Vaginal Probe Research Articles

Ultrasound in in vitro fertilization programs

Ultrasound examination is an integral part of in vitro fertilization programs. This work shows that the antral follicle count compared to the level of antimüllerian hormone is a preferred marker for assessing the ovarian reserve, response to ovarian stimulation and the results of in vitro fertilization programs, while counting the antral follicle count can be carried out on any day of the menstrual cycle without reducing the informativeness of the study of the ovarian reserve, which is convenient for both patients and doctors. 3D transvaginal ultrasound allows automated assessment of the number of antral follicles with high accuracy and efficiency in less time than 2D transvaginal ultrasound. Using 3D transvaginal ultrasound and artificial intelligence, a threshold value of dominant follicle volume of 0.5 cm3 or greater was determined as a marker for predicting the number of mature oocytes in in vitro fertilization programs. The measurement of endometrial thickness and volume in combination with the determination of vascularization index, flow index, vascularization-flow index and systole-diastolic ratio in the uterine artery at transvaginal ultrasound allows predicting the results of in vitro fertilization programs. Modern possibilities of transabdominal oocyte aspiration using vaginal probe are presented.

Safety and effectiveness of controlled ovarian stimulation and oocyte retrieval during prepubertal and peripubertal period.

Is itsafe and effective to perform controlled ovarian stimulation (COS) and oocyte retrieval (OR) in prepubertal and peripubertal patients? In this retrospective cohort study, data of 20 pre-/peripubertal patients who underwent COS and OR for the purpose of oocyte cryopreservation (OC) between 2008 and 2023 were reviewed.Following COS, all OR procedures were performed transabdominally using a vaginal ultrasound probe. Ovarian reserve was assessed by serum FSH, LH, estradiol, AMH, and antral follicle counts (AFC) in all subjects. All mature oocytes were vitrified. Mean age of the patients was 15.05 ± 1.87, mean AMH was 0.84 ± 0.8ng/ml, mean FSH was 6.39 ± 3.95IU/L, mean estradiol was 61.6 ± 51.9pg/ml, mean LH was 4.69 ± 3.46IU/L, and mean AFC was 5.5 ± 5.82. Among the patients, 12 had regular menstrual cycle, 5 had irregular menstrual cycle, whereas 3 patients still did not have their menarche yet. The indications for OC were as follows: primary ovarian insufficiency (n = 7), ovarian surgery for ovarian tumors (n = 5) or ovarian torsion (n = 1), mosaic Turner syndrome (n = 2), acute lymphoblastic leukemia (n = 1) anaplastic B-cell lymphoma (n = 1), Ewing's sarcoma (n = 1), Noonan syndrome (n = 1), and Thalassemia (n = 1). The mean number of oocytes retrieved, MII oocytes frozen, and maturation rate were 5.11 ± 5.0, 3.92 ± 4.48, and 75.1 ± 25.6%, respectively.Stepwise linear regression analysis demonstrated a positive correlation between AFC and number of total oocytes retrieved and number of MII oocytes. In the case diagnosed with Noonan syndrome, all 7 retrieved oocytes were MI and all frozen at MI phase. No patient had any complication related to COS or OR. Even though number of the enrolled subjects is limited and mean AMH is lower in our cohort, we demonstrated that performing COS and OR is safe in pre-/peripubertal patients. If required, transabdominal route can be performed in this age group for OR. AFC appears as a prognostic factor for stimulation outcome in this age group. Pediatric patients or young adolescents at risk for primary ovarian insufficiency should not bediscouragedfrom utilizing OC.

