with septum length, but showed a negative correlation with uterine angle and remaining uterine cavity length (all P<0.05). The area under the curve (AUC) of septum length for predicting a distortion rate higher than 50% was 0.969; with a cutoff value of 2.15 cm, and a diagnostic accuracy of 97.14%, sensitivity was 81.80% and specificity was 98.90%, respectively. Patients with lower septum length coupled with a higher remaining uterine cavity length had a lower risk of uterine cavity distortion.ConclusionsSeptum length was shown to have the most important effect on uterine cavity distortion of all the uterine parametrics measured by 3D-TVS. Patients with septum lengths higher than 2.15 cm indicated a distortion rate of more than 50%, and tend to experience adverse pregnancy outcomes.

1277 Trends and Factors Associated with Antibiotic Use by Gynecologic Surgeons during Myomectomy

Study Objective There are limited guidelines regarding antibiotic use for myomectomies. The objective of this study was to determine perioperative factors that influence antibiotic use by gynecologic surgeons for myomectomies, and to assess adverse postoperative outcomes with and without perioperative antibiotics. Design Retrospective chart review. Setting Tertiary care academic center. Patients or Participants Patients that underwent abdominal (ABD), laparoscopic or robotic (LSC/RA), and hysteroscopic (HSC) myomectomies, from April 2018 and earlier. Interventions ABD, LSC/RA, or HSC myomectomies. Measurements and Main Results One hundred patients were included in each of the myomectomy categories. In the ABD group, 85% of patients received perioperative antibiotics. There were no identifiable factors between those that received antibiotics and those that did not. In the LSC/RA group, 65% of patients received perioperative antibiotics. Minimally invasive gynecologic surgeons were more likely to give antibiotics (72.7% vs 27.3%, p=0.0002), whereas gynecologic oncologists were not (0% vs 100%, p=0.001). Those who had preoperative MRI, uterine cavity distortion on imaging, abnormal uterine bleeding, intramural fibroids, higher number of fibroids removed, higher fibroid weight and longer operative times were more likely to receive antibiotics. In the HSC group, 5% patients received perioperative antibiotics. Those with abnormal uterine bleeding or infertility, higher fibroid weight, uterine perforation and unanticipated laparoscopy were more likely to receive antibiotics. In both the ABD and LSC/RA groups, there were no differences in postoperative complications or use of postoperative antibiotics with or without perioperative antibiotics. In the HSC group, there was also no difference in postoperative complications, but those that received antibiotics perioperatively were more likely to receive postoperative antibiotics (100% vs. 22.1%, p=0.001). Conclusion Majority of surgeons adhered to the recommendations against prophylactic antibiotics for hysteroscopic procedures. Though there are no clear recommendations for antibiotic prophylaxis for open, laparoscopic, and robotic myomectomies, perioperative antibiotics were frequently used without demonstrating a decrease in adverse postoperative complications.

Synthesis and application of novel hydroxylated thia-crown ethers as composite ionophores for selective recovery of Ag+ from aqueous sources

Selective recovery of silver ions Ag+ has been a big challenge due to its difficult separation from complex aqueous feed streams. Herein, four novel highly selective 13- to 19-membered thia-crown ethers (TCEs) were successfully developed by intermolecular cyclization of S- and O-containing intermediates. The TCEs have reactive hydroxyl group(s) for coating on solid supports. To evaluate their ability to capture Ag+, the TCEs were coated on polypropylene (PP) membrane (TCE@PP) at high loading (∼280wt%) via wet-incipient technique with glutaraldehyde acetalization. Adsorption results of all TCE@PP reveal high Ag+ capacities with qe ∼124–179mgg−1, excellent Ag+ selectivities with Kd ∼291–778Lg−1 and rapid uptake rate within 1h. But DH19-TCE4 or 19TCE@PP is the most effective as it achieved 96% Ag+ complexation compared with others ∼53–86% at feed Co=1.5mM. Density functional theory calculations reveal that DH19-TCE4 had the closest cavity size (∅c=2.35Å) with Ag+ (∅Ag+=2.30Å), the most negative binding energy (BE=−65.76kcalmol−1), and the least cavity distortion during Ag+ complexation. All adsorbents are reusable and stable with consistent performance even after five cycles of adsorption/desorption runs. Overall results demonstrate the effectiveness of the synthesis strategies for TCEs and their high potential as adsorbents, especially DH19-TCE4, for selective Ag+ recovery from aqueous sources.

