Effects of Transcranial Direct Current Stimulation and Pelvic Floor Muscle Training in Women: protocol for a controlled, randomized, double-blind clinical trial / Efectos de la estimulación transcraneal por corriente directa y del entrenamiento muscular del suelo pélvico en mujeres: protocolo de un ensayo clínico controlado, aleatorizado y doble ciego / Efeitos da estimulação transcraniana por corrente contínua e treinamento muscular do assoalho pélvico em mulheres: protocolo para um ensaio clínico controlado, randomizado e duplo-cego

ABSTRACT Pelvic floor muscle weakness can lead to urinary incontinence, pelvic organ prolapse, and sexual dysfunction. Although it can be minimized by pelvic floor muscle training (PFMT), its effects are not lasting. Therefore, using combination therapy seems promising. This study aims to evaluate the effect of transcranial direct current stimulation (tDCS) combined with PFMT on intravaginal pressure, pelvic floor muscle strength (PFMS), sexual function (SF), and quality of life (QoL) in healthy women. A total of 32 women, aged from 18 to 45 years, will undergo PFMT (with perineal contractions and relaxation) with the aid of pressure biofeedback associated with active tDCS or sham tDCS. Sessions will last 20 minutes, three times per week, for four weeks, totaling 12 sessions. During the protocol, participants will be instructed to also perform the home-based PFMT daily. The tDCS anodal electrode will be positioned over the supplementary motor area of the dominant cortical hemisphere, whereas the cathodal will be over the contralateral supraorbital region, with a 2mA intensity for 20 minutes. Intravaginal pressure (pressure gauge), PFM strength (measured by digital palpation and the PERFECT scheme), FSFI (Female Sexual Function Index), and QoL (SF-36 questionnaire) will be evaluated before and after the 12 sessions and after a 30-day follow-up.

RESUMEN La debilidad de la musculatura del suelo pélvico puede provocar incontinencia urinaria, prolapso de órganos pélvicos y disfunción sexual, y puede minimizarse mediante el entrenamiento de la musculatura del suelo pélvico (EMSP). Sin embargo, este efecto no es duradero. En este contexto, una terapia combinada puede ser prometedora para mejorar la situación. Este estudio tiene por objetivo evaluar el efecto de la estimulación transcraneal por corriente directa (ETCC) combinada con EMSP sobre la presión intravaginal, la fuerza muscular del suelo pélvico (FMSP), la función sexual (FS) y la calidad de vida (CV) en mujeres sanas. Participarán 32 mujeres, de entre 18 y 45 años, que se someterán a EMSP (contracciones y relajación del perineo) y a Biofeedback asociado a ETCC activa o ETCC sham durante 20 minutos, tres veces por semana, durante 4 semanas, con un total de 12 sesiones. Durante el protocolo, las participantes también se someterán diariamente a EMSP en casa. El electrodo anodal de la ETCC se colocará sobre el área motora suplementaria del hemisferio cortical dominante, y el electrodo catodal sobre la región supraorbital contralateral, a una intensidad de 2 mA, durante 20 minutos. Se evaluarán la presión intravaginal (manómetro), la FMSP (palpación digital, esquema Perfect), la FS (Índice de Función Sexual Femenina) y la CV (cuestionario SF-36) antes y después de las 12 sesiones, así como tras un seguimiento de 30 días.

RESUMO A fraqueza muscular do assoalho pélvico pode gerar incontinência urinária, prolapso de órgãos pélvicos e disfunção sexual, e pode ser minimizada pelo treinamento muscular do assoalho pélvico (TMAP). No entanto, este efeito não é duradouro. Assim, terapia combinada parece ser promissora para a melhora deste quadro. Dessa forma, objetiva-se avaliar o efeito da estimulação transcraniana por corrente contínua (ETCC), combinada ao TMAP, sobre a pressão intravaginal, força muscular do assoalho pélvico (FMAP), função sexual (FS) e qualidade de vida (QV) em mulheres saudáveis. Serão 32 mulheres, entre 18 e 45 anos, que realizaram TMAP (contrações e relaxamento do períneo) e Biofeedback associados a ETCC ativa ou ETCC sham por 20 minutos, três vezes por semana, por 4 semanas, totalizando 12 sessões. Durante o protocolo, as participantes também realizarão diariamente, em domicílio, o TMAP. O eletrodo anodal da ETCC será posicionado sobre a área motora suplementar do hemisfério cortical dominante, e o catodal sobre a região supraorbital contralateral, com intensidade de 2mA, por 20 minutos. A pressão intravaginal (manômetro de pressão), FMAP (palpação digital, esquema Perfect), FS (Índice de Função Sexual Feminina) e QV (questionário SF-36) foram avaliadas antes e depois das 12 sessões, bem como após acompanhamento de 30 dias.

