Uterine septum and reproductive outcome. From diagnosis to treatment. How, why, when?

Background: Septate uterus is a benign congenital malformation and represents the most common uterine anomaly in women with poor reproductive outcome. Objectives: To review the available scientific data concerning the biological context of the intrauterine septum and the association with poor reproductive outcome, the best methods for diagnosis and treatment. Materials and Methods: From July 2020 to October 2020, we searched for relevant free full text articles in PubMed, written in English, and published from the 1st of January 2000 to 31st of July 2020. Main outcome measures: Association of the pathophysiology of septate uterus with poor reproductive outcome, evaluation of the different classification systems, the accuracy of diagnostic methods and the efficacy of the available treatment options. Results: 259 articles were screened, and 22 articles were finally included in our study. Many theories regarding the pathophysiology of this congenital anomaly and its' association with reproductive problems have been proposed along the recent decades. Combination of diagnostic methods should be used to avoid misclassification of this congenital anomaly. Conclusions: Lack of uniformity in the different classification systems makes the diagnosis of septate uterus challenging as there is no universally accepted definition. Data regarding the reproductive outcome of women with septate uterus are still limited, thus recommendations regarding optimal treatment of these women are biased. What is new?: According to new insights regarding the pathophysiology of the uterine septum, differences in the underlying embryological defects are associated with changes in the histological composition and vascularisation of septa, as well as in clinical significance.

A European survey on treatment of hydrosalpinges in infertile women on behalf of the European Society for Gynaecological Endoscopy (ESGE) Special Interest Group (SIG) on Reproductive Surgery.

A questionnaire-based survey was conducted among members of the European Society for Gynaecological Endoscopy (ESGE), with the aim of increasing awareness of the diagnosis and surgical treatment of tubal disease as an alternative to in-vitro fertiliszation (IVF). Seventeen participants (34%) occasionally used a test for prediction of the ovarian reserve before surgery, and the most commonly used test was anti-mullerian hormone assay (39/50; (80%). Laparoscopy was the preferred method for staging tubal disease (43/50; 86%).Thirty-seven (76%) participants always performed salpingectomy or tubal occlusion before the first IVF attempt. Thirty (60%) of the gynaecological surgeons considered the outcome with tubal surgery and IVF to be similar in mild tubal disease, whereas for severe disease, 31/50 (62%) felt that surgery had worse outcome. Among other factors to be considered in choosing a strategy for treating infertility, 20/50 (40%) of respondents listed the stage of disease. The findings of this survey suggest that first-line treatment for women younger than 35 years old with minor tubal pathology, is tubal surgery. IVF appears to be offered if there are other infertility factors, if the patient is >38 years old and if moderate to severe tubal disease is present.

A European survey on the conservative surgical management of endometriotic cysts on behalf of the European Society for Gynaecological Endoscopy (ESGE) Special Interest Group (SIG) on Endometriosis.

The mainstay of endometrioma management, when treatment is required, is surgical. Although laparoscopy is considered to be the gold standard for endometriosis surgery, there is no clarity on the preferred laparoscopic technique, which may depend on whether the primary goalis treatment of infertility or pelvic pain, prevention of recurrence or preservation of ovarian reserve. The aim of this survey to assess the surgical practice of the members of the European Society for Gynaecological Endoscopy (ESGE) on the conservative management of endometiotic cysts in women of reproductive age. The current survey showed that practice for the conservative management of endometriotic cysts was that laparoscopy accounted for 84.9% of the cases, expectant management for 12.1%, and laparotomy for 3%. The preferred surgical approach was cystectomy in 69% of the cases, while the parameters that determined the preferred surgical method were the diameter of the cyst (62%) and the bilaterality or non-location (53%). The type of energy used was in most cases bipolar (83%), 71.4% of surgeons did not reconstitute the ovary and 41% of responses included the administration of adhesion barrier agents. The primary surgical end-point was ovarian reserve (50%), which was tested preoperatively in 51.8%, mainly with an anti-mullerian hormone. In case of an incidentally deep-infiltrating endometriosis, 55.4% of the responses included concomitant treatment thereof, while 71% of the participants considered that a "pelvic surgeon", who could more effectively treat co- existing pelvic and intestinal disease, should be the ideal one to effectively manage endometriosis. The majority of participants (74%) in this survey consider that there is insufficient scientific evidence regarding the conservative management of endometriotic cysts. The treatment of ovarian endometrioma should be individualised, taking into consideration not only the relief of symptoms, pregnancy rates or recurrence rates, but also ovarian function and reserve after surgery.

Serum antioxidant capacity, biochemical profile and body composition of breast cancer survivors in a randomized Mediterranean dietary intervention study.