Effects of myomas and myomectomy on assisted reproductive technology outcomes

ObjectiveTo determine the effects of fibroids, and their removal, on ART outcomes. Materials and methodsSingle institution retrospective cohort study of infertility patients who underwent myomectomy prior to either in vitro fertilization (IVF) or intrauterine insemination (IUI) between August 2006 and October 2015 (N = 49). Two separate control groups were established: 1) women with fibroids left in situ during the ART process (N = 76), and 2) women with no fibroids (N = 103). The study was powered to detect a difference between a 42%, 11%, and 25% live birth (LB) rate in the myomectomy, fibroids in situ, and no fibroids groups at P < 0.05. ResultsThere were no significant differences in IVF cycle parameters between groups. Fibroids that were either submucosal or intramural with associated cavity distortion were significantly more likely to be removed. Amongst women undergoing IVF, the cumulative incidence of clinical pregnancy (CP) was significantly higher in the myomectomy group than the in situ or no fibroids groups. Women who underwent pre-IVF myomectomy also achieved CP more quickly. Cumulative LB rates did not differ significantly amongst women undergoing IVF. CP and LB rates per cycle were similar between myomectomy, in situ, and no fibroids groups (CP 49% vs. 37.5% vs. 54.4%, P = 0.21; LB 41.7% vs. 27.1% vs. 43.9%, P = 0.17). DiscussionIVF outcomes appear to be improved by judicious removal of clinically significant fibroids. Further prospective studies are required to confirm the role of fibroids, and their removal, on ART outcomes before advocating for routine myomectomy amongst women with fibroids undergoing ART.

Variation in MicroRNA Expression Profile of Uterine Leiomyoma with Endometrial Cavity Distortion and Endometrial Cavity Non-Distortion.

The expression profile of microRNA (miRNA) in uterine leiomyoma (UL) cells is different from that in normal uterine myometrial (UM) cells. The effect of UL cells on uterine receptivity might vary according to their ability to distort the uterine endometrial cavity. However, the variation in miRNA expression profiles between endometrial cavity-distorting leiomyoma (ECDL) and endometrial cavity non-distorting leiomyoma (ECNDL) cells remains unknown. This study aimed to elucidate whether the expression profile of miRNAs in ECDL cells is dissimilar to that of ECNDL cells in uterus. Pelviscopic myomectomy was performed to obtain tissue samples of UL and their corresponding normal UM tissues (matched) from patients with UL (n = 26), among whom women with ECNDL and ECDL numbered 15 and 11, respectively. The relative expression of hsa-miR-15b, -29a, -29b, -29c, -197, and -200c as well as the candidate target genes in UL cells was compared to those in the matched UM cells using qRT-PCR to assess their ability to cause ECD. The spatial expression of miRNAs and target genes in the UL tissues was analyzed using in situ hybridization. Target gene expression was analyzed using qPCR after transfection with the mimics and inhibitors of miRNAs in UL cells. The relative expression level of miR-15b was upregulated, and the relative expression levels of miR-29a, -29b, -29c, -197, and -200c were downregulated in UL cells compared to those in UM cells. The relative expression levels of progesterone receptor, estrogen receptor, and matrix metalloproteinases (MMPs) were upregulated in UL cells compared to those in UM cells. The relative expression levels of miR-29c and -200c were downregulated, and the relative expression levels of estrogen receptor, MMPs and tissue inhibitors of metalloproteinases (TIMPs) were upregulated in ECDL cells compared to those in ECNDL cells. The expression profile of miRNAs in UL cells varied with respect to the occurrence or absence of endometrial cavity distortion. The biochemical properties of UL might be regulated by miRNAs in order to alter their effect on structural homeostasis of the uterus.

