Diagnostic reliability and accuracy of the hydraulic contrast lift protocol in the radiographic detection of sinus lift and perforation: ex vivo randomized split-mouth study in an ovine model.

OBJECTIVES: Assessing the diagnostic reliability, validity, and accuracy of the hydraulic contrast lift protocol during transcrestal sinus floor elevation in detecting the lift and perforation of the sinus membrane before graft material application and assessing the effect of its use on the operator's diagnostic confidence. MATERIAL AND METHODS: A single-blind randomized split-mouth study on fresh refrigerated sheep heads. The first intervention consisted of injecting 0.5 ml iodinated contrast medium on the test side and 0.5 ml saline on the control side. In the second intervention artificial sinus membrane perforations were created followed by injecting 0.5 ml iodinated contrast medium on the test side and 0.5 ml saline on the control side. Intraoperative periapical radiographs were taken for both interventions. The resulting 40 radiographs were assessed by 10 examiners to provide interpretations and confidence ratings. The primary endpoints were diagnostic reliability, validity, accuracy, and perceived diagnostic confidence. RESULTS: In the hydraulic contrast lift protocol, the detection rate was 99% for sinus elevations and 98% for perforations, the saline protocol yielded a detection rate of 28% and 20% respectively. The hydraulic contrast lift protocol demonstrated a high level of inter-rater agreement for the diagnosis of elevations (p < 0.001) and perforations (p < 0.001), strong diagnostic validity for the diagnosis of elevations (p < 0.001) and perforations (p < 0.001), high sensitivity and specificity (p < 0.001) and higher mean diagnostic confidence ratings for both interventions when compared to the saline protocol (p < 0.001). The difference between the predicted probability for correct diagnosis of the hydraulic contrast lift protocol and the saline protocol was significant (p < 0.001) for the detection of both elevations and perforations. CONCLUSION: Following the hydraulic contrast lift protocol, the use of a radiographic contrast medium can reliably confirm sinus membrane lift and detect perforation during transcrestal sinus floor elevation prior to bone graft application in addition to improving the diagnostic confidence of the operator while relying on periapical radiographs.

Anatase-cellulose acetate for reinforced desalination membrane with antibacterial properties.

This study aimed to prepare antifouling and highly mechanical strengthening membranes for brackish and underground water desalination. It was designed from cellulose acetate (CA) loaded anatase. Anatase was prepared from tetra-iso-propylorthotitanate and carboxymethyl cellulose. Different concentrations of anatase (0.2, 0.3, 0.5, 0.6, 0.7, and 0.8)% were loaded onto CA during the inversion phase preparation of the membranes. The prepared membranes were characterized using Fourier Transform Infrared spectroscopy (FTIR), X-ray diffraction (XRD), thermogravimetric analysis (TGA), scanning electron microscopy (SEM & EDX), mechanical properties, swelling ratio, porosity determination, and ion release. The analysis confirmed the formation of anatase on the surface and inside the macro-voids of the membrane. Furthermore, anatase loading improved the CA membrane's mechanical properties and decreased its swelling and porosity rate. Also, CA-loaded anatase membranes displayed a significant antibacterial potential against Gram-positive and Gram-negative bacteria. The results showed that the salt rejection of the CA/anatase films as-prepared varies considerably with the addition of nanomaterial, rising from 46%:92% with the prepared membranes under the 10-bar operation condition and 5 g/L NaCl input concentration. It can be concluded that the prepared CA-loaded anatase membranes have high mechanical properties that are safe, economical, available, and can stop membrane biofouling.

The Prevalence and Molecular Biology of Staphylococcus aureus Isolated from Healthy and Diseased Equine Eyes in Egypt.

This work aimed to characterize S. aureus isolates from the eyes of healthy and clinically affected equines in the Kafrelsheikh Governorate, Egypt. A total of 110 animals were examined for the presence of S. aureus, which was isolated from 33 animals with ophthalmic lesions and 77 healthy animals. We also investigated the antimicrobial resistance profile, oxacillin resistance mechanism, and the major virulence factors implicated in many studies of the ocular pathology of pathogenic S. aureus. The association between S. aureus eye infections and potential risk factors was also investigated. The frequency of S. aureus isolates from clinically affected equine eyes was significantly higher than in clinically healthy equids. A significant association was found between the frequency of S. aureus isolation from clinically affected equine eyes and risk factors including age and season but not with sex or breed factors. Antimicrobial resistance to common antibiotics used to treat equine eyes was also tested. Overall, the isolates showed the highest sensitivity to sulfamethoxazole (100%) and the highest resistance to cephalosporin (90.67%) and oxacillin (90.48%). PCR was used to demonstrate that mecA was present in 100% of oxacillin- and ß-lactam-resistant S. aureus strains. The virulence factor genes Spa (x region), nuc, and hlg were identified in 62.5%, 100%, and 56%, of isolates, respectively, from clinically affected equines eyes. The severity of the eye lesions increased in the presence of γ-toxin-positive S. aureus. The phylogenetic tree of the Spa (x region) gene indicated a relationship with human reference strains isolated from Egypt as well as isolates from equines in Iran and Japan. This study provides insight into the prevalence, potential risk factors, clinical pictures, zoonotic potential, antimicrobial resistance, and ß-lactam resistance mechanism of S. aureus strains that cause eye infection in equines from Egypt.