Mucus-penetrating nonviral gene vaccine processed in the epithelium for inducing advanced vaginal mucosal immune responses

Establishment of vaginal immune defenses at the mucosal interface layer through gene vaccines promise to prevent infectious diseases among females. Mucosal barriers composed of a flowing mucus hydrogel and tightly conjugated epithelial cells (ECs), which represent the main technical difficulties for vaccine development, reside in the harsh, acidic human vaginal environment. Different from frequently employed viral vectors, two types of nonviral nanocarriers were designed to concurrently overcome the barriers and induce immune responses. Differing design concepts include the charge-reversal property (DRLS) to mimic a virus that uses any cells as factories, as well as the addition of a hyaluronic acid coating (HA/RLS) to directly target dendritic cells (DCs). With a suitable size and electrostatic neutrality, these two nanoparticles penetrate a mucus hydrogel with similar diffusivity. The DRLS system expressed a higher level of the carried human papillomavirus type 16 L1 gene compared to HA/RLS in vivo. Therefore it induced more robust mucosal, cellular, and humoral immune responses. Moreover, the DLRS applied to intravaginal immunization induced high IgA levels compared with intramuscularly injected DNA (naked), indicating timely protection against pathogens at the mucus layer. These findings also offer important approaches for the design and fabrication of nonviral gene vaccines in other mucosal systems.

Comparative evaluation of intravaginal slow release Dinoprostone insert, transcervical foley’s catheter, intracervical Dinoprostone gel for induction of labor in patients with poor Bishop’s score: a randomized control study

Background: Induction of labor is indicated when the continuation of pregnancy poses risk to the mother or fetus. A variety of mechanical and pharmacologic methods are available but the best method of labor induction still remains unknown, study aimed at comparing the efficacy and safety among the two agents: transcervical Foley’s balloon catheter (FBC) and intravaginal slow release Dinoprostone E2 insert (DVI) with dinoprostone gel as control.Methods: A total of 174 patients were randomized into three groups of 58 each (Group A: dinoprostone 10 mg slow release intravaginal insert, Group B: transcervical Foley’s 16 French catheters, and Group C as control: 0.5 mg intracervical Dinoprostone gel. The safety and efficacy was compared among the groups. A p value of < 0.05 was considered statistically significant.Results: The mean insertion to active labor time (in hours) was significantly lower in Group A as compared to Group B (5.88±3.06 versus 13.56±2.8, p < 0.0001). Meantime of insertion to delivery (in hours) was significantly lower in Group A as compared to Group B (10.91±5.24 versus 21.17±2.99, p < 0.0001). The requirement of oxytocin for induction and augmentation in Group A was significantly lower as compared to Group B. Majority of the patients had normal vaginal delivery (NVD) in all the three groups. Regarding safety profile we found that slow-release DVI had more incidence of uterine tachysystole, but none of the cases had any fetal heart rate abnormality. Maternal fever was more in the FBC group, however, neonatal outcomes were comparable in both groups.Conclusions: The study concludes that slow release DVI is better in terms of efficacy as compared to transcervical FBC for induction of labor as assessed by improvement in Bishop score, insertion to active labor time and insertion to delivery time and comparable in terms of safety profile.

A randomized controlled trial to study the efficacy of intravaginal hormonal ring for control of heavy menstrual bleeding as compared to combined oral contraceptive pills

Background: Heavy menstrual bleeding (HMB) is one of the commonest presenting complaints in reproductive age group. Although combined oral contraceptives (COCs) are commonly used in such patients, combined hormones by intravaginal route has been found acceptable and effective. Aim of the study is to compare the efficacy and side effects of combined intravaginal hormonal ring (IHR) with COCs in control of HMB in these patients.Methods: Hundred women with HMB fulfilling inclusion criteria were randomized into two equal groups and treated with either IHR or COCs for three cycles. Each cycle consisted of three weeks of IHR/COC use followed by 1-week ring-free/non-hormonal pills period. Outcome measures were change in PBAC score (pictorial blood loss assessment chart), hemoglobin rise, side effects and overall patient satisfaction.Results: The percentage reduction in PBAC score, the duration of menses and increase in hemoglobin levels were statistically significant at the end of study in each group. The PBAC score reduction was 87.37% vs 61.52%, menses duration was 4.24±0.74 versus 5.16±1.67, and hemoglobin increase was 3.16 (95% CI:0.142-1.412) and 1.24 (95% CI:1.048-1.640) in the IHR versus COC group. However, the intergroup reduction of mean PBAC score was not statistically significant. Significantly more ring users were satisfied and elected to continue with treatment.Conclusions: Both the IHR and COCs are effective treatments for HMB in reproductive age group. IHR may be an attractive option for HMB due to better compliance and lesser systemic side-effects.

Maternal and fetal outcomes with the use of prostaglandins E2 as a cervical ripening agent for induction of labour