The Effect of Uterine Fibroids on Infertility: A Systematic Review.

AbstractFibroids are present in up to 27% of patients seeking reproductive assistance, and can affect fertility through cavity distortion, alteration of endometrial receptivity, and sexual function. Surgical, noninvasive, and medical approaches have been developed to manage fibroids, but evidence-based data regarding their safety and efficacy for the treatment of infertility and the effects on pregnancy outcome are limited. Myomectomy, through minimally invasive techniques, is the most evidence-based approach to fibroids in women planning conception, and increases pregnancy rates by up to 68% in previously infertile patients. Laparoscopic uterine artery occlusion is under investigation as an alternative and simpler surgical approach to decrease fibroid size. Uterine artery embolization is not recommended for women intending future pregnancy, as the rate of spontaneous abortion (SAB) is up to 64% and the rate of abnormal placentation is 12.5%. Magnetic resonance imaging–guided focused ultrasound surgery is gaining interest as a noninvasive procedure with positive preliminary pregnancy outcomes, but appears to have an SAB rate of 20.6%. Selective progesterone receptor modulators, aromatase inhibitors, and vitamin D supplementation are under investigation to improve uterine conditions for pregnancy. Submucosal and intramural fibroids affect fertility and pregnancy outcomes and should be addressed during infertility workup.

Analysis of the Effect of Interferometer Cavity Distortion on Homogeneity Tests of Large-Diameter Optical Materials

Optical homogeneity of the optical materials directly affects the wavefront quality of the refractive optical system. There are some difficulties of testing large caliber optical materials, four-step method of Fizeau interferometry is a convenient and accurate method for measuring optical homogeneity. The article used the four-step method test the same quartz glass sample in a cavity with different precision and found that the optical homogeneity test results have a larger gap. While this article compared the effect of the fixed cavity surface shape and the changing cavity surface shape on 300 mm diameter quartz glass optical homogeneity test and analyzed the effect of different positions of fixed cavity distortion on optical homogeneity testing.

Infertility and uterine fibroids

Uterine fibroids are the most common tumors in women and their prevalence is higher in patients with infertility. At present, they are classified according to their anatomical location, as no classification system includes additional parameters such as their size or number. There is a general agreement that submucosal fibroids negatively affect fertility, when compared to women without fibroids. Intramural fibroids above a certain size (>4cm), even without cavity distortion, may also negatively influence fertility. However, the presence of subserosal myomas has little or no effect on fertility. Many possible theories have been proposed to explain how fibroids impair fertility: mechanisms involving alteration of local anatomical location, others involving functional changes of the myometrium and endometrium, and finally endocrine and paracrine molecular mechanisms. Nevertheless, any of the above mentioned mechanisms can cause reduced reproductive potential, thereby leading to impaired gamete transport, reduced ability for embryo implantation, and creation of a hostile environment. The published experience defines the best practice strategy, as not many large, well-designed, and properly powered studies are available. Myomectomy appears to have an effect in fertility improvement in certain cases. Excision of submucosal myomas seems to restore fertility with pregnancy rates after surgery similar to normal controls. Removal of intramural myomas affecting pregnancy outcome seems to be associated with higher pregnancy rates when compared to non-operated controls, although evidence is still nοt sufficient. Treatment of subserosal myomas of reasonable size is not necessary for fertility reasons. The results of endoscopic and open myomectomy are similar; thus, endoscopic treatment is the recommended approach due to its advantages in patient's postoperative course.

Alterations in uterine hemodynamics caused by uterine fibroids and their impact on in vitro fertilization outcomes.