Noninvasive bipolar radiofrequency - vaginal application on swine model

The aim of the study was to evaluate the concentration of collagen and elastin fibers, the number of fibroblasts/fibrocytes and vessels, as well as depth of action in the vaginal wall in a swine model before and after intravaginal 480 kHz bipolar radiofrequency heating created by a 360-degree intravaginal applicator (Berger and Kraft Medical). Three swine’s were treated with a bipolar radiofrequency vaginal probe. Exposure to RF was administered twice, every 4 weeks, and then the vaginas were removed after slaughter, four weeks after the last RF exposure. Histology specimens were obtained from control and exposed areas. Tissue samples were stained by hematoxylin-eosin, orcein, and Mallory trichrome. The concentration of elastin and collagen fibers increased distinctly after a treatment protocol: elastin, on average, was 52.8%, and collagen, on average, was 103.6%. After the treatment protocol, we revealed a significant dispersion of fibroblasts-fibrocytes nuclei for particular animals in segmented areas, with a slightly marked falling trend. A degree of data variability cannot lead to a conclusion concerning the influence of RF heating on several vessels in evaluated areas. The depth of action of the RF heating, measured by collagen concentration, reached up to 1.3 mm of the vaginal wall thickness. Results imply that heating of the vaginal wall, created by radiofrequency, induces neocollagenogenesis and neoelastogenesis, leading to a distinctive rise of collagen and elastin fibers concentration at a depth of up to 1.3 mm of the thickness of the vaginal wall in the animal model.

Can We Improve the Technique of Pelvic Floor Muscle Exercises in Postmenopausal Women Using a Single Electromyography Biofeedback Session? An Experimental Study.

Background: The aim of this study was to assess the effect of a single session of EMG biofeedback in a group of postmenopausal women on improving technique in pelvic floor muscle (PFM) contractions (exercises). Methods: Sixty-two women aged 60 to 85 years (69 ± 4; mean ± SD) participated in the study. We assessed the technique of PFM exercises via surface electromyography (EMG) using a vaginal probe. A single assessment sequence consisted of 11 exercises involving the conscious contraction of the PFM, during which the order of activation for selected muscles was determined. We then awarded scores for exercise technique on a scale from 0 to 4, where 4 represented the best technique and 0 represented no activation of PFMs. In the second assessment, we used a biofeedback method to teach PFM exercise technique. Results: In total, 32% (n = 20) of the participants were unable to correctly perform the first PFM contraction, scoring 0.9 ± 0.79. After a single EMG biofeedback session, these women received 1.7 ± 1.08 scores (p = 0.003). In the tenth exercise, there was also a statistically significant improvement between the first (baseline) and second assessment (1.7 ± 1.34 and 2.15 ± 1.09, respectively; p = 0.037). For the remaining exercises, the results were not statistically significant, but we observed a positive trend of change. Conclusions: The use of a single EMG biofeedback session is an effective method of improving technique in PFM exercises in a group of women who initially performed them incorrectly.

Effects of Dermal Fillers on Vaginal Laxity and Female Sexual Function: A Minimally Invasive Procedure for Vaginal Rejuvenation

Introduction: For improving vaginal rejuvenation and minimizing vaginal laxity, the increased demand for soft tissue fillers may give females seeking such therapies the chance to have better general health and sexual performance. To address a wider range of female health issues, and support a more all-encompassing approach to personal wellbeing as cosmetic treatments improve, it is crucial to research the possible repercussions of these minimally invasive operations. Methodology: The strength of pelvic floor muscles was measured using the Laborie Peritron 9300 (Portsmouth, New Hampshire, USA) perineometer. A 110 mm long conical vaginal probe with a 26 mm diameter, that may extend to 33 mm under pressure, is a characteristic of this device. The vaginal probe is connected to the perineometer’s main body by an 80 cm plastic tubing. When the probe is squeezed, the gadget has a pressure sensor that tracks vaginal pressure. A silicone rubber sensor loaded with air is included into the probe itself, to detect pressure in cmH2O. The Female Sexual Distress Scale-Revised (FSDS-R) was used to measure the participants’ degrees of sexual distress, and this method made it easier to gauge the participants’ pelvic floor muscle strength. Results: The participants’ mean age was 39.43±2.12 years, and further demographic characteristics provided evidence that 44% of the participants were married for 10 years and had children; 36% were married for 5 years with no children; and 20% had been married for less than 5 years. Conclusion: Soft tissue fillers, which have shown a rise in popularity, are a viable means of resolving issues with vaginal elasticity and rejuvenation.

Exploring Adherence to Pelvic Floor Muscle Training in Women Using Mobile Apps: Scoping Review.