Background: In modern medicine induction of labour is required in patients for a good feto-maternal outcome. PGE2 is a prostaglandin analogue which has been used as a cervical ripening agent to improve bishops score. Objective of this study was to evaluate the efficacy of intravaginal PGE2 gel as a cervical ripening agent in unfavourable cervix for induction of labor and any complications associated with its use.Methods: This study comprised of 90 women who required labor induction. Singleton pregnancy above 37 weeks, live intrauterine fetus, Cephalic presentation, Bishop score of 1-6, reactive FHR pattern were included. Women who required only single induction were categorized as Group 1. Those requiring more than one dose after reassessment of bishops scoring at 6, 12 and 18 hours belonged to Group 2.Results: Group1 had more of younger population below 30 years consisting more primigravidas with > 80% women having gestational age of > 39 weeks. Most common indication for induction of labour in both groups was post-dated pregnancy. 65 patients received one dose of cerviprime gel forming Group 1. In Group 2, 72% received 2 doses and 28%, 3 doses of gel. Initial bishops score mean was 4.2 in Group 1 and 4.1 in Group 2. Mean change in bishop score was analysed after 6, 12, and 18 hours of instillations of PGE2 gel. Significant p value was obtained in all groups requiring one, two and three doses of gel. In Group 1, 12.3% and in Group 2, 16% had LSCS. Maternal side effects were minimal and neonatal outcome was good.Conclusions: The study showed that intravaginal application of PGE2 is effective, safe and acceptable method as a cervical ripening agent for labor induction in women with poor bishops score. It reduces caesarean delivery rate without increasing maternal and neonatal morbidity.

Controlled Reproduction along with Crossbreeding for Genetic Up-gradation of Non-descriptive Goats

The present study was aimed on the genetic improvement of non-descriptive goats through estrus synchronization and by crossbreeding with Beetal goats they were reported to be a good milker, having higher body weight and dressing percentage. AVIKESIL-S, indigenously developed progesterone intra-vaginal sponges were utilized for estrus synchronization in does maintained at livestock farm complex, Veterinary College, Hassan. Response to estrus synchronization was noticed in all the does (100%) under study, irrespective of the genetic background. Natural service was practised with three mating designs ie. G1-Beetal × Beetal, G2-Beetal × non-descriptive, G-3 non-descriptive × non-descriptive. Pregnancy test was performed with ultrasonography at 45 days post-mating. The conception rates in does of G1, G2 and G3 groups were 87.5, 87.5, and 75.0% respectively. Kidding rate were 85.7, 85.7 and 100.0% in G1, G2 and G3 groups, respectively. Litter sizes were 1.5, 1 and 1 in G1, G2 and G3 groups, respectively. Average birth weight in G1, G2 and G3 groups were 3.82±0.20, 2.82±0.12 and 2.00±0.09 kg, respectively and average daily gain in G1, G2 and G3 groups were 42.86±1.69, 33.81±1.28, and 33.57±0.87 g, respectively. Better growth performances were noticed up to 3 months of study period in G1 and G2 compared to G3 groups. It could be concluded that combined utilization of ES technology and crossbreeding in non-descriptive goats would provide superior kids for bulk marketing and ease management by avoiding dispersed kidding. Also more number of animals would be available for selection thus increasing the selection intensity their by improving the genetic improvement

A comparative study of efficacy and safety of intramuscular carboprost and intravaginal misoprostol for cervical priming prior to first trimester surgical abortion

Background: MTP Act no 34 of 1971 has been defined as Legal termination of pregnancy before the age of viability of fetus that is 20 weeks of gestation. There is a need to find a medical agent which can help in the process of abortion by speeding it up, with minimal side effects. The objective of this study was to compare the efficacy of I.M carboprost and intravaginal Misoprostol and to evaluate the safety profile of I.M carboprost and Intravaginal Misoprostol. To compare the cervical dilatation caused by I.M carboprost and intravaginal Misoprostol and to compare the blood loss and adverse effects of I.M carboprost and Intravaginal Misoprostol.Methods: Prospective randomized experimental study including pregnant women up to 12 weeks of gestation opting for M.T.P. Study conducted on 200 patients selected from patients admitted in MGM Medical College and M.Y. Hospital, Indore and Kalyanmal Hospital, Indore during the period July 2014 to March 2015. They were randomly divided into 2 groups. Group A who received intramuscular injection of 250 mcg of caboprost or Group B,which received 400 mcg of vaginal Misoprostol 4 hours prior to suction evacuation.Results: Intravaginal misoprostol achieves better cervical dilatation compared I.M carboprost which is statistically significant. Misoprostol is associated with higher blood loss as compared to I.M carboprost which is associated with nausea/vomiting & more likelihood of loose stools and abdominal cramps which is proved statistically.Conclusions: Intravaginal misoprostol is associated with higher blood loss as compared to I.M carboprost which is significant but intravaginal misoprostol achieves more cervical dilatation and causes less adverse events than I.M carboprost which is statistically more significant and therefore intravaginal misoprostol is the drug of choice for cervical priming prior to surgical abortion in terms of both efficacy and safety.

