Removal of cervical mucus prior to embryo transfer improves pregnancy rates in women undergoing assisted reproduction

The removal of cervical mucus during embryo transfer has been postulated to increase the pregnancy and implantation rates by not interfering with embryo implantation. Even so, this is a time-consuming procedure that may increase the incidence of difficult transfers by removing the naturally lubricant mucus. In addition, any cervical manipulations at the time of embryo transfer may cause unwarranted uterine contractions. In this prospective, controlled study, 286 women undergoing embryo transfer between January and May 2006 were divided into two groups according to whether the cervical mucus was scheduled to be aspirated (group A) or not (group B). The two groups were similar with regards to the demographics, cause of infertility, characteristics of ovarian stimulation and embryos transferred. Even so, the clinical pregnancy rate was significantly higher in group (A) than group (B) (OR = 2.18, 95% CI = 1.32-3.58), although there were easier transfers in group (B) than group (A) (OR = 3.00, 95% CI = 1.05-8.55). This demonstrates that even though embryo transfers were easier to perform when the cervical mucus was left in place, aspiration resulted in an increased chance of clinical pregnancy.     

Effect of cryoprotectants on the stability and aerosol performance of nebulized aviscumine, a 57-kDa protein.

Nebulization of aqueous drug solutions is a suitable delivery system for pulmonary application of proteins because it can easily produce droplets small enough to reach the alveolar region. However, proteins are sensitive to nebulization. Therefore, stabilizers need to be added which on the other hand influence the aerosol performance, such as average droplet size or mass output. This research presents the effect of various cryoprotectants such as Na-polyphosphate, CaCl(2) x 6H(2)O and MgSO(4) x 7H(2)O on the stability and aerosol performance of freeze-dried aviscumine after reconstitution and nebulization using three different nebulizers. Formulations containing Tris-buffer, polysorbate 80, Na(2)-EDTA and HES450 were lyophilized and reconstituted with a buffered isotonic solution containing 100 mmol/l Tricine-buffer pH 8, 0.03% (w/v) octanoyl-N-methylglucamide, 150 mmol/l NaCl and a cryoprotectant. The aviscumine activity was determined by a binding assay. The addition of 0.2% Na-polyphosphate to the reconstitution medium led to retention of approx. 73% of the aviscumine activity after 20 min nebulization with the Systam ultrasonic nebulizer. It has been observed that 84 and 72% of the activity were retained by the addition of 10 mmol/l CaCl(2) x 6H(2)O using PariBoy air-jet and Multisonic ultrasonic nebulizer, respectively. In addition, a decrease in the mean droplet size with increasing the cryoprotectant concentration has been observed. A relationship between the average droplet size, surface tension and viscosity depending on the used cryoprotectant type and concentration could be established.     

Endometrial thermal balloon ablation with the ThermaChoice system: effect of intrauterine pressure and duration of treatment

STUDY OBJECTIVE: To determine the safety and efficacy of thermal balloon therapy under variable intrauterine pressures and durations of treatment. DESIGN: Retrospective cohort study. (Canadian Task Force classification II-1). SETTING: University-affiliated teaching hospital. Patients. Sixty-six women with menorrhagia. INTERVENTION: Eighteen patients were treated with the ThermaChoice thermal balloon system for 8 minutes at 80 to 150 mm Hg pressure, 15 were treated for 8 minutes at 151 to 180 mm Hg, and 33 were treated for 12 to 16 minutes at 151 to 180 mm Hg. MEASUREMENTS AND MAIN RESULTS: No intraoperative complications occurred and postoperative morbidity was minimal. At 12 to 24 months follow-up, persistent menorrhagia was reported in 56% of women treated at 80 to 150 mm Hg compared with 20% treated at 151 to 180 mm Hg for 8 minutes (p = 0.01), and in 24% treated for 12 to 16 minutes at 151 to 180 mm Hg (p = 0.1). CONCLUSION: Thermal balloon endometrial ablation is a safe and effective treatment for menorrhagia. Balloon pressure greater than 150 mm Hg increased the effectiveness of treatment. Success was not affected or influenced by increasing the duration of treatment from 8 to 12 minutes or more.     

Distinct nature of directional signals among parietal cortical areas during visual guidance

Eskandar, Emad N. andJohn A. Assad.Distinct Nature of Directional Signals Among Parietal CorticalAreas During Visual Guidance. J. Neurophysiol. 88: 1777-1790, 2002. We examined neuronal signals in themonkey medial superior temporal area (MST), the medial intraparietalarea (MIP), and the lateral intraparietal area (LIP) during visuallyguided hand movements. Two animals were trained to use a joystick toguide a spot to a target. Many neurons responded in adirection-selective manner in this guidance task. We tested whether thedirection selectivity depended on the direction of the stimulus spot orthe direction of the hand movement. First, in some trials, the movingspot disappeared transiently. Second, the mapping between the handdirection and the spot direction was reversed on alternate blocks oftrials. Third, we recorded the spot's movement while the animals moved the joystick and then played back that movement while the animals fixated without moving the joystick. Neurons in the three parietal areas conveyed distinct directional information. MST neurons were active and directional only on visible trials in both joystick-movement mode and playback mode and were not affected by the direction of handmovement. MIP neurons were mainly directional with respect to the handmovement, although some MIP neurons were also selective for stimulusdirection. MIP neurons were much less active in playback mode. LIPneurons were active and directional in both joystick-movement mode andplayback mode. Directional signals in LIP were unrelated to planningsaccades. The selectivity of LIP neurons also became evident hundredsof milliseconds before the start of movement. Since the direction ofmovement was consistent throughout a block of trials, these signalscould provide a prediction of the upcoming direction of motion. Wetested this by alternating blocks of trials in which the direction wasconsistent or randomized. The direction selectivity developed earlieron trials in which the upcoming direction could be predicted. Theseresults suggest that LIP neurons combine "bottom-up" visual motionsignals with extraretinal, predictive signals about stimulus motion.