Pelvic floor dysfunction is a public health issue, with 1 in 3 women experiencing symptoms at some point in their lifetime. The gold standard of treatment for pelvic floor dysfunction is supervised pelvic floor muscle training (PFMT); however, adherence to PFMT in women is poor. Mobile apps are increasingly being used in the National Health Service to enable equity in the distribution of health care and increase accessibility to services. However, it is unclear how PFMT mobile apps influence PFMT adherence in women. We aimed to identify which behavior change techniques (BCTs) have been used in PFMT mobile apps, to distinguish the core "capability, opportunity, and motivation" (COM) behaviors targeted by the BCTs used in PFMT mobile apps, and to compare the levels of PFMT adherence in women between those using PFMT mobile apps and those receiving usual care. We conducted a scoping review of the literature. Published quantitative literature that compared the use of a PFMT mobile app to a control group was included to address the objectives of the study. The electronic bibliographic databases searched included MEDLINE, CINAHL, Scopus, Web of Science, and PEDro, along with CENTRAL. Studies were also identified from reference searching of systematic reviews. Original articles written in English from 2006 onward were included. Nonexperimental quantitative studies, qualitative studies, studies that use male participants, case studies, web-based interventions, and interventions that use vaginal probes were excluded. Narrative synthesis was conducted on eligible articles based on the aims of the study. Of the 114 records retrieved from the search, a total of 6 articles met the eligibility and inclusion criteria. The total number of participants in the studies was 471. All PFMT mobile apps used the BCT "prompts and cues." Opportunity was the core COM behavior targeted by the PFMT mobile apps. Higher levels of adherence to PFMT were observed among women using PFMT mobile apps. Digital "prompts and cues" are a BCT commonly used in PFMT mobile apps, and further research is required to practically assess whether a future randomized controlled trial that investigates the effectiveness of digital "prompts and cues" on PFMT adherence in women can be conducted.

311 Evaluation of Post-Transit Growth Performance and Carcass Characteristics of Feedlot Heifers Sourced and Finished in Different Regions of the U.S

Abstract The objective was to evaluate growth performance and carcass traits following transit of feedlot heifers sourced and finished in different geographical regions in the U.S. Yearling heifers [n = 190; initial body weight (BW) 483 and 425 kg for SD and TX sourced, respectively] were used in a 2×2 factorial arrangement of origin state (SD vs TX) and finishing state (SD vs TX). Heifers were allotted on d -1 into four treatments: sourced from SD and finished in SD (SD-SD), sourced from SD and finished in TX (SD-TX), sourced from TX and finished in SD (TX-SD), and sourced from TX and finished in TX (TX-TX). Heifers were weighed on d -1, 3, 15, 28, 56, 78 (TX-TX and SD-TX) and 90 (SD-SD and TX-SD). On d 0, SD-TX and TX-SD heifers were shipped to the finishing location and weighed the following morning (d 1) to determine transportation shrink. To monitor transportation effects, vaginal temperature probes were inserted into all SD-TX and TX-SD heifers and a portion of SD-SD and TX-TX heifers on d -1 and removed on d 3. Clinical attitude scores (CAS) were recorded on d -1, 0, 1, 2 and 3 for indications of bovine respiratory disease symptoms. The GLIMMIX procedure of SAS was used to analyze growth performance and carcass measures with fixed effects of origin and finishing state. The MIXED procedure was used for CAS and temperature data with the same fixed effects and time as a repeated measure. Transported heifers had reduced temperatures (P < 0.05) during transit and post-transit compared with non-transported heifers. Temperatures of transported heifers increased (P < 0.05) during loading and unloading. On d 0, 1 and 3 there was a shift in the distribution of heifers that had a CAS score greater than 0 for TX-TX, SD-TX and TX-SD. Cattle endured high ambient temperatures (temperature humidity index value > 75) 54% and 18% of the feeding period for TX and SD finished heifers, respectively. All cumulative growth performance measures and carcass trait interactions were statistically significant (P < 0.05) besides initial BW, percent shrink of transported heifers, average daily gain, dressing percent, ribeye area and liver abscess severity, which were similar (P > 0.30). There was a shift in the distribution (P < 0.05) towards a greater proportion of Yield Grade 1 and Select carcasses for heifers fed in TX compared with those fed in SD, likely due to fewer days on feed. Overall, heifers transported to higher ambient temperatures had reduced dry matter intake, quality grades (QG) and limited growth recovery (45 kg lighter) compared with non-transported heifers. Heifers transported to lower ambient temperatures recovered growth and had improved QG at the same level of rib fat compared with non-transported heifers.

