Effect of co-culturing of half-destroyed and intact 4-cell mouse embryos in varying ratios on subsequent in vitro development.

We studied the co-culturing effect of intact and half-destroyed 4-cell mouse embryos on blastocyst formation rate and cell counts. A laser beam was used to produce a hole and destroy an adjacent blastomere in two opposite areas of the zona in the experimental group (n = 342), and to open two opposite zonal holes in the controls (n = 318). Control and half-destroyed embryos were cultured together in varying ratios of 10:0, 7:3, 5:5, 3:7, and 0:10 (group 1-5, respectively) for 48 h in 10 µl drops of cleavage medium. They were then separated and cultured in blastocyst medium for 24 h. The results showed that half-destroyed embryos had no effect on the blastulation rates of controls (97-100%, P = 0.28). Neither was there a difference in the number of ICM (27.3 ± 6.7, 29.4 ± 9.9, 27.7 ± 9.3, 26.5 ± 6.4, in group 1-4, respectively; P = 0.491), TE (47.7 ± 18.6, 52.3 ± 13.9, 48.4 ± 19.2, 57.3 ± 12.9, in group 1-4, respectively; P = 0.101), nor total cells (75.0 ± 19.5, 81.3 ± 17.1, 76.1 ± 19.6, 83.7 ± 16.2, in group 1-4, respectively; P = 0.188) in the resulting blastocysts. However, among half-destroyed embryos, cleavage arrest decreased (58.3%, 39.6%, 17.9%, and 8.3%, in group 5 to 2, respectively; P < 0.001) and blastocyst development increased (38.3%, 58.2%, 72.6%, and 88.9%, in group 5 to 2, respectively; P < 0.001) following co-culturing with intact controls. These embryos had a higher number of ICM cells (P = 0.035), but no significant changes in TE (P = 0.262) and total cell counts (P = 0.065). The findings indicate that the co-culturing of half-destroyed with intact embryos increased the blastulation rate of the first but had no effect on the latter.

Early versus delayed (traditional) oral fluids and food for reducing complications after major abdominal gynaecologic surgery.

BACKGROUND: Traditionally postoperative oral intake is withheld until the return of bowel function. There has been concern that early oral intake would result in vomiting and severe paralytic ileus with subsequent aspiration pneumonia, wound dehiscence, and anastomotic leakage. However, supporting scientific evidence for this traditional practice is lacking and there are potential benefits from early postoperative oral intake. OBJECTIVES: To assess the effects of early versus delayed (traditional) initiation of oral intake of food and fluids after major abdominal gynaecologic surgery. SEARCH STRATEGY: We searched the Menstrual Disorders & Subfertility Group's Specialised Register of controlled trials, the electronic databases (MEDLINE, EMBASE, CINAHL), the Cochrane Controlled Trials Register, and the citation lists of relevant publications in April 2007. SELECTION CRITERIA: Randomised controlled trials that compared the effect of early versus delayed initiation of oral intake of food and fluids after major abdominal gynaecologic surgery were considered. Early feeding was defined as having oral intake of fluids or food within the first 24 hours after surgery regardless of the presence or absence of the signs that indicate the return of bowel function and delayed feeding was defined after first 24 hours following surgery and only after clinical signs of resolution of postoperative ileus. DATA COLLECTION AND ANALYSIS: Studies considered were assessed for methodological quality criteria for inclusion. For dichotomous data, relative risks and 95% confidence intervals were calculated. Continuous data were examined using weighted mean difference and 95% confidence interval. Heterogeneity between the results of different studies were examined by using the forest plot of a meta-analysis, the statistical tests of homogeneity of 2 x 2 tables and the I(2) value. MAIN RESULTS: Early commencement of oral fluids and food was associated with: increased nausea (one study, 195 patients; relative risk 1.79, 95% confidence interval 1.19 to 2.71), shorter time to the presence of bowel sound (one study, 195 patients; weighted mean difference -0.5 day, 95% confidence interval -0.84 to -0.16), shorter time to first solid diet (two studies, 301 patients; weighted mean difference -1.47 day, 95% confidence interval -2.26 to -0.68), and a trend toward shorter hospital stay (two studies, 301 patients; weighted mean difference -0.73 day, 95% confidence interval -1.52 to 0.07). The shorter hospital stay with early feeding was also evident in the study that reported length of hospital stay in median (-2 days, 4.0 days in early feeding group and 6.0 days in traditional feeding group). There was no significant difference in postoperative ileus, vomiting, and abdominal distension, time to presence of flatus, time to the first passage of stool, postoperative nasogastric tube placement, febrile morbidity, wound complications, and pneumonia. AUTHORS' CONCLUSIONS: Early feeding after major abdominal gynaecologic surgery is safe however associated with the increased risk of nausea and a reduced length of hospital stay. Whether to adopt the early feeding approach should be individualised. Further studies should focus on the cost-effectiveness, patient's satisfaction, and other physiological changes.

Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial.