Cabergoline versus calcium infusion in the prevention of ovarian hyperstimulation syndrome: a randomised controlled study.

The aim of this study was to compare the efficacy of calcium infusion versus cabergoline in the prevention of ovarian hyperstimulation syndrome (OHSS) in IVF patients at high risk for OHSS. One hundred and seventy patients who were stimulated using the long luteal GnRH agonist protocol and at high risk for developing OHSS were randomised in a 1:1 ratio to cabergoline group and calcium gluconate group. In cabergoline group, 0.5 mg of cabergoline was administered once daily p.o. for eight days starting on the day of HCG administration. In calcium gluconate group, intravenous calcium gluconate (10%, 10 ml in 200 ml of physiologic saline) was administered daily for four days starting on the day of ovum pickup. Six patients in cabergoline group and eight patients in calcium gluconate group developed moderate OHSS. One patient in each group developed severe OHSS. The incidence of moderate/severe OHSS was comparable between both groups (8.24% vs. 10.59%, p value = .599, OR = 0.76, 95% CI [0.269-2.138]). The implantation, clinical and ongoing pregnancy rates were similar in the two groups (16.91% vs. 15.84%, p = .771, 35.29% vs. 32.94%, p = .746, and 30.59% vs. 28.24%, p = .736, respectively). In conclusion, calcium infusion and cabergoline have comparable effectiveness in the prevention of OHSS. Both drugs are well tolerated, cheap and have no adverse effects on the reproductive outcomes of IVF cycle.Clinical trial registration: The trial was registered on clinical trials.gov database [NCT02875587].Impact StatementWhat is already known on this subject? The effectiveness of cabergoline in the prevention of OHSS in IVF patients at high risk for OHSS is confirmed by overwhelming scientific evidence. Calcium infusion is a novel strategy for prevention of OHSS. Few studies reported the use of calcium infusion in the prevention of OHSS. A retrospective study and a randomised controlled study revealed that calcium infusion reduces the incidence of OHSS. Moreover, a quasi-randomised study revealed that calcium infusion is as effective as cabergoline in the prevention of OHSS.What the results of this study add? Calcium infusion and cabergoline have comparable effectiveness in the prevention of OHSS. Both drugs are well tolerated, cheap and have no adverse effects on the reproductive outcomes of IVF cycle.What the implications are of these findings for clinical practice and/or further research? Calcium infusion should be used to minimise the incidence of OHSS in IVF patients at high risk for OHSS.

How and Why to Define Unexplained Infertility?

Unexplained infertility represents up to 30% of all cases of infertility. It is a diagnosis of exclusion, where no cause for infertility may be identified in the investigation of the couple, be it anovulation, fallopian tube blockage, or severe male factor. Unexplained infertility therefore cannot be considered a diagnosis to which a specific treatment is directed, rather that it indicates a failure to reach a diagnosis of the true cause of infertility. In this review, we explore the evidence base and potential limitations of the current routine infertility assessment. We also aim to highlight the importance of considering the prognosis of each individual couple through the process of assessment and propose a reconsidered approach to treatment, targeted to the prognosis rather than the diagnosis. Ultimately, a better understanding of the mechanisms of infertility will reduce the number of couples diagnosed with "unexplained" infertility.

Epidemiological and Molecular Investigation of Ocular Fungal Infection in Equine from Egypt.