To Assess the Safety and Efficacy of Misoprostol Administered Sublingually For Induction of Labour in Patient with PROM with Poor Bishop’s Score

Background: The management of PROM has often been adilemma in obstetrics. Different regimens are followed indifferent centres all over the world for management of PROM.This study is aimed to compare the safety and efficacy ofsublingually equivalent dose regimen administered vaginally forinduction of labour in patient with PROM with poor Bishop’sScore.Material & Methods: A prospective randomised controlled trialdone on 60 Patients of PROM admitted in labour room ofGovernment Medical College, Dungarpur, as per inclusion andexclusion criteria. Group 1- Received 25µg misoprostol,intravaginally 4 hourly up to maximum of 3 doses, placed inposterior fornix. Group 2- Received 25 µg misoprostol,sublingually 4 hourly up to maximum of 3 doses. Foetal heartand labour progress monitoring was done. Before every dose apervaginum examination was performed to assess the Bishopscore.Results: Our study showed that the foetal distress (foetal heartrate (FHR) abnormalities; FB<120bpm, FT >160bpm) wasmost common intrapartum complication in both groups(13.33% each). Mean induction delivery interval in sublingualgroup was 8.13±4.29 hours and in intravaginal group was7.31±4.11hours. Majority of women in both groups deliveredvaginally; 25 patients (83.33%) in intravaginal and 26 patients(86.66%) in sublingual group. 2 patients in intravaginal and 1patient in sublingual group had atonic PPH. However nopatient required blood transfusion. None had retained placenta.There was no maternal mortality.Conclusion: We concluded that both sublingual andintravaginal route of administration of 25µg misoprostol areequally effective in achieving favourable Bishop’s score,vaginal delivery rates, with comparable induction to deliveryintervals without increasing the caesarean rates and thepostpartum complications.

Pelvic muscle floor rehabilitation as a therapeutic option in lifelong premature ejaculation: long-term outcomes / 亚洲男科学杂志(英文版)

The aim of the study was to evaluate the long-term outcomes of pelvic floor muscle (PFM) rehabilitation in males with lifelong premature ejaculation (PE), using intravaginal ejaculatory latency time (IELT) and the self-report Premature Ejaculation Diagnostic Tool (PEDT) as primary outcomes. A total of 154 participants were retrospectively reviewed in this study, with 122 completing the training protocol. At baseline, all participants had an IELT ≤60 s and PEDT score >11. Participants completed a 12-week program of PFM rehabilitation, including physio-kinesiotherapy treatment, electrostimulation, and biofeedback, with three sessions per week, with 20 min for each component completed at each session. The effectiveness of intervention was evaluated by comparing the change in the geometric mean of IELT and PEDT values, from baseline, at 3, 6, and 12 months during the intervention, and at 24 and 36 months postintervention, using a paired sample 2-tailed t-test, including the associated 95% confidence intervals. Of the 122 participants who completed PFM rehabilitation, 111 gained control of their ejaculation reflex, with a mean IELT of 161.6 s and PEDT score of 2.3 at the 12-week endpoint of the intervention, representing an increase from baseline of 40.4 s and 17.0 scores, respectively, for IELT and PEDT (P < 0.0001). Of the 95 participants who completed the 36-month follow-up, 64% and 56% maintained satisfactory ejaculation control at 24 and 36 months postintervention, respectively.

Injection of botulinum-A toxin into bulbospongiosus muscle for primary premature ejaculation: A preliminary clinical study / 中华男科学杂志

<p><b>Objective</b>To evaluate the efficacy and safety of injection of botulinum-A toxin into the bulbospongiosus muscle in the treatment of primary premature ejaculation (PPE).</p><p><b>METHODS</b>According to the inclusion criteria, we randomly assigned 70 outpatients with PPE to a trial and a control group of equal number, the former injected with 100 U botulinum-A toxin at 10 U/ml and the latter with the same volume of saline into the bulbospongiosus muscle. Then, we obtained the intravaginal ejaculatory latency time (IELT), scores of the Premature Ejaculation Profile (PEP), Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD), and Hospital Anxiety and Depression Scale (HADS), and the incidence of adverse reactions between the two groups before and 4 weeks after treatment.</p><p><b>RESULTS</b>Complete data were obtained from 69 of the patients, 34 in the trial and 35 in the control group. The effectiveness rate was 47.06% (16/34) in the former but 0 in the latter. At 4 weeks after treatment, the patients of the trial group showed a significantly longer IELT than the controls and the baseline (［2.35 ± 1.83］ vs ［0.79 ± 0.21］ and ［0.74 ±+ 0.27］ min, P < 0.01) and the controls. The patients in the trial group, in comparison with those in the saline control group and the baseline, also exhibited significant improvement in the scores of PEP-ejaculation control (1.21 ± 1.04 vs 0.49 ± 0.56 and 0.47 ± 0.51, P < 0.05), PEP-sexual satisfaction (1.32 ± 1.01 vs 0.71 ± 0.57 and 0.79 ± 0.48, P < 0.05), PEP-PE-related distress (2.12 ± 1.01 vs 2.80 ± 0.68 and 2.76 ± 1.26, P < 0.05), and PEP-PE-induced difficult relationship with the partners (1.38 ± 0.70 vs 2.37 ± 0.55 and 2.12 ± 1.49, P < 0.05). The sexual satisfaction score of the female partners after treatment was markedly improved in the trial group as compared with the control group and the baseline (1.18 ± 1.00 vs 0.57 ± 0.50 and 0.62 ± 0.60, P < 0.05). There were no statistically significant differences in MSHQ-EjD and HADS scores between the two groups before and after treatment. Adverse reactions were observed in 6 cases (17.65%) in the trial group, including 4 cases of decreased erectile hardness (11.76%) and 2 cases of incomplete urination (5.88%), which occurred from the 3 to 4 days after injection, and those with decreased erectile hardness could complete sexual intercourse without any other treatment and recovered after 3 weeks.</p><p><b>CONCLUSIONS</b>Injection of botulinum-A toxin into the bulbospongiosus muscle can be used as an option for the treatment of PPE. Its clinical application value, however, needs to be verified by further studies with larger samples.</p>