Transabdominal and transvaginal egg retrieval guided by a vaginal ultrasound probe in an adenomyosis patient: a case report

Objective To explore a non-routine method of oocyte retrieval in patients with difficulty in obtaining oocytes via the vagina during a cycle of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)-embryo transfer (ET). Methods We report the clinical data of one case of combined transabdominal and transvaginal egg retrieval with a vaginal ultrasound probe in a patient with adenomyosis undergoing IVF/ICSI for fertilization. Results A patient with infertility due to adenomyosis desired fertility. During vaginal ultrasound monitoring before ovulation induction, it was found that most of the pelvic cavity was occupied by the uterus. The uterus was (116 mm + 30 mm) × 110 mm × 108 mm and the right ovary was extremely high. The right ovary was not clear on transvaginal ultrasound but it could be displayed by abdominal ultrasound. The Cancer antigen 125(CA125)before starting the fertility cycle was 532.5 U/ml. On the 7th day of the cycle, she complained of mild pain and discomfort in the abdomen, and the size of the uterus was found to be (128 mm + 30 mm) × 125 mm × 110 mm, and her Cancer antigen 125(CA125) was 1109 U/ml. After a total of 13 days of stimulation, the eggs were retrieved. The ovum retrieval procedure used a vaginal ultrasound probe to guide retrieval of the eggs via puncture through the abdomen. A total of 12 and 9 mature eggs were obtained from the left and right ovaries, respectively, and 1 embryo and 9 blastocysts were frozen after insemination. The patient was undergoing treatment for adenomyosis, and no embryos had been transferred. Conclusion Transabdominal ovum retrieval guided by a vaginal ultrasound probe is a feasible, effective, and safe method for obtaining oocytes for patients who cannot retrieve eggs vaginally. In the clinical work of IVF/ICSI fertility, it is necessary to obtain a thorough medical history and assess the patient’s condition before the cycle and conduct multidisciplinary consultation on difficult cases to improve the likelihood of pregnancy.

Effect of dual trigger with chorionic gonadotropin hormone and follicle-stimulating hormone on endometrial thickness in infertile women who had superovulation with an aromatase inhibitor

Beginning in October 2020 and ending in April 2021, researchers from Al-Nahrain University's High Institute for Infertility Diagnosis and Assisted Reproductive Technologies compared the success rates of two different methods of diagnosing and treating infertility. The major purpose of the research was to assess the impact of a combined trigger (follicle-stimulating hormone [FSH] and human chorionic gonadotropin [hCG]) on endometrial receptivity (endometrial thickness, endometrial pattern, sub-endometrial blood flow). A total of 100 females took part in the study. All patients gave their informed written consent, and the study was approved by the Al-Nahrain University Ethics Committee. Procedure Time To confirm ovulation, measure and analyze the endometrial pattern, and examine the sub-endometrial blood flow, a vaginal ultrasound was done 36 to 48 hours following trigger ovulation. All four hormones (FSH, LH, Progesterone, and E2) were tested in the blood at the same time to determine whether a couple was fertile, a complete medical history, and physical examination whereas performed on each member of the pair. An ultrasound vaginal probe was used to do the transvaginal examination. Patients were placed in the dorsal lithotomy position with an empty bladder for early follicular US (CD 2-3) to assess the number of antral follicles, measure endometrial thickness, and rule out ovarian cysts or other pathology. A second ultrasound was performed during the middle of the cycle (CD9-14) to determine whether a mature follicle had been found. A multiplanar image of the uterus was acquired after an ultrasound scan was swept across the mid-sagittal plane. Endometrial thickness in the median longitudinal plane of the uterus was calculated as the largest distance from one basal endometrial interface via the endometrial canal to the opposite endometrial-myometrial interface of the anterior-posterior uterine wall. A statistically significant difference was found between Group A's average E2 concentration of 69.62 pg/mL and Groups B and C's concentrations of 53.32 and 36.65 pg/mL. (P 0.001). In group C, there was a statistically significant difference in E2 levels on the day of the trigger and the day of the IUI (P = 0.036). On the day of IUI compared to the day of trigger, no statistically significant differences were seen between the study groups for any of the other hormonal indicators (P > 0.05). There were no significant differences (P > 0.05) in any of the baseline clinical measures between the research groups. All clinical indicators were comparable across groups (P > 0.05). There were no statistically significant differences (P > 0.05) between the research groups on any other clinical indicators. When comparing groups, A, B, and C on the decline in RI between the trigger and IUI days, group A significantly outperformed the others (P = 0.003). There was no statistically significant difference (P > 0.05) in any of the other clinical parameters between the IUI and trigger groups on the day of IUI.