Diagnosis and treatment of ocular fungal infection in equine seems very challenging for owners and clinicians. The present study aimed to identify and characterize fungal species isolated from the eyes of clinically healthy and diseased equines (N = 100) from Dakahlia Governorate, Egypt. The work also involved morphological and molecular characterization of the major fungal species. In addition, correlations between the occurrence of isolated fungi and some of the potential risk factors were also investigated. Interestingly, the prevalence rate of ocular mycosis in all examined equines in the study was 28% and there were major clinical signs associated with ocular fungal infection. Moreover, the identified fungal species included Aspergillus flavus, A. fumigatus, A. niger, Penicillium spp., Mucor spp., and Alternari spp. with a corresponding prevalence rate of 63.9%, 27.8%, 15.3%, 18.1%, 13.9%, and 4.2%, respectively, in healthy equine eyes, while their prevalence in diseased equine eyes was 57.1%, 32.1%, 21.4%, 7.1%, 3.6%, and 0%. Furthermore, a statistical significant association (p < 0.05) was found between the frequency of isolation of A. fumigatus and Penicillium and several risk factors (breed, sex, and ground type), while the remaining risk factors and occurrence of fungi were not statistically correlated. A subset of the Aspergillus species samples positive by polymerase chain reaction (PCR) were sequenced and their phylogenetic analysis identified three species of Aspergillus. Taken together, our study provides novel data related to the occurrence of ocular mycosis in equine in Egypt. Given the zoonotic potential of some identified fungi, our data may be helpful for implementation of novel diagnostic and therapeutic strategies for combating this sight-threatening infection in equine.

Extended doxycycline treatment versus salpingectomy in the management of patients with hydrosalpinx undergoing IVF-ET.

BACKGROUND: The aim of this study was to determine whether the treatment with doxycycline before and after oocyte retrieval is as effective as salpingectomy in minimizing the detrimental effect of hydrosalpinx on the outcomes of IVF-ET. METHODS: A retrospective analysis was done for the outcomes of the IVF-ET cycles of patients with hydrosalpinx who underwent laparoscopic salpingectomy prior to IVF cycle (n = 260) or were treated with extended doxycycline treatment during the IVF cycle (n = 45). In doxycycline group, doxycycline (100 mg twice daily) was started 1 week before anticipated oocyte retrieval and was continued for 1 week after oocyte retrieval. In salpingectomy group, the mesosalpinx was coagulated as close as possible to the fallopian tube. RESULTS: The implantation, clinical pregnancy, ongoing pregnancy and live birth rates were significantly higher in the salpingectomy group (20.87% Vs. 9.91%, P value =0.007, 44.62% Vs. 20%, P value = 0.002, 39.62% Vs. 17.78%, P value = 0.005 and 37.31% Vs. 15.56%, P value = 0.005 respectively). CONCLUSION: Salpingectomy is more effective than extended doxycycline treatment in improving the outcomes of IVF-ET in patients with hydrosalpinx undergoing IVF-ET. Further, larger well designed randomized controlled trials should be conducted to confirm the findings of this study.

Relationship between expression pattern of vitamin D receptor, 1 alpha-hydroxylase enzyme, and chemokine RANTES genes and selected serum parameters during transition period in Holstein dairy cows.

OBJECTIVES: The objective of the present study was to evaluate the pattern of genetic expression of vitamin D receptor (VDR), 1 alpha-hydroxylase (1α-OHase) enzyme and chemokine regulated on activation normal T-cell expressed and secreted (RANTES) in peripheral blood of Holstein dairy cows during transition period. METHODS: Blood samples were collected from 16 Holstein dairy cows at 3 weeks prior expected date of delivery (EDD), at the day of parturition, and 3 weeks post-partum for assessment of expression profile of studied genes using real-time PCR and measurement of glucose, ionized calcium (Ca), parathyroid hormone (PTH), inorganic phosphorous (P), sodium (Na), potassium (K), chloride (Cl), and magnesium (Mg) levels. RESULTS: Compared with 3 weeks prior EDD, VDR gene expression decreased significantly at the day of parturition then increased significantly at 3 weeks post-partum. The genetic expression of 1α-OHase enzyme as well as PTH, K, Na and Cl levels increased significantly at the day of parturition. The Ca level decreased significantly at the day of parturition then increased significantly at 3 weeks post-partum. The P level increased significantly at the day of parturition then decreased significantly at 3 weeks post-partum. Glucose level decreased significantly at the day of parturition and at 3 weeks post-partum. RANTES gene expression showed non-significant changes among the three different time points. The expression of VDR gene had a negative correlation with the expression of 1α-OHase enzyme gene, and serum levels of glucose, PTH, P and K, but had a positive correlation with the serum Ca level. The expression of 1α-OHase enzyme gene had a positive correlation with serum levels of PTH, P and K, but had a negative correlation with the serum Ca level. CONCLUSIONS: Results of the current study indicate the importance of monitoring the genetic expression of VDR and 1α-OHase enzyme as indicators of metabolic changes during transition period, suggesting that they are candidate genes to judge the health status of dairy cows during such period.