Research progress of traditional chinese medicine in treating premature ejaculation / 国际中医中药杂志

Premature ejaculation is common male sexual dysfunction, with a high incidence. This article summarized the relevant literature on the treatment of premature ejaculation in the internal treatment of traditional chinese medicine (Syndrome differentiation, Special prescription for specific disease, Chinese patent medicine), external treatment of traditional chinese medicine, acupuncture and massage treatment, integrated traditional and western medicine treatment, Comprehensive treatment and so on. The advantages and disadvantages of traditional Chinese medicine treatment for premature ejaculation were discussed.

Pelvic muscle floor rehabilitation as a therapeutic option in lifelong premature ejaculation: Long-term outcomes / 亚洲男科学杂志(英文版)

The aim of the study was to evaluate the long-term outcomes of pelvic floor muscle (PFM) rehabilitation in males with lifelong premature ejaculation (PE), using intravaginal ejaculatory latency time (IELT) and the self-report Premature Ejaculation Diagnostic Tool (PEDT) as primary outcomes. A total of 154 participants were retrospectively reviewed in this study, with 122 completing the training protocol. At baseline, all participants had an IELT ≤60 s and PEDT score >11. Participants completed a 12-week program of PFM rehabilitation, including physio-kinesiotherapy treatment, electrostimulation, and biofeedback, with three sessions per week, with 20 min for each component completed at each session. The effectiveness of intervention was evaluated by comparing the change in the geometric mean of IELT and PEDT values, from baseline, at 3, 6, and 12 months during the intervention, and at 24 and 36 months postintervention, using a paired sample 2-tailed t-test, including the associated 95% confidence intervals. Of the 122 participants who completed PFM rehabilitation, 111 gained control of their ejaculation reflex, with a mean IELT of 161.6 s and PEDT score of 2.3 at the 12-week endpoint of the intervention, representing an increase from baseline of 40.4 s and 17.0 scores, respectively, for IELT and PEDT (P < 0.0001). Of the 95 participants who completed the 36-month follow-up, 64% and 56% maintained satisfactory ejaculation control at 24 and 36 months postintervention, respectively.

Prepartum progestagen supplementation in swine: a strategy to facilitate piglet care and prevent early parturition / Suplementação de progestágenos no pré-parto em suínos: estratégia para facilitar assistência aos leitões e evitar partos precoces

ABSTRACT: Gestation length in swine has a considerable amplitude and both early and delayed parturition are common. This variation increases the occurrence of unassisted farrowing and could lead to a wide-ranging age at weaning for piglets born from one batch. Supervision of sow parturition is crucial to reduce mortality of neonate piglets. To facilitate assistance, induction of farrowing using prostaglandin F2α (PGF) has been widely used in batch farrowing systems, whereby synchronization would concentrate the time of farrowing, allowing for better organization of employees. However, a viable alternative method that can be implemented to manage farrowing is to sustain high progestagen levels in the final days of gestation and, consequently, prevent early parturition. Efficient techniques to delay farrowing such as using oral progestagen supplementation have been previously described, but are only recently being considered for commercial use. The present manuscript reviews publications regarding delaying parturition and discusses the use of intravaginal devices (IVDs) containing progestagen. There is limited data addressing the effect of progestagen treatment during gestation on productive and reproductive performance. Therefore, future studies should focus on improving synchronization protocols following progestagen supplementation and evaluating piglet viability and sow fertility, before widely using progestagen supplementation to manipulate parturition.

RESUMO: Como a duração da gestação de suínos pode ter ampla variação, é comum a ocorrência de partos antecipados ou gestações prolongadas. Isso aumenta as chances de partos sem assistência e leva a uma grande variação de idade dos leitões dentro do lote de produção. Portanto, a supervisão do parto é indispensável para reduzir as perdas neonatais. Para facilitar o auxílio aos leitões, a indução do parto com prostaglandina F2α (PGF) é eficaz e amplamente utilizada, sendo indicada para concentrar os partos em momentos mais adequados, preferencialmente durante o horário com maior disponibilidade de colaboradores. Uma alternativa viável é manipular o momento do parto, através da manutenção de níveis plasmáticos elevados de progestágeno durante o final da gestação, a fim de evitar partos antecipados. Formas eficientes de evitar o parto através de suplementação oral de progestágenos foram descritas há décadas, mas apenas recentemente tem sido cogitada a utilização comercial. A presente revisão aborda estudos disponíveis na literatura relacionados ao protelamento do parto, incluindo a utilização de dispositivos intravaginais (DIVs) impregnados com progestágeno. São poucos os dados disponíveis relacionados ao uso de progestágenos na gestação com índices produtivos e reprodutivos. Portanto, alguns pontos ainda devem ser melhor avaliados, especialmente com relação à determinação da sincronia dos partos após o fim da suplementação com progestágenos, à viabilidade dos neonatos e à fertilidade subsequente das fêmeas antes da ampla adoção desta técnica.