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

Transabdominal ultrasound-guided oocyte retrieval for oocyte cryopreservation using a vaginal probe: a comparison of applicability, effectiveness, and safety with conventional transvaginal approach.

We aimed to compare the feasibility, effectiveness, and safety of transabdominal ultrasound-guided oocyte retrieval (TUGOR) using a vaginal probe and traditional vaginal approach in virgin patients undergoing oocyte cryopreservation. A total of 116 virgin patients who underwent transabdominal ultrasound-guided oocyte retrieval using a vaginal ultrasound probe and 33 patients matched for BMI, antral follicle count, age, day 3 FSH, estradiol, and AMH who underwent vaginal approach were enrolled. Mean number of total oocytes collected, mean number of cryopreserved MII oocytes, duration of the procedure, duration of stimulation, mean gonadotropin consumption, mature oocyte ratio, and a modified follicle-oocyte index were compared between the groups. No statistical difference was found between the groups in mean number of follicles > 12mm (4.62 ± 4.54 vs. 5.44 ± 4.52), mean number of oocytes collected (4.44 ± 4.14 vs. 5.33 ± 4.52), mean number of cryopreserved MII oocytes (4.01 ± 3.67 vs. 4.53 ± 4.13), mean duration of the procedure (12.4 ± 1.2 vs. 13.4 ± 1.6min), mean days of stimulation (8.05 ± 1.91 vs. 8.35 ± 1.72days), mean gonadotropin consumption (1507.9 ± 475.3 vs. 1571.74 ± 404.6 units), mature oocyte ratio (0.78 ± 0.24 vs. 0.82 ± 0.26), and modified follicle oocyte index (0.86 ± 0.63 vs. 0.84 ± 0.19). In the TUGOR group, superficial epigastric artery injury occurred in two patients and resolved spontaneously. Transabdominal oocyte retrieval using a vaginal ultrasound is a safe, effective, and feasible method of oocyte retrieval in some selected patient groups.

The Cx Device: Benchtop Testing of a Medical Device to Treat Cervical Insufficiency

A cerclage prevents preterm birth, in part, by compressing the cervix and preventing preterm dilation. However, a cerclage does not prevent preterm birth in all cases and adverse effects can occur. To address the limitations of a cerclage, a proof-of-principle, medical device was designed. Like a cerclage, the device uses a suture to apply compression. Unlike a cerclage, the suture applies compression to polymer plates, which compress the tissue (Figure). Thus, compression forces are distributed over a larger tissue contact area. Called the Cx Device (CxD), our objective was to compare the CxD to a cerclage suture in benchtop tests of 1) cervical laceration and 2) ultrasound-derived cervical length. To simulate a cervical laceration, a previously described silicone cervix model was used. Mersilene tape was sutured to the silicone cervix. The suture was pulled through the silicone until material failure was observed. For the CxD, a polymer plate was sutured to the silicone cervix model and pulled through until failure was observed. The peak load at failure was measured for the Mersilene and the CxD polymer plate (n=5 replicates). To simulate ultrasound-derived cervical length, a custom, cervix-shaped, ultrasound phantom was constructed using Zerdine hydrogel (CIRS). The inside canal of the ultrasound phantom formed a funnel to simulate a short, dilated cervix. A Mersilene cerclage vs. CxD was installed on the ultrasound phantom. The ultrasound phantom was attached to a cerclage simulator (Limbs and Things, Model 80180) and cervical length was measured with a vaginal probe (n=3 replicates) (Philips 3D9-3V). The peak load at failure of the silicone cervix was significantly higher for the CxD compared with Mersilene (166 Newtons vs. 73 Newtons, p< 0.001). Compared to Mersilene, the closed cervical length was 0.6 cm longer when the CxD was installed (p< 0.01) The CxD compresses the cervix over a larger contact area, which significantly decreased laceration risk and improved cervical length in benchtop testing.