Order differences to enhance the delineation of rock units boundaries by using aerospectrometric data of Wadi Al Mushash area, Central Eastern Desert, Egypt: A new approach.

The present work utilizes airborne gamma-ray spectrometric data, in a trial to refine the surface geological mapping of sedimentary rocks at Wadi Al Mushash, Central Eastern Desert of Egypt. The acquired aerospectrometric data were supported by the surface geology concerning the study area. This area is mainly covered by sedimentary rocks of Tertiary to upper Cretaceous as Nubian Sandstone Formations (Quseir Clastics and Tarif Sandstone), Duwi Phosphates Formation, Dakhla Shale Formation, Esna Shale Formation, Tarawan Formation, Thebes Formation, and Quaternary deposits. High-resolution airborne gamma-ray spectrometry can be very helpful in mapping the surface geology. The method provides estimation of the apparent surface concentrations of the most common naturally occurring radioactive elements, such as potassium (K), equivalent uranium (eU) and equivalent thorium (eTh). This work is based on the assumption that, the absolute and relative concentrations of these radioelements vary measurably and significantly with lithology. The composite image technique is used to display and simulate three parameters of the radioelements concentrations. The technique offered much in terms of lithologic discrimination, based on color differences and showed efficiency in defining areas, where different lithofacies occur within areas mapped as one continuous lithology. The Differences technique is used to delineate contacts of the rock units and the mainly structures of the study area. It is based mainly on varying in change of concentration of successive total count measurements within each line in the study area. Then, a suitable difference order is selected and matched to original measured line. Moreover, plotting the suitable order as grid and applied grid peaks on this grid. Then, these ridge grid peaks are symbolized over surface geological information and prepared radioelement composite map. This provides more detail about the surface geology, and addition more contacts occurred within original rock units. These subdivisions of rock units may be related to one formation that consists of more than one member having a different composition.

Impacts on soil nitrogen availability of converting managed pine plantation into switchgrass monoculture for bioenergy.

Biofuels derived from lignocellulosic materials is one of the options in addressing issues on climate change and energy independence. One of the most promising bioenergy crops is switchgrass (Panicum virgatum L.), particularly in North America. Future advancement in large-scale conversion of lignocellulosic feedstocks and relatively more competitive price for biomass and other economic advantages could lead to landowners opting to venture on switchgrass monoculture (SWITCH) in lieu of loblolly pine monoculture (PINE). Therefore, we investigated the conversion of previously managed loblolly pine stand into SWITCH in eastern North Carolina, U.S.A. on soil N availability. Treatments included PINE, SWTICH, and mature loblolly pine stand (REF). Each treatment was replicated three times on 0.8 ha plots drained by open ditches dug 1.0-1.2 m deep and spaced at 100 m. Rates of net N mineralization (Nm) and nitrification (Nn) at the top 20 cm were measured using sequential in-situ techniques in 2011 and 2012 (the 3rd and 4th years of establishment, respectively) along with a one-time laboratory incubation. On average, PINE, SWITCH, and REF can have field net Nm rates up to 0.40, 0.34 and 0.44 mg N·kg soil-1·d-1, respectively, and net Nn rates up to 0.14, 0.08 and 0.10 mg N·kg soil-1·d-1, respectively. Annually, net Nm rates ranged from 136.98 to 167.21, 62.00 to 142.61, and 63.57 to 127.95 kg N·ha-1, and net Nn rates were 56.31-62.98, 16.45-30.45, 31.99-32.94 kg N·ha-1 in PINE, SWITCH, and REF, respectively. Treatment effect was not significant on field Nm rate (p = 0.091). However, SWITCH significantly reduced nitrate-N production (p < 0.01). Overall, results indicated that establishment of SWITCH on poorly drained lands previously under PINE is less likely to significantly impact total soil N availability and potentially has minimum N leaching losses since soil mineral N under this system will be dominated by ammonium-N.

Drying-Rewetting Cycles Affect Nitrate Removal Rates in Woodchip Bioreactors.