OBJECTIVE: To determine the effectiveness of ginger for the treatment of nausea and vomiting of pregnancy. METHODS: Women with nausea and vomiting of pregnancy, who first attended an antenatal clinic at or before 17 weeks' gestation, were invited to participate in the study. During a 5-month period, 70 eligible women gave consent and were randomized in a double-masked design to receive either oral ginger 1 g per day or an identical placebo for 4 days. Subjects graded the severity of their nausea using visual analog scales and recorded the number of vomiting episodes in the previous 24 hours before treatment, and again during 4 consecutive days while taking treatment. At a follow-up visit 7 days later, five-item Likert scales were used to assess the severity of their symptoms. RESULTS: All participants except three in the placebo group remained in the study. The visual analog scores of posttherapy minus baseline nausea decreased significantly in the ginger group (2.1 +/- 1.9) compared with the placebo group (0.9 +/- 2.2, P =.014). The number of vomiting episodes also decreased significantly in the ginger group (1.4 +/- 1.3) compared with the placebo group (0.3 +/- 1.1, P <.001). Likert scales showed that 28 of 32 in the ginger group had improvement in nausea symptoms compared with 10 of 35 in the placebo group (P <.001). No adverse effect of ginger on pregnancy outcome was detected. CONCLUSION: Ginger is effective for relieving the severity of nausea and vomiting of pregnancy.

Comparison of sex chromosome aneuploidy in spermatozoa of fertile men and those requiring ICSI treatment detected by fluorescence in situ hybridization.

OBJECTIVE: To compare the frequencies of aneuploidy for chromosomes X, Y and 18 in spermatozoa of infertile and fertile males, using 3-color fluorescence in situ hybridization. METHODS: Twelve infertile patients who underwent intracytoplasmic sperm injection treatment at Queen's Medical Centre, Nottingham were studied. Three fertile men served as controls. Aneuploidy frequencies in both groups were compared using 2-sample t-tests. RESULTS: A total of 26,615 ad 93,649 cells were scored in the control and infertile groups respectively. The frequencies of diploidy, sex chromosome disomy and chromosome 18 disomy in the fertile (0.11, 0.28 and 0.11%) compared to the infertile males (0.05, 0.18 and 0.06%) were not statistically significantly different. CONCLUSION: Our preliminary data do not indicate an increased risk from paternal origin sex chromosome aneuploidies in ICSI. However, we recommend further investigations of the cytogenetic constitution of spermatozoa from severe male factor patients.

A randomized controlled trial of membrane stripping at term to promote labor.

OBJECTIVE: To determine the effectiveness of membrane stripping at term to promote the onset of labor. METHODS: One hundred twenty gravidas at 38 weeks' gestation, who were attending an antenatal clinic and planned to deliver at Maharaj Nakorn Chiang Mai University Hospital in northern Thailand, were assigned randomly to one of two groups. One group had weekly pelvic examinations only, and the other also had membrane stripping, beginning at 38 weeks' gestation and continuing until the onset of labor or until 42 completed weeks' gestation. Outcome measures included the proportion of patients who delivered with 7 days after the first examination, Bishop scores among those who did not deliver, days from the first examination to delivery, incidence of postterm pregnancy, and maternal and fetal complication. RESULTS: Twenty-five of 61 patients (41%) assigned to membrane stripping delivered within 1 week, compared with 12 of 59 controls (20.3%), a statistically significant difference (P = .014). There was also a statistically significant difference (P = .013, Mann-Whitney U test) in the Bishop scores among those who did not deliver within 1 week (4 +/- 2.5 versus 2.6 +/- 1.7 in the study and control groups, respectively). A significant difference was also observed with respect to the mean number of days to delivery (8.8 +/- 6.7 versus 13.6 +/- 7.5, respectively; P < .001). The incidence of postterm pregnancy was one of 61 (1.6%) and three of 59 (5.1%) in the stripping and control groups, respectively. No significant differences were observed in maternal and fetal complications. CONCLUSION: Membrane stripping is safe and effective in promoting the onset of labor at term.

Pyridoxine for nausea and vomiting of pregnancy: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: Our purpose was to determine the effectiveness of pyridoxine for nausea and vomiting of pregnancy. STUDY DESIGN: During an 11-month period 342 women who first attended Chiang Mai University Hospital antenatal clinic at < or = 17 weeks' gestation were randomized to received either oral pyridoxine hydrochloride, 30 mg per day, or placebo in a double-blind fashion. Patients graded the severity of their nausea by a visual analog scale and recorded the number of vomiting episodes over the previous 24 hours before treatment and again during 5 consecutive days on treatment. RESULTS: There was a significant decrease in the mean of posttherapy minus baseline nausea scores in the pyridoxine compared with that in the placebo group (t test, p = 0.0008). There was also a greater reduction in the mean number of vomiting episodes, but the differences did not reach statistical significance (p = 0.0552). CONCLUSION: Pyridoxine is effective in relieving the severity of nausea in early pregnancy.