The 'chicken-egg-model': a simple in vitro model for 3D-ultrasonography and elastography.

Three-dimensional ultrasound (3D-ultrasound) and elastography are imaging techniques facilitating the diagnosis of gynaecological diseases and uterine anomalies. These non-invasive ultrasound applications may be of important added diagnostic value in gynaecological ultrasonography. The main objective of this study was to develop a simple and cheap in vitro model for elastography and 3D-ultrasound, with an adaptable probe-target distance. The target should be visible within the model and its hardness should be modifiable. The orientation and inclination of the model should also be adjustable. We used a boiled chicken egg in a gel basis as this mimics the elastic properties of human tissues. Different boiling times were compared with the stiffness at elastography. Both 3D-ultrasonography and strain elastography were conducted with a Voluson™ E10 4-9 MHz vaginal probe. Altering the eggs' boiling times modulates the levels of stiffness, and hence the aspect on elastography. Our model can help trainees to practice acquisition and interpretation of elastography images. This cheap and easy-to-reproduce, in vitro "chicken-egg-model" allows for education and training of 3D-ultrasound and elastography, without causing discomfort to patients. We created a cheap and easy to reproduce in vitro model for the education of 3D-ultrasound and elastography.

A Novel Biofeedback Device For Urinary Incontinence In Women: A Pilot Randomized Controlled Trial

<h3>Research Objectives</h3> To compare the outcomes of stress urinary incontinence (SUI) treatment through pelvic floor muscle training (PFMT) performed with a newly developed electromyography (EMG) biofeedback device, with conventional EMG biofeedback using a vaginal probe, or without biofeedback. <h3>Design</h3> An assessor-blinded, three-arm, parallel-group, randomized controlled pilot trial. <h3>Setting</h3> The trial was conducted in a hospital (Kwong Wah), two community centers in Hong Kong, and at the Hong Kong Polytechnic University. <h3>Participants</h3> Fifty-one women were included in the trial. Women were included if they were aged 35–60 years and were diagnosed with SUI. Women diagnosed with urge/ mixed incontinence were excluded from the trial. <h3>Interventions</h3> Women with SUI were randomly allocated to the following treatment groups: PMFT with the new biofeedback device (n = 17), PMFT with conventional biofeedback (n = 17), or a PFMT alone (n = 17; standard care control). Study interventions were provided 3 times a week for 4 weeks, followed by unsupervised video-guided home exercises for 12 weeks. <h3>Main Outcome Measures</h3> International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), one-hour pad test, pelvic floor muscle (PFM) strength, and feasibility measures (treatment adherence and safety). Treatment adherence was measured using a 0–10 adherence scale, where 0 indicates low adherence and 10 indicates high adherence. <h3>Results</h3> The between-group analysis revealed statistically significant effects for the new biofeedback compared with the conventional biofeedback and PFMT for improving SUI symptoms (p < 0.01), the severity of urine loss (p < 0.05) and PFM strength (p < 0.05). Treatment adherence was higher in the new biofeedback group than in the conventional and PFMT groups. <h3>Conclusions</h3> The pilot trial found that participants in the new biofeedback device group expressed good device acceptance. PFMT combined with the new biofeedback device was more effective for reducing SUI symptoms in women than PFMT combined with conventional biofeedback or PFMT alone. Results demonstrated good PFMT adherence in the new biofeedback group compared to the conventional biofeedback and PFMT alone groups. <h3>Author(s) Disclosures</h3> None declared.