Clinical Study on Qilin Pills Combined with Three-Spot Caressing in Treatment of Acquired Non-consolidated Kidney Qi Premature Ejaculation / 中国中医药信息杂志

Objective To observe clinical efficacy of Qilin Pills combined with Three-Spot Caressing in the treatment of acquired non-consolidated kidney qi premature ejaculation (PE). Methods Totally 129 acquired non-consolidated kidney qi PE patients were randomly divided into TCM group, Fangzhognshu group and combination group. TCM group was given Qilin Pills, 6 g each time, three times a day, orally. Fangzhognshu group was guided to conduct Three-spot Caressing during sexual intercourse, no less than twice a week. Combination group was given Qilin Pills and Three-spot Caressing with the same method as Fangzhognshu group. The treatment course for each group lasted for 8 weeks. Before and after treatment of 4 weeks, 8 weeks and 4 weeks after with drawal, the intravaginal ejaculatory latency time (IELT), Chinese Index of Sexual Function for Premature Ejaculation-5 (PECI-5) scores and TCM syndrome scores (TCMS) were compared. Results Compared with before treatment, IELT increased in three groups at different time points after treatment (P<0.05). In the combination group, IELT was superior to the other two groups (except for TCM group after 4-week treatment), with statistical significance (P<0.05). Compared with before treatment, PECI-5 scores improved in three groups (except for Q6 and Q7 in Fangzhongshu group after 4-week treatment) at different time point after treatment (P<0.05). The improvement of Q5, Q6 and Q7 scores in PECI-5 of combination group was significantly better than that in the other two groups at 8-week treatment and 4-week after treatment (P<0.05). Compared with before treatment, TCMS in TCM group and combination group were improved significantly (P<0.05), PE and loss of libido score improved significantly in Fangzhongshu group (P<0.05);mental malaise and move spontaneous perspiration were significantly improved at 8-week treatment and 4 weeks after treatment (P<0.05). The improvement in TCMS was significantly better in combination group than that in the other two groups at 8-week treatment and 4 weeks after treatment (P<0.05). Conclusion Qilin Pills combined with Three-Spot Caressing has definite and long-term efficay for the treatment of acquired non-consolidated kidney qi PE.

Qualitative and quantitative analysis of bacteria from vaginitis associated with intravaginal implants in ewes following estrus synchronization / Análise qualitativa e quantitativa de bactérias da vaginite associadas com implante intravaginal em ovelhas após sincronização de estro

ABSTRACT: This study evaluated the presence of vaginitis and the bacterial load associated with different intravaginal implants in ewes. Twenty-four Dorper and crossbred ewes were allocated into three groups and received intravaginal implant containing 0.3g progesterone (CIDR(r)), 60mg MAP or sponges without progesterone (CONTROL) for six days. Then, CIDR and MAP treated-ewes received 12.5mg dinoprost and 300IU eCG. Vaginal mucus samples were collected at four times: before device insertion, at the day of its removal, 24 and 48 hours after. The samples were cultured and the colonies were counted (CFU/mL) and identified. The results obtained from the counting of CFU mL-1 were submitted to Kruskal-Wallis H test, with P<0.05 being considered significant. Before device insertion, 68.2% of the samples yielded Staphylococcus spp. and 60.0% of them were Staphylococcus aureus. After implant removal, 100% of ewes had clinical signs of vaginitis. However, the level of local infection in the CONTROL-ewes was lower (P>0.05) in comparison with MAP and CIDR-treated ewes. During the occurrence of vaginitis, the predominant isolates belonged to the coliform group, mainly Escherichia coli (72.7%). Such infection was not determined by the members of the vaginal microbiota that were present before implant insertion and normal microbiota was restored between 24 to 48 hours after insert removal.

RESUMO: Este estudo avaliou a presença de vaginite e contagem bacteriana associada ao uso de diferentes dipositivos intravaginais em ovelhas. Vinte e quatro fêmeas Dorper e mestiças foram alocadas em três grupos e receberam implante intravaginal contendo 0,3g de progesterona (CIDR(r)), 60mg de acetato de medroxiprogesterona (MAP) ou esponjas sem progesterona (CONTROLE) por seis dias. Posteriormente, as ovelhas tratadas com CIDR e MAP receberam 12,5mg de dinoprost e 300 UI de eCG. Amostras do muco vaginal foram coletadas em quatro momentos: antes da inserção do dispositivo, no dia de sua retirada, 24 e 48 horas após. As amostras foram cultivadas e as colônias foram contadas (UFC mL-1) e identificadas. Os resultados obtidos da contagem das UFC mL-1 foram submetidos ao teste do qui-quadrado, com P<0,05 sendo considerado significativo. Antes da inserção do dispositivo, 68,2% das amostras continham Staphylococcus spp., sendo 60,0% delas Staphylococcus aureus. Após a remoção do implante, 100% das ovelhas apresentaram sinais clínicos de vaginite. Entretanto, o grau de infecção local nas ovelhas do grupo CONTROLE foi menor (P>0.05), em comparação com as ovelhas recebendo CIDR e MAP. Durante a ocorrência da vaginite, os isolados predominantes pertenciam ao grupo dos coliformes, principalmente Escherichia coli (72,7%). Tal infecção não foi determinada pelos membros da microbiota vaginal, que estavam presentes antes da inserção dos dispositivos, e a microbiota normal foi reestabelecida entre 24 e 48 horas após sua remoção.