Woodchip bioreactors are widely used to control nitrogen export from agriculture using denitrification. There is abundant evidence that drying-rewetting (DRW) cycles can promote enhanced metabolic rates in soils. A 287-d experiment investigated the effects of weekly DRW cycles on nitrate (NO) removal in woodchip columns in the laboratory receiving constant flow of nitrated water. Columns were exposed to continuous saturation (SAT) or to weekly, 8-h drying-rewetting (8 h of aerobiosis followed by saturation) cycles (DRW). Nitrate concentrations were measured at the column outlets every 2 h using novel multiplexed sampling methods coupled to spectrophotometric analysis. Drying-rewetting columns showed greater export of total and dissolved organic carbon and increased NO removal rates. Nitrate removal rates in DRW columns increased by up to 80%, relative to SAT columns, although DRW removal rates decreased quickly within 3 d after rewetting. Increased NO removal in DRW columns continued even after 39 DRW cycles, with ∼33% higher total NO mass removed over each weekly DRW cycle. Data collected in this experiment provide strong evidence that DRW cycles can dramatically improve NO removal in woodchip bioreactors, with carbon availability being a likely driver of improved efficiency. These results have implications for hydraulic management of woodchip bioreactors and other denitrification practices.

Use of beta subunit of human chorionic gonadotropin assay as a diagnostic tool for prelabor rupture of membranes.

PURPOSE: The study aimed at assessment of the accuracy of the ß-hCG test in vaginal washing fluid for diagnosis of prelabor rupture of membranes (PROM). PATIENTS AND METHODS: Two groups of pregnant women from 17 to 38 weeks of gestation were recruited. The first group (PROM group) included 50 pregnant women with unequivocal PROM. The other group included 50 pregnant women with intact membranes. A sterile speculum examination was performed. If less than 5 cc was collected or no fluid found, 10 cc sterile saline was sprinkled on the vaginal wall and 5 cc were recollected in a sterile syringe. Two drops of collected fluid were used for qualitative testing of ß-hCG. The remaining fluid was used for quantitative assessment of ß-hCG. RESULTS: The quantitative ß-hCG test results were significantly higher in PROM group (median and range: 138.5 (23-475) versus 13 (1-55); the difference in medians and 95% CI: 105 (91-166); p value: <.001). The qualitative ß-hCG test was positive in 42/50 (84%) of the PROM group, while it was negative in 50/50 (100%) of the intact membranes group. Areas under receiver operating characteristics (AUC) for both the quantitative and qualitative ß-hCG tests were high (0.97, 95% CI: 0.91-0.99, p value: <.001 and .92, 95% CI: 0.84-0.96, p value: <.001, respectively). The suggested cut-off of ß-hCG for the quantitative test was 32 mIU/ml. The sensitivity of quantitative and qualitative tests are: 94, 95% CI: 83.5-98.7% and 84, 95% CI: 70.9-92.8%, respectively. The specificity of quantitative and qualitative tests are: 94, 95% CI: 83.5-98.7% and 100, 95% CI: 92.9-100%, respectively. CONCLUSION: ß-hCG test (either quantitative or qualitative) in vaginal washing fluid can be used in the diagnosis of PROM in both preterm and term cases.

Barbed sutures versus conventional sutures for uterine closure at cesarean section; a randomized controlled trial.

INTRODUCTION: The aim of this randomized control trial was to compare the operative data and the early postoperative outcomes of cesarean sections in which the uterine incision was closed with a barbed suture (STRATAFIX™ Spiral PDO Knotless Tissue Control Device, SXPD2B405, Ethicon Inc.) with those of cesarean sections in which the uterine incision was closed with a conventional smooth suture (VICRYL™; Ethicon Inc.). MATERIALS AND METHODS: One hundred pregnant patients were randomized in a 1:1 ratio to the Stratafix group or the Vicryl group. The uterine incision was closed by two layers of sutures in both groups. In the Vicryl group, the first layer was continuous and the second layer was interrupted. In the Stratafix group, both layers were continuous. RESULTS: The uterine closure time was significantly lower in the Stratafix group (224 ± 46 versus 343 ± 75 s, p < .001). Operative time was comparable between both groups. Twelve patients in the Vicryl group and two patients in the Stratafix group required additional sutures to achieve hemostasis (p value = .009). The mean blood loss during closure of uterine incision and mean hospital stay were lower in the Stratafix group but these differences failed to reach statistical significance. CONCLUSION: The use of barbed suture for uterine incision closure at cesarean section is associated with shorter uterine closure time and similar early perioperative complications compared with conventional smooth suture. The difference between both groups in the technique of suturing the second layer of the uterine incision may be the cause of the reduction in the uterine closure time and the need for additional sutures to achieve hemostasis during suturing the uterine incision with a barbed suture. Further, well designed randomized controlled trials should be conducted to investigate the association between the type of suture (barbed or conventional smooth) and remote complications of cesarean section (infertility, pelvic pain, abnormal placentation and rupture uterus).

siRNA Blocking of Mammalian Target of Rapamycin (mTOR) Attenuates Pathology in Annonacin-Induced Tauopathy in Mice.