A randomized double-blind trial of tinidazole treatment of the sexual partners of females with bacterial vaginosis.

OBJECTIVE: To determine whether a single oral 2-g dose of tinidazole for women with clinically diagnosed bacterial vaginosis and their partners increases the cure rates as compared with the same treatment for the female patients alone. METHODS: During a 15-month period, 250 women aged 17-40 years who attended a gynecologic outpatient clinic for abnormal vaginal discharge and/or pruritus vulvae were randomized into two groups. They received a single oral dose of 2 g tinidazole while their partners received either 2 g tinidazole or placebo. Symptomatic improvement and clinical cure rates were assessed at 1 and 4 weeks after treatment. RESULTS: There were no statistical differences (P > .05) in symptomatic improvement, clinical cure rates, or culture results between the groups of women whose partners were treated with either tinidazole or placebo. However, male consorts of women in the tinidazole group experienced side effects more often than those in the placebo group (P = .0006). CONCLUSION: Routine treatment is not recommended for male partners of women with bacterial vaginosis.

The antigenic structure of the human glycoprotein hormone alpha-subunit. I. Characterization of anti-alpha monoclonal antibodies.

The glycoprotein hormones CG, LH, FSH, and TSH are composed of two noncovalently linked subunits, alpha and beta. The beta-subunit confers hormone specificity, while the alpha-subunit is homologous within a species. To help in determining the antigenic structure of the common alpha-subunit, six monoclonal antibodies (mAbs) to the free or heterodimeric alpha-subunit of human (h) gonadotropic hormones have been prepared and, along with two previously isolated mAbs, have been characterized for binding specificity to alpha- and beta-subunits and the human glycoprotein hormones, CG, LH, FSH, and TSH. Each mAb was derived from hybidomas of FO myeloma cells fused with spleen cells from mice immunized with free alpha-subunit, hCG or hFSH. mAbs A101, A102, and E512 were specific for the alpha-subunit but showed the highest affinity for the intact hormone; K2.18, K94.6, E501, E502, and E511 were specific for free alpha. All of the antibodies inhibited binding of 125I-hCG to luteal membrane receptor, and 125I-labeled mAbs did not recognize hCG/receptor complex. Characterization by two-site binding assays using alpha, hCG, or hFSH as antigen revealed that all the mAbs bind to unique sites on alpha which may be overlapping, and which are modified in the intact hormone. The antigenic sites for mAbs E502, E511, and K2.18 are at least partially linear because they bind to reduced, carboxymethylated alpha.

Cervical and vaginal agenesis: a case report.

An 18-year-old single female presented with primary amenorrhea and cyclic lower abdominal pain. Pelvic examination revealed normal appearing external genitalia but absent vagina. Pelvic sonogram was compatible with cervical and vaginal agenesis, which was confirmed at operation. Hysterectomy and construction of a new vagina by the McIndoe's technique were performed. Clinical features and management of this rare Mullerian anomaly were reviewed and discussed.

Secondary amenorrhea at Maharaj Nakhon Chiang Mai Hospital.

One hundred and thirty-seven patients attending the gynaecological endocrine clinic at Maharaj Nakhon Chiang Mai hospital between April 1, 1982 and July 31, 1987 were studied. Detailed history, physical and pelvic examination were obtained on all patients, followed by progesterone withdrawal test and other appropriate laboratory studies including thyroid and reproductive hormone profiles. The most common cause of secondary amenorrhea in this study was hypothalamic-pituitary dysfunction (54.7%), not unlike those reports from other foreign series. However, it was notable that nearly 40 per cent of our patients in this group experienced amenorrhea after discontinuation of contraceptive steroids. Premature ovarian failure was the second leading cause of amenorrhea in our patients (13.9%) and, perhaps, deserve future detailed studies. The other causes of amenorrhea in decreasing frequency were: hyperprolactinemia (11.7%), hypothalamic-pituitary failure (8.0%), Asherman's syndrome (5.1%) and androgen excess (2.9%). Primary hypothyroidism was a rare cause of amenorrhea in this study.

Serum prolactin and cortisol levels after suckling for varying periods of time and the effect of a nipple shield.

Plasma prolactin and cortisol levels were measured in mothers breast feeding with or without the use of a thin latex nipple shield, and in mothers wearing a nipple shield but who were not nursing. Suckling duration and milk transfer were also recorded. Suckling duration ranged between 6 and 31 min, being significantly correlated with prolactin levels 40 to 120 min after the feed started. At the latter time, baseline prolactin level and time spent nursing accounted together for most of the variance in prolactin levels: R2 was 0.79 and 0.82 at 90 min and 120 min respectively. Prolactin was released as usual when the shield was in place: levels were not significantly different from levels without the shield. Suckling duration was also unaffected by the shield, but milk transfer was significantly reduced. Cortisol was not released by using the shield, and the shield alone (without suckling) did not release prolactin. The thin latex nipple shield has therefore no untoward effect on the release of these hormones during nursing.