Retrospective cohort study of the risk factors for secondary infertility following hysteroscopic metroplasty of the uterine septum in women with recurrent pregnancy loss

Purpose

A hysteroscopic metroplasty was performed for women with recurrent pregnancy loss owing to a uterine septum, following which some women became infertile. The aim of this study was to elucidate the risk factors of secondary infertility 1 year after hysteroscopic metroplasty for a uterine septum.

Methods

A retrospective, single‐center, cohort study included women with a history of at least two miscarriages that had been attributed to a uterine septum who underwent a hysteroscopic metroplasty. The patients’ background data were compared between the patients who conceived and those who remained infertile at 1 year postoperatively. The data were analyzed by using the Mann–Whitney U‐test and multivariate analyses.

Results

The postoperative live birth rate was 83.9% (n = 26), with persistent infertility in five women at 1 year. When comparing the pregnancy group with the infertile group, the women in the postoperative infertility group were significantly older than those in the postoperative pregnancy group. The multivariate analysis showed that age was an independent risk factor for persistent infertility.

Conclusion

Age was identified as an independent risk factor for postoperative secondary infertility. Therefore, surgery as early as possible is recommended.     

The Vasopressin Injection Technique for Laparoscopic Excision of Ovarian Endometrioma: A Technique to Reduce the Use of Coagulation

Study ObjectiveTo estimate the efficacy of the vasopressin injection technique for laparoscopic cystectomy of ovarian endometriomas with regard to operative time and coagulation events.DesignProspective study (Canadian Task Force Classification II-1)SettingOsaka Central Hospital in Osaka, JapanPatientsFifteen women with single lobular similarly-sized ovarian endometrioma.InterventionsWomen who planned to undergo laparoscopic cystectomy of endometrioma were allocated randomly to 3 groups: (1) ordinary laparoscopic cystectomy without injection, (2) laparoscopic cystectomy with the injection of saline solution, and (3) laparoscopic cystectomy with the vasopressin injection technique.Measurements and Main ResultsReviewing the video, we counted the number of pinpoint bipolar coagulations on the normal ovarian cortex that were required from the beginning of stripping until hemostasis had been achieved, as well as the times required to achieve hemostasis. The group with the vasopressin injection technique required significantly fewer coagulation events (p = .041) to achieve hemostasis, as compared with the group receiving an ordinary cystectomy.ConclusionThe vasopressin injection technique reduces the use of coagulation, in such a way as to suggest the possibility to protect ovarian reserves.     

PD-1+ memory phenotype CD4+ T cells expressing C/EBPα underlie T cell immunodepression in senescence and leukemia

Although altered T cell function plays a part in immunosenescence, the mechanisms remain uncertain. Here we identify a bona fide age-dependent PD-1⁺ memory phenotype (MP) CD4⁺ T cell subpopulation that hardly proliferates in response to T cell receptor (TCR) stimulation and produces abundant osteopontin at the cost of typical T cell lymphokines. These T cells demonstrate impaired repopulation in Rag2^−/− mice, but a homeostatic proliferation in γ-ray–irradiated mice. These T cells also reveal a unique molecular signature, including a strong expression of C/EBPα normally expressed in myeloid-lineage cells, with diminished c-Myc and cyclin D1. Transduction of Cebpa in regular CD4⁺ T cells inhibited the TCR-mediated proliferation with c-Myc and cyclin D1 repression and caused a striking activation of Spp1 encoding osteopontin along with concomitant repression of T cell lymphokine genes. Although these T cells gradually increase in number with age and become predominant at the senescent stage in normal mice, the generation is robustly accelerated during leukemia. In both conditions, their predominance is associated with the diminution of specific CD4⁺ T cell response. The results suggest that global T cell immunodepression in senescence and leukemia is attributable to the increase in PD-1⁺ MP CD4⁺ T cells expressing C/EBPα.     

An improved neurosurgical system: New operating table,chair, microscope and other instrumentation

Summary We have developed what we call the instrument trio in the neurosurgical operating theatre: a remotecontrolled operating microscope with magnetic lock, an operating table with remote-controlled X-Y shifter, and a floating operating chair. In addition other important improvements in instrumentation have been made; they include a quick sterilization system for the operating microscope, a multipurpose head frame and an improved retractor system. The instruments and their characteristics are described in detail.     

Fixation behavior in advanced stage glaucoma assessed by the MicroPerimeter MP-1

Purpose  

To investigate fixation behavior in eyes with advanced glaucoma using the MicroPerimeter MP-1.     

Percutaneous transluminal angioplasty of a non-mainstream venous route to restore an occluded hemodialysis fistula

Purpose

To report the usefulness of percutaneous transluminal angioplasty (PTA) of a non-mainstream venous route in an occluded native hemodialysis fistula when a mainstream outflow vein could not be traversed.

Materials and methods

This cohort included seven patients with an occulted hemodialysis fistula with difficulty in traversing via a mainstream route. A non-mainstream vein near the occluded portion was traversed until it connected with a proximal large-sized vein and the route was dilated using a 4- or 5-mm balloon catheter. Metallic stent placement was performed, if necessary. Technical aspects and long-term patency was evaluated.

Results

PTA could be performed in all patients; however, stent placement was required in two because of residual stenosis and clotting. The clinical success rate of fistula restoration was 100 %. Fistula dysfunction recurred in six patients 17–668 days (mean ± standard deviation 229.3 ± 225.0) later. PTA was repeated in four patients, but not in two. The mean duration of the primary patency was 336.6 ± 417.2 days (range 17–1,190) and that of the secondary patency was 897.1 ± 801.4 days (range 17–2,230).

Conclusion

PTA of a non-mainstream venous route is useful for restoring an occluded hemodialysis fistula when the mainstream outflow vein cannot be traversed.     

Identification of Small Hepatocellular Carcinoma and Tumor-feeding Branches with Cone-beam CT Guidance Technology during Transcatheter Arterial Chemoembolization

PurposeTo evaluate the performance of transcatheter arterial chemoembolization guidance software that uses cone-beam computed tomography (CT) technology in identifying small hepatocellular carcinoma (HCC) tumors and feeding branches.Materials and MethodsCone-beam CT and manual feeder vessel detection (MFD) software were used in chemoembolization of 68 HCCs 30 mm or smaller (mean±standard deviation, 15.3 mm±5.2). Detectability of tumors and tumor-feeding sub-subsegmental arteries was compared versus that of nonselective digital subtraction angiography (DSA). Technical success of chemoembolization was divided into three grades according to 1-week CT findings: entire tumor embolized with at least a 5-mm-wide margin (ie, complete), tumor embolized without a margin in parts (ie, adequate), or entire tumor not embolized (ie, incomplete). All cone-beam CT data were also reanalyzed with automatic feeder vessel detection (AFD) software that was developed later.ResultsCone-beam CT could depict all tumors, including eight that were first discovered during chemoembolization. Sixty-one tumors (89.7%) were detected on CT during arterial portography and during hepatic arteriography, and seven (10.3%) were detected with one or the other. Nonselective DSA depicted 49 tumors (72.1%). Among 100 tumor-feeding vessels, 81 were identified with MFD and 38 with nonselective DSA. Detectability of tumors with CT and tumor-feeding branches with MFD was significantly better than with nonselective DSA (both P<.001). Fifty-nine tumors (86.8%) were completely embolized and nine (13.2%) were adequately embolized. AFD identified 96 feeder vessels; 88 (88%) represented true-positive findings.ConclusionsTranscatheter arterial chemoembolization guidance software with cone-beam CT technology has a sufficient performance level to detect small HCCs and their feeding branches.