Tauopathy is a pathological hallmark of many neurodegenerative diseases. It is characterized by abnormal aggregates of pathological phosphotau and somatodendritic redistribution. One suggested strategy for treating tauopathy is to stimulate autophagy, hence, getting rid of these pathological protein aggregates. One key controller of autophagy is mTOR. Since stimulation of mTOR leads to inhibition of autophagy, inhibitors of mTOR will cause stimulation of autophagy process. In this report, tauopathy was induced in mice using annonacin. Blocking of mTOR was achieved through stereotaxic injection of siRNA against mTOR. The behavioral and immunohistochemical evaluation revealed the development of tauopathy model as proven by deterioration of behavioral performance in open field test and significant tau aggregates in annonacin-treated mice. Blocking of mTOR revealed significant clearance of tau aggregates in the injected side; however, tau expression was not affected by mTOR blockage.

Effects of forest-based bioenergy feedstock production on shallow groundwater quality of a drained forest soil.

Managed forests in southern U.S. are a potential source of lignocellulosic biomass for biofuel production. Changes in management practices to optimize biomass production may impact the quality of waters draining to nutrient-sensitive waters in coastal plain regions. We investigated shallow groundwater quality effects of intercropping switchgrass (Panicum virgatum L.) with managed loblolly pine (Pinus taeda L.) to produce bioenergy feedstock and quality sawtimber in a poorly drained soil of eastern North Carolina, U.S.A. Treatments included PINE (traditional pine production), PSWITCH (pine-switchgrass intercropped), SWITCH (switchgrass monoculture) and REF (mature loblolly pine stand). Each treatment was replicated three times on 0.8ha plots drained by parallel-open ditches, 1.0-1.2m deep and 100m apart. Water samples were collected monthly or more frequently after fertilizer application. Water samples were analyzed for organic nitrogen (ON), ammonium N (NH4+- N), and nitrite+nitrate N (NO3-+ NO2-- N), ortohophosphate phosphorus (OP), and total organic carbon (TOC). Overall, PSWITCH did not significantly affect shallow groundwater quality relative to PINE and SWITCH. ON, NO3-+ NO2-- N, and TOC concentrations in PSWITCH, PINE and SWITCH were substantially elevated during the two years after tree harvest and site establishment. The elevated nutrient concentrations at the beginning of the study were likely caused by a combination of rapid organic matter decomposition of the abundant supply of post-harvest residues, warming of exposed soil surfaces and reduction of plant nutrient uptake that can occur after harvesting, and pre-plant fertilization. Nutrient concentrations returned to background levels observed in REF during the third year after harvest.

Effect of female genital cutting performed by health care professionals on labor complications in Egyptian women: a prospective cohort study.

AIM: To examine the effect of the degree of female genital cutting (FGC) performed by health-care professionals on perineal scarring; delivery mode; duration of second stage of labor; incidence of perineal tears and episiotomy in a cohort of uncircumcised versus circumcised (types I and II) women. METHODS: A prospective cohort study included 450 primigravida women in active labor attending the Faculty of Medicine Cairo University Hospital between January 2013 and August 2014. Women were divided into three groups based on medical examination upon admission. Group I (Control) included 150 uncut women, Group II included 150 women with type I FGC and Group III included 150 women with type II FGC. A structured questionnaire elicited the information on women's socio-demographic characteristics including age, residence, occupation, educational level, age of marriage and FGC circumstances. Association between FGC and labor complications was examined. MAIN OUTCOMES: risk of perineal scarring; delivery mode; duration of second stage of labor; incidence of perineal tears and episiotomy. RESULTS: Family history of genitally cut mother/sister was the most significant socio-demographic factor associated with FGC. FGC especially type II was associated with significantly higher incidence of vulvar scar (P<0.0002), perineal tears (P<0.0001) and increased likelihood of additional vaginal and perineal trauma [odds ratio (OR): 1.85, 95% CI: 0.60-5.65. P≤0.001]. There was insignificant difference in risks of cesarean section (CS), instrumental delivery, episiotomy and short-term neonatal outcomes. CONCLUSION: The study strengthens the evidence that FGC increases the risk of tears in spite of medicalization of the practice.

Misoprostol Prior to Diagnostic Office Hysteroscopy in the Subgroup of Patients with No Risk Factors for Cervical Stenosis: A Randomized Double Blind Placebo-Controlled Trial.