Efficacy and safety of Qiaoshao Formula () on patients with lifelong premature ejaculation of Gan (Liver) depression and Shen (Kidney) deficiency syndrome: A randomized controlled trial / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the effificacy and safety of Qiaoshao Formula (, QSF) on patients with lifelong premature ejaculation (LPE) of Gan (Liver) depression and Shen (Kidney) defificiency syndrome.</p><p><b>METHODS</b>A total of 60 LPE patients were randomly divided into treatment (QSF) and control (dapoxetine) groups. The treatment group received QSF twice a day and the control group received dapoxetine 1 to 2 h prior to planned sexual intercourse for 4 weeks. The outcomes included intra-vaginal ejaculation latency time (IELT), premature ejaculation diagnostic tool (PEDT), clinical global impression of change (CGIC), scores of Chinese medicine symptoms (CMSS), sex life satisfaction (SLS) and adverse events (AEs).</p><p><b>RESULTS</b>In the treated group, the median IELT was 3 min vs. 1.5 min before and after treatment (P<0.05). PEDT in the treated group was reduced to 11.76±1.68 from 15.83±2.30 after treatment (P<0.05). Besides, patient's SLS was improved from 1.30±0.05 to 6.30±0.04 (P<0.05), and spouse's SLS was increased from 1.30±0.to 6.10±0.06 (P<0.05); CMSS was decrease from 14.86±3.02 to 9.62±2.87 (P<0.05). In addition, no significant AE was observed in both groups.</p><p><b>CONCLUSION</b>QSF may be effective and safe on LPE patients with Gan depression and Shen defificiency syndrome.</p>

Efficacy and safety of Yimusake Tablets plus dapoxetine hydrochloride in the treatment of premature ejaculation / 中华男科学杂志

<p><b>Objective</b>To evaluate the effect and safety of Yimusake Tablets combined with dapoxetine hydrochloride and either of them used alone in the treatment of premature ejaculation (PE).</p><p><b>METHODS</b>We randomly assigned 180 PE patients to oral medication of Yimusake Tablets at 1.5 g per night (group A), dapoxetine hydrochloride at 30 mg at 1－3 hours before anticipated sexual activity (group B), the Yimusake Tablets plus dapoxetine hydrochloride simultaneously (group C), all for 8 weeks. After 4 and 8 weeks of medication, we recorded and compared the changes in the intravaginal ejaculation latency time (IELT), measures of the PE profile (PEP), and adverse events among the three groups of patients.</p><p><b>RESULTS</b>The treatment was accomplished and complete data obtained from 154 of the patients, 56 in group A, 52 in group B, and 46 in group C. After 4 and 8 weeks of medication, the mean IELT was dramatically prolonged in all the three groups as compared with the baseline (P<0.01), most significantly at 8 weeks in group C (［2.08±0.68］ min), followed by B (［1.76±0.52］ min) and A (［1.47±0.44］ min), with statistically significant differences among the three groups (P<0.01). The PEP measures were remarkably improved in group A at 8 weeks (P<0.05), and both in B and C at 4 and 8 weeks (P<0.05), most significantly at 8 weeks in group C (P<0.05), in which the patients scored 1.96±0.77 in perception of control over ejaculation, 2.62±0.98 in satisfaction with sexual intercourse, 3.04±0.62 in PE-related distress, and 3.57±0.80 in PE-induced difficult relationship with their partners, all markedly improved as compared with groups A and B (P<0.05). Adverse reactions were observed in 2 cases (3.6%) in group A, 6 cases (9.6%) in B, and 5 cases (10.9%) in C. No severe adverse events occurred in any of the patients during the study.</p><p><b>CONCLUSIONS</b>Combined medication of Yimusake Tablets and dapoxetine hydrochloride, with its advantages of effectiveness and safety, deserves to be recommended for the treatment of PE.</p>

Evaluation of profertility effect of probiotic Lactobacillus plantarum 2621 in a murine model.

