Ultrasound-guided embryo transfer: a meta-analysis of randomized controlled trials

OBJECTIVE: To conduct a meta-analysis of randomized controlled studies to evaluate abdominal ultrasound-guided embryo transfer compared to the clinical touch method. DESIGN: Meta-analysis. SETTING: Four studies performed in academic research centers in Barcelona, Vizcaya, Hong Kong, and Madrid. PATIENT(S): A total of 2,051 patients: 1,024 received ultrasound-guided embryo transfers and 1,027 received clinical touch method transfers. INTERVENTION(S): Fourteen studies were retrieved from the literature, but only four of them fitted our selection criteria. The meta-analysis was conducted using the RevMan software with the Peto-modified Mantel-Haenszel method and the fixed effect model. MAIN OUTCOME MEASURE(S): The primary outcome measures were the clinical pregnancy and ongoing pregnancy rates. The secondary outcome measures were the incidences of ectopic pregnancies, miscarriage rate, multiple pregnancies, and difficult transfers. RESULT(S): Compared to the clinical touch method, abdominal ultrasound-guided transfer significantly increased the clinical pregnancy rate and the ongoing pregnancy rate. There was no effect on the incidence of ectopic pregnancy, multiple pregnancy, or miscarriage rate. CONCLSUION(S): Ultrasound-guided embryo transfer increases the clinical pregnancy and ongoing pregnancy rates significantly compared to the clinical touch method.     

Laminin alpha-1, alpha-3, and alpha-5 chain expression in human prepubertal [correction of prepubetal] benign prostate glands and adult benign and malignant prostate glands

BACKGROUND: Laminins (Lns) are a family of extracellular matrix glycoproteins located in the basement membrane (BM) of epithelial cells. They exist as heterotrimers composed of an alpha, beta, and gamma chain. Presently, five alpha (alpha1-5), three beta (beta1-3), and three gamma (gamma1-3) chains have been identified with different combinations of these chains resulting in 14 laminin heterotrimers thus far identified (1, 3-5). METHODS: In this study, using immunohistochemistry with chain-specific antibodies, we characterized the expression of the alpha1 (Lns-1/3), alpha3 (Lns 5,6,7), and alpha5 (Lns 10/11) chains in fetal, newborn, infant, prepubertal, and adult benign and malignant prostate glands. RESULTS: In general, alpha1 expression was higher in normal fetal prostate glands and declined by full-term birth, whereas the alpha3 and alpha5 chains remained highly expressed in the adult normal glands. In carcinoma alpha1 (Lns 1/3) and alpha5 (Lns 5,6,7) are lost, whereas alpha5 (Lns 10/11) persists. CONCLUSIONS: Alpha 1 (Lns 1/3) is prominent in BM, but is replaced by a laminin matrix rich in alpha3 (Lns 5,6,7) and alpha5 (Lns 10/11) in benign adult prostate glands. In carcinoma, both alpha1 (Lns-1/3) and alpha3 (Lns 5,6,7) are not expressed with persistence of a BM rich in alpha5 (Lns 10/11).     

Monitoring gonadotrophin therapy by real-time ultrasonic scanning of ovarian follicles

Real-time ultrasound scanning of ovarian follicles was performed during 61 cycles in 22 infertile patients being treated with sequential injections of human menopausal gonadotrophin (hMG) and human chorionic gonadotrophin (hCG). Total 24-h urinary oestrogens were estimated (and in 13 cycles plasma oestradiol) but the amount of gonadotrophin given was based mainly on the ultrasound findings. A retrospective analysis of the results showed that there was a poor statistical correlation between the diameter of the largest follicle and the total urinary oestrogens (r=0.39) and with the level of plasma oestradiol (r=0.56), although similar clinical information was obtained by all methods. Ovulation was induced in 58 cycles when the leading follicle had a mean diameter of 20-25 mm (mean 21.3 mm); follicular rupture was observed in 57 cycles and in these cases there was biochemical evidence of luteinization (plasma progesterone greater than 15 nmol/1; total urinary pregnanediol greater than 8 nmol/24h). Three patients (three cycles) were not given hCG; one developed micropolycystic ovaries and two showed evidence of hyperstimulation (one follicle greater than 25 mm diameter, three or more follicles 20-25 mm diameter). Twelve patients became pregnant, all with single fetuses. Subsequently one aborted, one had an ectopic pregnancy, three gave birth to normal babies at term and seven pregnancies are continuing. Real-time ultrasound scanning of ovarian follicles is a simple, practical method for monitoring follicular growth during the administration of hMG and predicting the response to hCG.     

新缩瞳剂包公藤甲素人工合成研究

包公藤甲素是从包公藤(Erycibe obtusifolia Benth.)茎中提得的一个新莨菪烷生物碱,具有强烈的缩瞳作用,临床用于治疗青光眼。本文报道用合成的6β-乙酰氧基托品酮为原料,经卤代、水解、还原和N-去甲基化等反应合成包甲素(8)。经光谱测定证实8与天然包甲素的结构完全一致。合成品系外消旋体,其作用机理与天然品相同,而强度则减半。     

Infusion aspiration mismatch during 25-gauge vitrectomy with conversion to 20-gauge vitrector.

We report intraoperative hypotony throughout the 25G vitrectomy procedure of an elderly patient with dense vitreous hemorrhage when switching to a 20G cutter. This was due to fluidic mismatch between the 25G infusion and 20G aspiration systems. No leakage from the sclerotomy sites or choroidal effusion was noted.     

彩色多普勒超声对移植肾急性排斥反应的评价

目的:肾移植的成功与否关键在于及时发现和正确处理排斥反应。探讨无创伤性形态学和血流动力学检查手段彩色多普勒超声在移植肾急性排斥反应中的作用,为临床评估肾移植效果及移植肾功能提供客观的辅助性数据。方法:选择2004-01/2005-12在南京医科大学附属第一医院、江苏省人民医院行同种异体移植肾患者57例,其中经穿刺活检证实或最后临床诊断为急性移植肾排斥反应者22例,未发生排斥反应等并发症的移植肾功能正常者35例,患者均知情同意。采用Philips EnVisor彩色多普勒超声血流显像仪,对急性排斥反应肾移植患者进行二维超声和彩色多普勒血流显像检测,观察排斥反应患者甲基强的松龙冲击治疗前后移植肾脏的大小、形态结构、肾内血管树分布、血流灌注以及各级动脉血流参数(阻力指数,搏动指数)等指标的变化,并与移植肾功能正常患者进行比较。结果:急性排斥反应组2例患者发生严重并发症死亡,进入结果分析急性排斥反应组20例,移植肾功能正常组35例。①发生急性排斥反应时肾移植患者移植肾体积明显大于肾功能正常组(P<0.01);肾实质增厚,皮髓质界限模糊。给予甲基强的松龙冲击治疗后急性排斥反应组患者肾脏厚径显著小于治疗前(P<0.05);肾实质回声减低,皮髓质交界变清。②发生急性排斥反应时肾移植患者移植肾血流阻力指数、搏动指数均显著高于移植肾功能正常组(P<0.01)。治疗后急性排斥反应组患者肾血流阻力指数、搏动指数均显著低于治疗前(P<0.01),与移植肾功能正常组差异无显著性意义(P>0.05)。结论:彩色多普勒超声作为一种简便、经济的无创性技术,对移植肾血流阻力指数、搏动指数的追踪观察可为临床上评估肾移植效果提供较可靠的客观依据,对移植肾急性排斥反应的早期诊断有较高的评估价值。