ObjectiveTo investigate the impact of fibroids on the blood flow of the uterine and subendometrial arteries and in vitro fertilization (IVF) outcomes.MethodsIn this study, we analyzed 86 IVF/intracytoplasmic sperm injection (ICSI) cycles in which a gonadotropin-releasing hormone antagonist protocol was used for controlled ovarian stimulation between January 2008 and March 2009. The subjects comprised 86 infertile women with (fibroid group, n=43) or without (control group, n=43) uterine fibroids.ResultsPatient characteristics were similar between the fibroid and control groups. The IVF/ICSI outcomes in patients with fibroids were similar to those of patients in the control group. The resistance index (RI) and pulsatile index (PI) of the uterine and subendometrial arteries on the day of embryo transfer were also comparable between the two groups. IVF outcomes and uterine hemodynamics in patients with multiple (≥2) fibroids were similar to those of patients with a single fibroid. However, clinical pregnancy and implantation rates were significantly lower in patients with fibroids who experienced uterine cavity distortion than in patients with fibroids who had a normal uterine cavity (both p<0.05). The RI and PI of the subendometrial artery were significantly higher on the day of embryo transfer in patients with fibroids who experienced uterine cavity distortion than in patients with fibroids who had a normal uterine cavity (both p<0.05).ConclusionFibroids which distorting the uterine cavity might impair the subendometrial artery blood flow clinical pregnancy rate and embryo implantation rate in infertile patients undergoing IVF. Otherwise, IVF outcomes were not influenced by the presence of uterine fibroids.

Inter-cage dynamics in structure I, II, and H fluoromethane hydrates as studied by NMR and molecular dynamics simulations.

Prospective industrial applications of clathrate hydrates as materials for gas separation require further knowledge of cavity distortion, cavity selectivity, and defects induction by guest-host interactions. The results presented in this contribution show that under certain temperature conditions the guest combination of CH3F and a large polar molecule induces defects on the clathrate hydrate framework that allow intercage guest dynamics. (13)C NMR chemical shifts of a CH3F/CH4/TBME sH hydrate and a temperature analysis of the (2)H NMR powder lineshapes of a CD3F/THF sII and CD3F/TBME sH hydrate, displayed evidence that the populations of CH4 and CH3F in the D and D' cages were in a state of rapid exchange. A hydrogen bonding analysis using molecular dynamics simulations on the TBME/CH3F and TBME/CH4 sH hydrates showed that the presence of CH3F enhances the hydrogen bonding probability of the TBME molecule with the water molecules of the cavity. Similar results were obtained for THF/CH3F and THF/CH4 sII hydrates. The enhanced hydrogen bond formation leads to the formation of defects in the water hydrogen bonding lattice and this can enhance the migration of CH3F molecules between adjacent small cages.

Intramural leoimyoma without endometrial cavity distortion may negatively affect the ICSI - ET outcome

BackgroundTo assess the impact of intramural fibroids on the intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycle outcome, when there is no compression of the endometrial cavity.MethodsIn this retrospective, matched control study, the ICSI-ET outcome of sixty-two patients (Group I) with intramural fibroid (mean diameter <7 cm) and normal endometrial cavity demonstrated by office hysteroscopy was compared with matched-control group of patients (n = 301) with no fibroid (Group II). The diagnosis of fibroids was done by transvaginal ultrasonography.ResultsThe mean age in fibroid group was 32.66 +/- 5.30 while this figure was 32.95 +/- 3.98 in control group. The clinical pregnancy rate was significantly lower in the fibroid group although fibroids not distorting the uterine cavity (25.8% vs. 39.9%, p = 0.04). In fibroid group the implantation rate was significantly lower than control group (20.97 +/- 37.93 vs.32.89 +/- 43.18%, p = 0.04). However, spontaneous abortion rate was higher in fibroid group but it did not reach the significant level (12.5% vs. 9.2%, p > 0.05).ConclusionWomen having intramural leiomyomas not encroaching on the uterine cavity have unfavorable ICSI/ET outcomes comparable to those of women without such leiomyomas. Therefore, myomectomy may be a good option for such patients with intramural fibroids even they do not have any endometrial distortion.

