Embryo transfer techniques

Embryo transfer is the final and rate-limiting step of the assisted reproductive technique. Few advances have occurred in the last few decades with regard to this procedure. Studies conducted thus far have focused on factors and interventions taking place before, during and after this procedure. These factors are highly varied and range from methods to improve the psychological state of the patients to methods aimed at reducing uterine contractility and methods aimed at optimising the precise transfer of the embryo. The key question is which factors and interventions have thus far been proven to increase pregnancy rates and live birth rates. This paper aims to review the evidence relating to embryo transfer techniques in a systematic manner with a view to provide practical recommendations to practitioners involved in the procedure.     

Assessment of inhibitory potential of Pothos scandens L. on ovalbumin-induced airway hyperresponsiveness in balb/c mice

Pothos scandens L. was used in Indian traditional medicine as an antiasthmatic drug. The ethanolic and aqueous extracts were prepared with aerial parts of P. scandens (PSE & PSA). ESI MS/MS of PSE ethanolic extract was carried out for the determination of chemical constituents. CP1 is isolated from the PSE, structurally confirmed with NMR and LCMS/MS. PSE, PSA and CP1 are evaluated against ovalbumin (OVA) induced airway hyperresponsiveness (AHR) in balb/c mice. The test drugs are administered p.o. prior to challenge with aerosolized 2.5% w/v OVA. Total and differential leucocyte count, nitrite (NO₂), nitrate (NO₃), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-13 (IL-13) are estimated in bronchoalveolar lavage fluid (BALF). Similarly, myeloperoxidase (MPO), malonaldehyde (MDA) and total lung protein (TLP) are estimated in the lungs. The results reveal a significant increase in total and differential leucocyte count, NO₂, NO₃, TNF-α, IL-6, and IL-13 in OVA induced AHR. However, these parameters are significantly decreased in PSE and PSA tested doses (PSE 100 & 200 mg/kg). While, treatment with CP1 is less effective at 5 & 10 mg/kg doses. Similar observations obtain for MPO and MDA in lungs. However, the mean value indicated that the PSE at 200 mg/kg showed a significant restoration in all the parameters. Pro-inflammatory mediators are known to be responsible for AHR. Histopathology revealed justifies the effectiveness. The present investigations suggest PSE are interesting molecules for further research for asthma, with an approach through pro-inflammatory inhibitory pathway. P. scandens is a potential herbal medicine for allergy induced asthma.     

Disparities in the prevalence of comorbidities among US adults by state Medicaid expansion status

IntroductionAbout 92% of US older adults have at least one chronic disease or medical condition and 77% have at least two. Low-income and uninsured adults in particular experience a higher burden of comorbidities, and the Medicaid expansion provision of the Affordable Care Act was designed to improve access to healthcare in this population group. However, a significant number of US states have declined expansion. The purpose of this study is to determine the distribution of low-income and uninsured adults in expanded versus non-expanded states, and evaluate the prevalence of comorbidities in both groups.MethodsData from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) dataset was analyzed, and Medicaid expansion status was assessed from the Center for Medicare and Medicaid Services report on State Medicaid and CHIP Income Eligibility Standards. Next, age adjusted mean number of comorbidities between expanded and non-expanded states was compared, with adjustment for socio-demographic differences.ResultsExpanded states had a higher proportion of adults with income of at least $50,000 per year (39.6% vs. 35.5%, p < 0.01) and a lower proportion of individuals with no health insurance coverage (15.2% vs. 20.3%, p < 0.01) compared with non-expanded states. Among the uninsured, there was a higher proportion of obese (31.6% vs. 26.9%, p < 001), and higher average number of comorbidities (1.62 vs. 1.52, p < 0.01) in non-expanded states compared to expanded states. Overall, the prevalence of comorbidities was higher among BRFSS participants in states that did not expand Medicaid compared with those in expanded states.ConclusionStates without Medicaid expansion have a greater proportion of poor, uninsured adults with more chronic diseases and conditions.     