AIMS: To assess the effectiveness of vaginal misoprostol in minimizing the pain perceived by patients with no risk factors for cervical stenosis (i.e., parous women of reproductive age who have no history of cesarean section or cervical surgery) during diagnostic office hysteroscopy. METHODS: A total of 100 patients with no risk factors for cervical stenosis were randomized to the misoprostol group (n = 50) or the placebo group (n = 50). In the misoprostol group, 2 misoprostol tablets (400 µg) were administered vaginally 12 h before office hysteroscopy. In the placebo group, 2 placebo tablets were administered. The patients rated the intensity of pain perceived during the procedure and at 30 min after the procedure with the use of a 100 mm visual analog scale (VAS). The hysteroscopists also scored the difficulty of hysteroscope insertion into the uterine cavity with the use of a 100 mm VAS. RESULTS: There were no significant differences between both groups in the VAS pain scores during or at 30 min after the procedure (28.3 ± 13.58 vs. 30.42 ± 15.13 and 11.1 ± 10.23 vs. 13.32 ± 11.12, respectively). The difficulty of hysteroscope insertion into the uterine cavity was comparable between both groups. CONCLUSION: Misoprostol administration prior to diagnostic office hysteroscopy appears to have no beneficial role in the subgroup of patients with no risk factors for cervical stenosis.

Airborn gamma-ray spectrometric data as guide for probable hydrocarbon accumulations at Al-Laqitah area, Central Eastern Desert of Egypt.

An exploration method has been developed to understand the relation between the radiometric measurements and the subsurface petroleum accumulations, where subtle anomalous patterns of radiation flux are detected over subsurface hydrocarbon basins. This technique is mainly based on utilizing the aerial gamma-ray spectral data in the prospecting for petroleum in stratigraphic and structural traps. Al-Laqitah area, Central Eastern Desert, Egypt, was selected to apply this method on its recorded aerial gamma-ray spectrometric survey data. The method presented in this work may play a major role in making these measurements an effective contributor for finding oil and gas resources. Thorium normalization, as an exploration technique, was applied on the Foreland sedimentary cover of Al-Laqitah area to prospect the possible subsurface hydrocarbon accumulations. The DRAD arithmetic means, plus the three times standard deviations(X+3S) for the data set were computed. Any single DRAD value, within the boundary of rock units, greater than this quantity that possesses a probability of 99.87% represents a valid anomaly that is not caused by random variations in the background values. The application of these criteria has led to the identification of nine zones over the investigated area that are statistically valid. These might indicate a prospective possibility for feasible subsurface hydrocarbon accumulations and oil-bearing pay zones at Al-Laqitah area.

Modulation of immunity and inflammatory gene expression in buffalo (Bubalus bubalis) with some digestive disorders.

So far, there has been scarce information about the status of immunoglobulins (Ig) and the gene expression of inflammatory cytokines in buffaloes showing digestive troubles. The purpose of the present study was to explore the modulation of gene expression of some immune-inflammatory markers in buffaloes suffered from various digestive disorders. For this reason, 50 native breed water buffaloes were studied. Forty of these buffaloes showed various symptoms of digestive disorders and were allocated into 4 groups of equal sizes (group 1: uncategorized stomatitis; group 2: acute traumatic reticuloperitonitis [TRR]; group 3: acute rumen impaction; and group 4: undifferentiated enteritis). Ten apparently healthy buffaloes were randomly selected and considered as a control group. RNA was firstly extracted from the whole blood then a reverse transcription kits was used to convert the RNA to cDNA. Real-time PCR was used to measure the expression of mRNAs of interleukin (IL)-1ß, IL-6, IL-10, and tumor necrosis factor (TNF)-α, IgG, and IgA, while glyceraldehyde-3-phosphate dehydrogenase (GAPDH) used as an internal reference. The results of real-time PCR revealed a significant (P ≤ 0.05) upregulation of the gene expression of IL-1ß, IL-6, IL-10, and TNF-α in blood of diseased buffaloes compared with those of controls. Animals showing acute TRP had peak values of both IL-6 and IL-10; while those exhibiting enteritis and rumen impaction had the highest values of IL-1ß and TNF-α, respectively. The results of qPCR also revealed a significant (P ≤ 0.05) downregulation of both IgG and IgA gene expression in blood of all diseased buffaloes compared with controls. The lowest values of both genes were recorded in buffaloes showing acute TRP. The results herein suggest that the tested genes could have a pivotal role in the pathophysiologic mechanism of the underlying diseases.

Volume expanders for the prevention of ovarian hyperstimulation syndrome.