Recurrent IVF failure: other factors

IVF failure is a problem for a couple in the singular but can be a tragedy in the plural. Recurrent IVF failure has multiple known causes but many which are not routinely considered as part of the posttreatment analysis. The reason is there are several causes associated with lifestyle and other causes related to pre-existing conditions that have only a tenuous or no apparent connection to fertility. This article examines the impact of obesity, cigarette smoke, uterine anatomy, body mass index, thyroid dysfunction, immune factors, the hereditary and acquired thrombophilias, and embryo transfer technique on recurrent IVF failure.

Nature of disorder in synthetic hectorite

The disorder of synthetic Na-hectorite was investigated using structural simulation of X-ray powder patterns.The method used to characterize this clay mineral was based on the comparison between experimental and calculated X-ray diffraction profiles. The study was achieved in two steps: (i) the quantitative interpretation of 00l reflections enabled the determination of the number of intercalated water molecules, their positions and the stacking mode of the clay mineral layers along the normal to the (a, b) plane; and (ii) the study of the hkl reflections with h and/or k≠0 enabled the characterization of the structural evolution in the (a, b) plane of synthetic hectorite. Many models of disorder with random shifts of ±a/3, a/3+b/3, 80% of a/3+b/3 and 20% of a/3 with a total density of defects of 80%, gave the best fit to the observed data at the level of (02, 11), (20, 13), (04, 22), (15, 24, 31) and (06, 33) bands with 5° of tetrahedral cavity distortion (the rotation angle of the tetrahedra).

Experimental study of ventilated supercavities with a dynamic pitching model

An investigation of the ventilated supercavitation for a supercavitating vehicle pitching up and down in the supercavity was carried out in a high-speed water tunnel. The emphasis is laid on the understanding of the interaction of the vehicle aft body with the cavity boundary. The flow characteristics were measured and the stability of supercaviting flow with different pitching frequencies and amplitudes was analyzed. In particular, the objectives of this study are to understand the effect of the impact upon the cavity distortion, and to quantify the impact process by investigating the evolution of the pressure inside the cavity and then the loads on the vehicle during the pitching motion. It is also shown that the evolution of the pressure detected in different, as inside the supercavity, is coherent and uniform during the periods of the pitching motion. This study is of direct relevance to reliable and accurate prediction of hydrodynamic loads associated with the slamming and impact on supercavitating vehicles.

Gene expression profiles of bronchoalveolar cells in pulmonary TB

The host response to Mycobacterium tuberculosis includes macrophage activation, inflammation with increased immune effector cells, tissue necrosis, and cavity formation, and fibrosis, distortion, and bronchiectasis. To evaluate the molecular basis of the immune response in the lungs of patients with active pulmonary tuberculosis (TB), we used bronchoalveolar lavage to obtain cells at the site of infection. Affymetrix GeneChip microarrays and cDNA nylon filter microarrays interrogated gene expression in bronchoalveolar lavage (BAL) cells from 11 healthy controls and 17 patients with active pulmonary TB. We found altered gene expression for 69 genes in TB versus normal controls that included cell surface markers, cytokines, chemokines, receptors, transcription factors, and complement components. In addition, TB BAL cell gene expression patterns segregated into 2 groups: one suggestive of a T helper type 1 (Th1) cellular immune response with increased signal transducer and activator of transcription-4 (STAT-4), interferon-gamma (IFN-gamma receptor), and monokine induced by IFN-gamma (MIG) expression with increased IFN-gamma protein levels in BAL fluid; the other group displayed characteristics of Th2 immunity with increased STAT-6, CD81, and IL-10 receptor expression. We were able to demonstrate that a Th2 presentation could change to a Th1 pattern after anti-tuberculous treatment in 1 TB patient studied serially. These gene expression data support the conclusion that pulmonary TB produces a global change in the BAL cell transcriptome with manifestations of either Th1 or Th2 immunity.