7585 A Systematic Approach to Endometriosis Lesion Mapping and Radical Excision

<h3>Study Objective</h3> To illustrate a systematic approach to laparoscopic endometriosis lesion mapping and radical wide field excision. Significant variation exists regarding the optimal approach to surgical management of endometriosis with attempts for standardization being fairly recent. We hereby contribute to these efforts by presenting our approach to radical, wide-field endometriosis excision in our institution. <h3>Design</h3> Edited surgical video demonstrating laparoscopic radical wide field endometriosis excision. <h3>Setting</h3> Academically affiliated community hospital. <h3>Patients or Participants</h3> Surgical videos of multiple surgical cases from our practice <h3>Interventions</h3> Laparoscopic radical wide field excision of endometriosiss. <h3>Measurements and Main Results</h3> As illustrated in this video, important considerations are the non-contact, mm by mm dissection along the avascular planes, use of the perirectal tissue fat as an insulator and landmark for dissection, as well as the deliberate use of rectal and vaginal probes in order to delineate anatomy and optimize dissection geometry. <h3>Conclusion</h3> With a systematic approach to radical wide field excision of endometriosis, both in high and low ASRM stage disease, via a lateral to medial approach and clockwise progression from the left pelvic brim to the left pelvic sidewall and so on, virtually all cases will be completed safely and efficiently.

Non-Invasive Methods of Quantifying Heat Stress Response in Farm Animals with Special Reference to Dairy Cattle

Non-invasive methods of detecting heat stress magnitude for livestock is gaining momentum in the context of global climate change. Therefore, the objective of this review is to focus on the synthesis information pertaining to recent efforts to develop heat stress detection systems for livestock based on multiple behavioral and physiological responses. There are a number of approaches to quantify farm animal heat stress response, and from an animal welfare point of view, these can be categorized as invasive and non-invasive approaches. The concept of a non-invasive approach to assess heat stress primarily looks into behavioral and physiological responses which can be monitored without any human interference or additional stress on the animal. Bioclimatic thermal indices can be considered as the least invasive approach to assess and/or predict the level of heat stress in livestock. The quantification and identification of the fecal microbiome in heat-stressed farm animals is one of the emerging techniques which could be effectively correlated with animal adaptive responses. Further, tremendous progress has been made in the last decade to quantify the classical heat stress endocrine marker, cortisol, non-invasively in the feces, urine, hair, saliva and milk of farm animals. In addition, advanced technologies applied for the real-time analysis of cardinal signs such as sounds through microphones, behavioral images, videos through cameras, and data stalking body weight and measurements might provide deeper insights towards improving biological metrics in livestock exposed to heat stress. Infrared thermography (IRT) can be considered another non-invasive modern tool to assess the stress response, production, health, and welfare status in farm animals. Various remote sensing technologies such as ear canal sensors, rumen boluses, rectal and vaginal probes, IRT, and implantable microchips can be employed in grazing animals to assess the quantum of heat stress. Behavioral responses and activity alterations to heat stress in farm animals can be monitored using accelerometers, Bluetooth technology, global positioning systems (GPSs) and global navigation satellite systems (GNSSs). Finally, machine learning offers a scalable solution in determining the heat stress response in farm animals by utilizing data from different sources such as hardware sensors, e.g., pressure sensors, thermistors, IRT sensors, facial recognition machine vision sensors, radio frequency identification, accelerometers, and microphones. Thus, the recent advancements in recording behavior and physiological responses offer new scope to quantify farm animals’ heat stress response non-invasively. These approaches could have greater applications in not only determining climate resilience in farm animals but also providing valuable information for defining suitable and accurate amelioration strategies to sustain their production.

The influence of one-time biofeedback electromyography session on the firing order in the pelvic floor muscle contraction in pregnant woman-A randomized controlled trial.