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is a serious and potentially fatal complication of ovarian stimulation which affects 1% to 14% of all in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) cycles. A number of clinical studies with conflicting results have reported on the use of plasma expanders such as albumin, hydroxyethyl starch (HES), mannitol, polygeline and dextran as a possible intervention for the prevention of OHSS. Women with very high estradiol levels, high numbers of follicles or oocytes retrieved, and women with polycystic ovary syndrome (PCOS), are at particularly high risk of developing OHSS. Plasma expanders are not commonly used nowadays in ovarian hyperstimulation. This is mainly because clinical evidence on their effectiveness remains sparse, because of the low incidence of moderate and severe ovarian hyperstimulation syndrome (OHSS) and the simultaneous introduction of mild stimulation approaches, gonadotropin-releasing hormone (GnRH) antagonist protocols and the freeze-all strategy for the prevention of OHSS. OBJECTIVES: To review the effectiveness and safety of administration of volume expanders for the prevention of moderate and severe ovarian hyperstimulation syndrome (OHSS) in high-risk women undergoing IVF or ICSI treatment cycles. SEARCH METHODS: We searched databases including the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and trial registers to September 2015; no date restrictions were used as new comparators were included in this search. The references of relevant publications were also searched. We attempted to contact authors to provide or clarify data that were unclear from trial or abstract reports. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing volume expanders versus placebo or no treatment for the prevention of OHSS in high-risk women undergoing ovarian hyperstimulation as part of any assisted reproductive technique. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the studies, assessed risk of bias and extracted relevant data. The primary review outcome was moderate or severe OHSS. Other outcomes were live birth, pregnancy and adverse events. We combined data to calculate pooled Peto odds ratios (ORs) and 95% confidence intervals (CIs) for each intervention. Statistical heterogeneity was assessed using the I(2) statistic. We assessed the overall quality of the evidence for each comparison, using GRADE methods. MAIN RESULTS: We included nine RCTs (1867 women) comparing human albumin (seven RCTs) or HES (two RCTs) or mannitol (one RCT) versus placebo or no treatment for prevention of OHSS. The evidence was very low to moderate quality for all comparisons. The main limitations were imprecision, poor reporting of study methods, and failure to blind outcome assessment.There was evidence of a beneficial effect of intravenous albumin on OHSS, though heterogeneity was substantial (Peto OR 0.67 95% CI 0.47 to 0.95, seven studies, 1452 high risk women; I² = 69%, very low quality evidence) . This suggests that if the rate of moderate or severe OHSS with no treatment is 12%, it will be about 9% (6% to12%) with the use of intravenous albumin. However, there was evidence of a detrimental effect on pregnancy rates (Peto OR 0.72 95% CI 0.55 to 0.94, I² = 42%, seven studies 1069 high risk women, moderate quality evidence). This suggests that if the chance of pregnancy is 40% without treatment, it will be about 32% (27% to 38%) with the use of albumin.There was evidence of a beneficial effect of HES on OHSS (Peto OR 0.27 95% CI 0.12 to 0.59, I² = 0%, two studies, 272 women, very low quality evidence). This suggests that if the rate of moderate or severe OHSS with no treatment is 16%, it will be about 5% (2% to 10%) with the use of HES. There was no evidence of an effect on pregnancy rates (Peto OR 1.20 95% CI 0.49 to 2.93, one study, 168 women, very low quality evidence).There was evidence of a beneficial effect of mannitol on OHSS (Peto OR 0.38, 95% CI 0.22 to 0.64, one study, 226 women with PCOS, low quality evidence). This means that if the risk of moderate or severe OHSS with no treatment is 52%, it will be about 29% (19% to 41%) with mannitol. There was no evidence of an effect on pregnancy rates (Peto OR 0.85 95% CI 0.47 to 1.55; one study, 226 women, low quality evidence).Live birth rates were not reported in any of the studies. Adverse events appeared to be uncommon, but were too poorly reported to reach any firm conclusions. AUTHORS' CONCLUSIONS: Evidence suggests that the plasma expanders assessed in this review (human albumin, HES and mannitol) reduce rates of moderate and severe OHSS in women at high risk. Adverse events appear to be uncommon, but were too poorly reported to reach any firm conclusions, and there were no data on live birth. However, there was evidence that human albumin reduces pregnancy rates. While there was no evidence that HES, or mannitol had any influence on pregnancy rates, the evidence of effectiveness was based on very few trials which need to be confirmed in additional, larger randomised controlled trials (RCTs) before they should be considered for routine use in clinical practice.