Background & objectives: Urogenital infections of bacterial origin have a high incidence among the female population at reproductive age, affecting the fertility. Strains of Escherichia coli can colonize the vagina and replace natural microflora. Lactobacillus the predominant vaginal microorganism in healthy women, maintains the acidic vaginal pH which inhibits pathogenic microorganisms. Studies on Lactobacillus have shown that these can inhibit E. coli growth and vaginal colonization. An alternative therapeutic approach to antimicrobial therapy is to re-establish Lactobacillus in this microbiome through probiotic administration to resurge fertility. Therefore, the aim of the present study was to determine the capability of L. plantarum 2621 strain with probiotic properties, to prevent the vaginal colonization of E. coli causing agglutination of sperms and to evaluate its profertility effect in a murine model. methods: Screened mice were divided into five groups i.e. control group, E. coli group, Lactobacillus group, prophylactic and therapeutic groups. The control group was infused with 20 μl PBS, E.coli group was administered with 106cfu/20 μl E. coli, and probiotic group was administered with Lactobacillus (108cfu/20 μl) for 10 consecutive days. In prophylactic group, the vagina was colonized with 10 consecutive doses of Lactobacillus (108cfu/20 μl). After 24 h, it was followed by 10 day intravaginal infection with E. coli (106 cfu/20 μl) whereas for the therapeutic group vagina was colonized with (106cfu/20 μl) E. coli for 10 consecutive days, followed by 10 day intravaginal administration with Lactobacillus after 24 h. Results: Upon mating and completion of gestation period, control, probiotic and the therapeutic groups had litters in contrast to the prophylactic group and the group administered with E. coli. Interpretation & conclusions: Results indicated that Lactobacillus intermitted colonization of pathogenic strains that resulted in reinforcement of natural microflora and resurge fertility.

Potential of Probiotic Lactobacillus plantarum 2621 for the Management of Infertility.

Background: Infertility outcomes may be associated with the infections that would lead to morphological defects of spermatozoa in vitro. The purpose of this work was to investigate the effect of Lactobacillus plantarum 2621 (L. plantarum) on adherence of sperm agglutinating Escherichia coli (E. coli) in vitro and in vivo as well as its effect on fertility outcome. Materials and Methods: Interference of E. coli adherence to vaginal epithelial cells (VECs) by L. plantarum was studied by carrying out different assays such as exclusion, competition and displacement. Further, in vivo study was carried out in mouse model to evaluate the effect of presence of L. plantarum against E. coli and its effect on fertility outcome by administering intravaginally at one hour interval between L. plantarum (108c.f.u./20μl) and different concentrations of E. coli (102,104, and 106 c.f.u/20 μl) for ten consecutive days. Results: 116•8 bacteria/VEC adhesion levels were observed for L. plantarum 2621 whereas values for E. coli were 60•5 bacteria/VEC. L. plantarum interfered to different extents with the adherence of E. coli. L. plantarum 2621 decreased the adhesion by displacement and competition in a significant level (90.3% and 68.5% of inhibition). L. plantarum 2621 also excluded the E. coli attached to VEC (25.8% of inhibition).Upon mating and completion of gestation period 100% fertility was observed with 108c.f.u./20μl L. plantarum and 102 c.f.u/20μl E. coli, whereas 100% females were infertile when administered with 106 c.f.u/20μl of E. coli alongwith 108c.f.u./20μl L. plantarum and only 50% fertility outcome was observed with 104 c.f.u/20μl E. coli. Conclusion: Results indicated that L. plantarum displaces colonization of E. coli and endows competition that resulted in reinforcement of natural microflora and affects fertility outcome depending on the presence and count of E. coli.

Resultados preliminares de cultivo intravaginal de ovocitos-inyección intracitoplasmática de espermatozoides (INVO-ICSI), en el centro de fertilidad procrear

Objetivos: Conocer los resultados preliminares de tasa de embarazo por transferencia en las pacientes en quienes se realizó cultivo intravaginal de ovocitos-inyección intracitoplasmática de espermatozoides (INVO-ICSI) en un centro de fertilidad. Diseño: Estudio descriptivo de una serie de casos. Institución: Centro de Fertilidad Procrear, Lima, Perú. Participantes: Parejas con tratamiento de infertilidad. Intervenciones: Se analizó todos los 13 procedimientos de INVO-ICSI realizados en 12 pacientes desde diciembre 2011 a julio 2013. Para el estudio se utilizó el programa SPSS. Principales medidas de resultados: Tasa de gestación. Resultados: La edad promedio de la mujer fue 35,38 años ± 3,35, con promedio de búsqueda de embarazo de 2,25 años ±1,88. La causa de infertilidad en 46,2% era el factor masculino y en 53,2%, el factor femenino. En todos los ciclos se realizó transferencia de embriones. Se obtuvo un total de 5 gestaciones (38,46% por transferencia), de las cuales 3 fueron gestación única (60%) y 2 dobles (40%). Conclusiones: La tasa de embarazo por transferencia mediante el método INVO - ICSI fue comparable y aceptable frente a la de FIV/ICSI reportada en la literatura mundial.

Objectives: To determine preliminary results of pregnancy rate per transfer in patients undergoing intravaginal oocyte culture-intracytoplasmatic sperm injection (INVO-ICSI) at a fertility center. Design: Descriptive, series of cases study. Setting: Procrear Fertility Center, Lima, Peru. Participants: Couples with infertility treatment. Interventions: Thirteen INVO-ICVSI performed in 12 patients from December 2011 through July 2013 were reviewed. SPSS program was used. Main outcome measures: Pregnancy rate. Results: Womens average age was 35.38 years ± 3.35 and were seeking pregnancy 2.25 years ± 1.88 average. Infertility was due to male factor in 46.2% and to female factor in 53.2%. Embryo transfer was done in all cycles and 5 pregnancies were obtained (38.46% of cycles), 3 singleton (60%) and 2 double pregnancy (40%). Conclusions: INVO-ICSI fertilization rate was comparable and acceptable against other fertilization techniques.