Patient satisfaction and psychological well-being after internet-based cognitive behavioral stress management (IB-CBSM) for women with preterm labor: A randomized controlled trial

Objective and methodsDespite its value for the management of psychological burden, little is known about the efficacy of and patient satisfaction with internet-based cognitive behavioral stress management (IB-CBSM) for women with preterm labor. The present study sets out to analyze stress/anxiety reduction, patient satisfaction and patient's working alliance in a group of 58 women with preterm labor participating in an online psychological stress management project. As part of the project, women were randomly assigned to online stress management or a control condition.ResultsLevels of stress and anxiety decreased significantly in both conditions from pre- to post-treatment measure. Participants in IB-CBSM reported significant higher working alliance inventory (WAI) scores in the task and goal subscale (p < .001; p < .05) than women in the control condition. In Addition the IB-CBSM group showed significant correlations of the WAI subscale task and goal and the stress/anxiety outcome. Regarding patient satisfaction, women in the IB-CBSM reported significantly higher satisfaction scores (p < .001) than women in the control condition. WAI explained nearly 40% of the variance in patient satisfaction. Furthermore, WAI mediates, at least in part, the relationship between group condition and patient satisfaction.ConclusionThe current analysis indicated that participants in IB-CBSM had higher WAI scores and were more satisfied with the program. In addition only the IB-CBSM group showed significant correlations of the WAI with the stress/anxiety reduction outcome. Based on these findings, it can be presumed that measures of agreement with working alliance parameters, especially task and goal components, are substantially important for more effective and satisfactory therapeutic interventions.     

Puerperal ventral epidural hematoma after epidural labor analgesia

Serious complications in obstetric anesthesia are a rare occurrence. High neuraxial block, respiratory arrest in labor and delivery, and an unrecognized spinal catheter are among the most frequently reported serious complications. A serious complication occurs in approximately 1:3 000 obstetric patients. Neuraxial hematoma after obstetric epidural analgesia or anesthesia is extremely rare.We present a case of a puerperal spinal epidural hematoma following epidural labor analgesia. The patient presented with foot drop, which resolved after conservative treatment. We reviewed the epidemiology, clinical manifestations and treatment options for this rare complication.     

能量平台中结扎束在阴式子宫全切手术中的应用

目的探讨Force Triad能量平台中血管结扎闭合系统（结扎束）在阴式子宫全切术（Transvaginal total hysterectomy,TVH）中的应用价值。方法 2013年4~12月住院患者60例,随机分成观察组（ligasuren血管闭合系统组）与对照组（传统手术组）,比较两组间在手术时间、术中出血量、术后排气时间、术后发热时间、术后离床活动时间以及平均住院天数等情况。结果观察组手术时间、术中出血量、术后离床活动时间及平均住院时间明显少于开腹手术组（P〈0.05）,差异有统计学意义;术后排气时间、术后发热时间差异均无显著性（P〉0.05）。结论 Ligasuren血管闭合系统在阴式子宫全切手术的应用方面有一定的优势,可以更有效地闭合血管,减少出血量及缩短手术时间,减少术后并发症等优点,值得推广。     

电子阴道镜在宫颈疾病诊断中的临床应用

目的探讨电子阴道镜在宫颈疾病诊断中的应用价值、临床意义及应用体会。方法收集我院2001年~2004年妇产科240例宫颈疾病患者,进行阴道镜检查并行宫颈活检组织学检查,结果进行回顾性分析、比较和总结。结果①电子阴道镜在诊断宫颈病变中敏感度为80.4%,特异度为87.8%,假阴性率(漏诊率)为4.3%,阳性预测值为83.9%;②阴道镜图像与组织学结果相比:醋白上皮符合率为66.7%,二联征符合率为77.8%,三联征符合率100%,可疑宫颈癌符合率100%;③宫颈疾病在年龄分布上,其中以30~39岁发病者所占比例最大(46.5%),为CIN发病高峰年龄。结论电子阴道镜检查技术诊断宫颈疾病结果准确可靠,有一定的应用价值,特别对CIN的早期诊断、早期治疗及降低宫颈癌的发生率有重要的指导意义。