Sacral neuromodulation in the older woman

In the last 10 years, sacral neuromodulation has evolved from an experimental therapy to a safe and proven treatment option for patients with a variety of complex lower urinary tract disorders. It is currently Food and Drug Administration approved for the following indications: intractable urge incontinence, urgency-frequency, and nonobstructive urinary retention. Herein, we will discuss some of the factors complicating incontinence treatment in the elderly population paying particular attention to sacral neuromodulation, its history, indications, and applications within the elderly female population.     

Novel studies on influence of gonadotropins and insulin-like growth factor-I on growth of cumulus oophorus in the rat

In the final developmental stage of a Graafian follicle, there are two functionally distinct types of granulosa cells: the cumulus cells (CCs) and the mural granulosa cells (MGCs). Previous studies focused on follicle-stimulating hormone (FSH) and insulin-like growth factor I (IGF-I) interactions in MGCs. Our goal was to study these interactions in CC proliferation. Immature rats received in vivo treatments of either saline, equine chorionic gonadotropin (eCG) with high FSH activity, an IGF-I analog (LR3-IGF-I) with poor binding to IGF-I binding proteins, or a combination of both hormones. CCs from each in vivo treatment were then cultured and treated in vitro with either saline, FSH, or IGF-I. CCs proliferation were assessed by measurement of 3H-thymidine incorporation. Prior in vivo treatment with eCG resulted in the highest proliferative activity of CCs when combined with FSH in vitro treatment. In vivo treatment with LR3-IGF-I had no effect on CC replication. CC replication was higher in FSH in vitro treatment than of IGF-I. The combination of eCG and LR3-IGF-I was the only in vivo treatment to stimulate higher CC proliferation with IGF-I in vitro treatment. This study suggests that FSH does not act through IGF-I, a mechanism previously proposed.     

The Status of Controlled Prospective Clinical Trials for Efficacy of Intracytoplasmic Sperm Injection in In Vitro Fertilization for Non-Male Factor Infertility

Purpose: Intracytoplasmic sperm injection (ICSI) of some sibling oocytes may have a beneficial effect in couples going through in vitro fertilization for causes of infertility not related to the male factor. Our purpose was to critically appraise the randomized controlled studies done in this area and arrive at some recommendations. Methods: The four controlled trials done so far have utilized similar methodology, i.e., they randomly allotted sibling oocytes to ICSI versus standard insemination in patients going through in vitro fertiliztion and embryo transfer. Results: In the first trial reported in 1995 there was no difference in fertilization rate, whereas the later trials reported in 1997, 1999, and 2000 showed improvement with ICSI that reached statistically significant level in the last two studies. Conclusions: Total fertilization failure of an in vitro fertilization cycle can be prevented and fertilization can be improved if half of sibling oocytes are subjected to ICSI.     

Current indications for neuromodulation

Neuromodulation is becoming a part of the clinical armamentarium for treatment ofa variety of lower urinary tract conditions. Its increased usage stems from the needs of patients who have exhausted all other therapeutic options. Currently, neuromodulation may consist of the use of nerve stimulation and injectable therapies. This article concentrates on nerve stimulation.     

Granulosa cells of the cumulus oophorus are different from mural granulosa cells in their response to gonadotrophins and IGF-I

There are two types of granulosa cells: those which surround the oocyte are cumulus cells (CC) and those which surround the antrum are mural granulosa cells (MGC). These cells are under the influence of several hormones and growth factors, the most important of which are gonadotrophins and IGF-I. In this article, we report novel observations on the differences between these two types of granulosa cells and their interaction with gonadotrophins and IGF-I. We were able to conduct physiological studies on the role of IGF-I by using an analogue of IGF-I which does not bind to IGF-I-binding proteins (LR3-IGF-I). Immature rats received saline, equine chorionic gonadotrophin (eCG), LR3-IGF-I or eCG plus LR3-IGF-I by infusion using a pump from 24-29 days of age. The rats were killed and the ovaries removed. Surface follicles were punctured and MGC and oocyte cumulus complexes were removed. These were cultured in saline (control) and in three different doses of FSH. Cell replication was assessed by 3H-thymidine incorporation and differentiation was evaluated by the measurement of progesterone secretion. It was noted that CC replicated ten times more than MGC. Similarly, progesterone secretion by CC was six times more than by MGC. In vivo exposure to gonadotrophins (eCG) positively influenced in vitro treatment with FSH in both cell types. This phenomenon was observed in both cell replication and progesterone secretion. The IGF-I analogue had a positive effect on cell replication of MGC but a negative effect on the cell replication of CC. With respect to progesterone secretion, the IGF-I analogue had a negative effect on CC but a positive effect on MGC. In conclusion, CC behaved differently from MGC in response to gonadotrophins and the IGF-I analogue. IGF-I and FSH acted additively, synergistically or antagonistically in different circumstances.     

Performing ICSI using an injection pipette with the smallest possible inner diameter and a long taper increases normal fertilization rate, decreases incidence of degeneration and tripronuclear zygotes, and enhances embryo development

Purpose: To compare the efficacy of two types of injection pipette used for ICSI, one with a larger (5–7 m) inner diameter and a shorter taper with that inner diameter, and another with the smallest (3–5 m) possible inner diameter and a longer taper with that inner diameter. Methods: Retrieved oocytes at metaphase II stage were injected using one of two types of injection pipette, in 33 and 94 cycles, respectively, in a total of 127 cycles in 108 patients. Results: In comparison to the injection pipette with a larger (5–7 m) inner diameter and a shorter taper with that inner diameter, the injection pipette with the smallest (3–5 m) possible inner diameter and a longer taper with that inner diameter increased normal fertilization rate ((70 ± 3.6)% vs. (86 ± 2.2)%; P = .001; mean ± SEM); decreased the incidence of degeneration ((14 ± 2.4)% vs. (5 ± 1.4)%; P = .001) and tripronuclear zygotes ((1.0 ± 0.35)% vs. (0.1 ± 0.21)%; P = .03); increased Day-2 diploid embryos ((69 ± 3.7)% vs. (85 ± 2.2)%; P = .001) and good-quality Day-2 diploid embryos ((67 ± 4.0)% vs. (79 ± 2.4)%; P = .03), all per injected oocyte; and increased the number of blastomeres per good-quality Day-2 diploid embryo ((3.0 ± 0.21 vs. 3.8 ± 0.12; P = .0003). Conclusions: Performing ICSI using an injection pipette with the smallest (3–5 m) possible inner diameter and a longer taper with thatn inner diameter maximizes normal fertilization rate, minimizes the incidence of postinjection degeneration and tripronuclear zygotes, and enhances embryo development.     

Increased mortality in HIV/HCV-coinfected compared to HCV-monoinfected patients in the DAA era due to non-liver-related death

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Advanced maternal age as a risk factor for stress urinary incontinence: a review of the literature

The pathophysiology of stress urinary incontinence (SUI) is multifactorial and evidence supports a critical role of pregnancy and vaginal delivery. This review dissects epidemiologic literature to determine the weight of evidence on the role of advanced maternal age (AMA) as a risk factor for the development of subsequent or persistent SUI. We conducted a Medline search using the keywords postpartum, SUI, maternal age, pregnancy, and incontinence. The published literature was critically analyzed. Evidence supports that childbirth trauma contributes to the development and severity of SUI. Yet, there is contradicting evidence as to whether AMA increases the risk. AMA clearly represents an independent risk factor for postpartum SUI. However, long-term studies did not confirm this observation. Whether this finding is suggestive of a true biologic signal that is lost with competing risk factors over time warrants further research.