Many women are initially unable to contract the pelvic floor muscles (PFMs) properly, activating other muscle groups before, or instead of, PFM. Numerous authors have proved that biofeedback can be an ideal tool supporting learning of the PFM contraction. However, there is currently a lack of scientific data on how many biofeedback sessions are necessary in this educational process. In this study we aimed at assessing the effects of one-time electromyography (EMG) biofeedback session on the order in which PFM are activated (so called firing order) during conscious contractions in relation to selected synergistic muscles in pregnant, continent women. A randomized controlled trial was conducted in 90 healthy nulliparous women with uncomplicated pregnancies and without diagnosed urinary incontinence. We divided the participants into a biofeedback group (50) and a control group (40). They were, respectively: 30 ± 4 and 30 ± 4 years old, at their 23 ± 5 or 25 ± 7 week of gestation and presented 23 ± 5 or 24 ± 5 kg/m2 BMI value (M + SD). Surface EMG with vaginal probes has been used to assess the PFM firing order in selected tasks: in five 3-s maximal contractions (quick flicks), five 10-s contractions, and in a 60-s contraction (static hold). We used the 1–5 scale, where “1” meant the best score, awarded when PFM was activated first in order. The most important finding of our study is that a single EMG biofeedback substantially improved the PFM contractions in pregnant women. First, when applying one-time biofeedback session, more women maintained correct technique or improved it in the second assessment, compared to the control group (73 vs. 65%). Secondly, using the quantitative and qualitative analysis with the Chi-square McNamara B/C test, in the biofeedback group we observed a statistically significant improvement of PFM firing order in four tasks: in the first quick flicks (p = 0.016), third quick flicks (p = 0.027), fifth quick flicks (p = 0.008), and in the first 10-s contractions (p = 0.046). In the control group we observed better outcome only in one motor task: in the fourth 10-s contraction (p = 0.009). Given the positive effects of a single session of EMG biofeedback on the firing order in the PFM contractions, it should be recommended for pregnant women without urinary incontinence to teach them how to perform PFM exercises correctly.

Clinical practice guidelines for endometriosis in Japan (The 3rd edition).

Clinical practice guidelines for endometriosis in Japan (The 3rd edition).

Analysis of the Correlation Between the Mode of Combined Ultrasound Examination and Image effect in Obstetrics and Gynecology

Objective: To analyze the correlation between ultrasound combined examination in obstetrics and gynecology and image effect. Methods: Five patients who were treated in obstetrics and gynecology department were examined by transvaginal ultrasound and transabdominal ultrasound, and the image effects after examination were analyzed and compared. Results: TAS (transabdominal ultrasound) has a wide visual field, but it needs patients' bladder filling. TVS (transvaginal ultrasound) does not need to fill the bladder of the patient, so that the uterus, appendages, etc. can be located naturally, and more detailed information can be obtained, but the image field of view is relatively small. Conclusion: Vaginal ultrasound probe has the advantages of high frequency and clear image, and transabdominal ultrasound examination has the advantages of economy, simplicity, practicality, strong penetrating power, large scanning area, wide field of vision and no restriction of marital status of patients. Transabdominal ultrasound examination and transvaginal ultrasound examination can complement each other, so it is suggested that gynecology and obstetrics should take joint examination during examination. In the process of examining patients, different examination methods can obtain different image effects, which is of great significance for the diagnosis of patients.

Analysis of the Correlation Between the Mode of Combined Ultrasound Examination and Image effect in Obstetrics and Gynecology

Objective: To analyze the correlation between ultrasound combined examination in obstetrics and gynecology and image effect. Methods: Five patients who were treated in obstetrics and gynecology department were examined by transvaginal ultrasound and transabdominal ultrasound, and the image effects after examination were analyzed and compared. Results: TAS (transabdominal ultrasound) has a wide visual field, but it needs patients' bladder filling. TVS (transvaginal ultrasound) does not need to fill the bladder of the patient, so that the uterus, appendages, etc. can be located naturally, and more detailed information can be obtained, but the image field of view is relatively small. Conclusion: Vaginal ultrasound probe has the advantages of high frequency and clear image, and transabdominal ultrasound examination has the advantages of economy, simplicity, practicality, strong penetrating power, large scanning area, wide field of vision and no restriction of marital status of patients. Transabdominal ultrasound examination and transvaginal ultrasound examination can complement each other, so it is suggested that gynecology and obstetrics should take joint examination during examination. In the process of examining patients, different examination methods can obtain different image effects, which is of great significance for the diagnosis of patients.