PURPOSE: Increasing evidence suggests that Mediterranean Diet (MD) is correlated with reduced risk of breast cancer (BC) and cancer mortality, since it modifies patients' serum antioxidant capacity, body composition and biochemical parameters. The aim of the study was to investigate whether a dietary intervention based on MD has a beneficial effect on these factors. METHODS: In this intervention study, seventy female BC survivors were randomly assigned to (1) the intervention group (personalized dietary intervention based on MD) and (2) the control group (received the updated American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention and ad libitum diet). Both groups were assessed twice [beginning, end of study (after 6 months)] regarding their anthropometric and biochemical parameters, serum vitamin C, vitamin A, a-tocopherol and CoQ10 levels, dietary intake and adherence to MD. An additional intermediate analysis was conducted on participants' body composition and biochemical profile. RESULTS: Concerning the intervention group, body weight, body fat mass, waist circumference, body mass index as well as HDL-cholesterol were significantly decreased (P < 0.2%). An increase was observed in the vitamin C levels in blood (P < 0.2%). In the control group, body weight, body fat mass and serum total cholesterol rose (P < 0.2%). At the end of the study the two groups were significantly different considering blood glucose, vitamin C, polyunsaturated fatty acids, vitamin A and a-tocopherol levels. CONCLUSIONS: This randomized dietary intervention based on MD managed to ameliorate serum antioxidant capacity, body composition, adherence to MD and glycemic profile of postmenopausal BC survivors.

erm(C) is the predominant genetic determinant for the expression of resistance to macrolides among methicillin-resistant Staphylococcus aureus clinical isolates in Greece.

OBJECTIVES: Macrolide, lincosamide and streptogramin type B (MLS(B)) resistance was determined in Staphylococcus aureus clinical isolates from two University Hospitals. METHODS: Antibiotic resistance was investigated by double disc diffusion and MIC determination. Resistance determinants were detected by PCR and DNA hybridization, while clonal types were identified by pulsed-field gel electrophoresis (PFGE) analysis of SmaI DNA fragments. RESULTS: Among methicillin-susceptible S. aureus (MSSA) isolates, inducible and MS phenotypes were detected, with the predominance of the erm(A) gene, followed by the msr(A) and erm(C) genes. The majority of methicillin-resistant S. aureus (MRSA) isolates expressed the constitutive phenotype and carried the erm(C) gene. PFGE revealed the dissemination of two major clones among the MRSA in both hospitals. CONCLUSIONS: erm(C) is the predominant genetic determinant for the expression of MLS(B) resistance among S. aureus isolates, especially MRSA, in Greece. This is due to the spread of two major clones in the country.

Kinetic analysis of parallel reactions, the initial reactant of which presents with two interconvertible isomeric forms (hydrolysis and hydroxylaminolysis of 6-phosphogluconolactone)

A mathematical treatment is presented of two parallel reactions each one of which can be described by the sum of two exponential functions of time. The two simplest reaction models consistent with this requirement are presented, and are shown to be described by a second-order non-homogeneous differential equation with constant coefficients. Solutions of this equation in closed form are given, and it is shown that, as is the case with pairs of parallel first-order reactions, description of the time course of one of the two reactions yields a complete description of the time course of the other reaction. Hypothetical cases, consistent with the reaction models presented, are given and are compared with experimental results, obtained on the parallel reactions of 6-phosphogluconolactone hydrolysis and hydroxylaminolysis. Results are compatible with the existence of enzymically generated 6-phosphogluconolactone in two interconvertible isomeric forms. Copyright 1999 Academic Press.

Reactivity of 6-phosphogluconolactone with hydroxylamine: the possible involvement of glucose-6-phosphate dehydrogenase in endogenous glycation reactions.

The reactivity of 6-phosphogluconolactone and of delta-gluconolactone with hydroxylamine (a model compound in electrophilicity determination studies) was examined and compared with the reactivity of several other electrophiles, such as acid anhydrides and esters, some of which exhibit adverse biological effects (e.g. carcinogenicity). At pH 7.6 and 30 degrees C, and with an excess of hydroxylamine concentration, most of the compounds tested disappear from the medium in a monoexponential reaction. On the other hand, the reaction of 6-phosphogluconolactone with hydroxylamine is biexponential. This finding indicates the existence of 6-phosphogluconolactone in two interconvertible, isomeric forms. The reactivity, towards hydroxylamine, of 6-phosphogluconolactone and, to a lesser extent of delta-gluconolactone, is on the upper scale of reactivity of the electrophiles tested. It is concluded that 6-phosphogluconolactone (and in particular, one of its isomeric forms) is a highly electrophilic compound, and may possibly react with sundry intracellular nucleophiles, thereby exerting untoward metabolic effects. In this connection, it is of interest that a positive correlation has been found to exist between glucose-6-phosphate dehydrogenase activity and cell proliferation.

Kinetic analysis of 6-phosphogluconolactone hydrolysis in hemolysates.

Hydrolysis of enzymatically generated 6-phosphogluconolactone in hemolysates has been found to be a first-order reaction, in all cases studied. It follows that the Michaelis constant of the reaction is higher than the highest 6-phosphogluconolactone concentration used in this study, viz., it is higher than 0.30 mmol l-1. The reaction first-order rate constant was found to decrease as the concentration, in the enzyme assay mixture, of the 6-phosphogluconolactone preparation was increased. It follows that this paradoxical effect may give rise to determinations involving spurious Michaelis constant and enzyme activity results. The possible causes of this effect are discussed.

Determination of NADH2-ferricyanide oxidoreductase (cytochrome b5 reductase, diaphorase) activity of human erythrocytes by an analysis of the time-dependence of NADH2 oxidation.

The time-dependence of the reaction of human erythrocyte diaphorase activity has been studied by the use of NADH2 and ferricyanide as substrates. Reaction was found to be first-order with respect to NADH2 concentration, and zero-order with respect to ferricyanide concentration. These findings indicate that human erythrocyte diaphorase has a Km value for NADH2 by far higher than, and for ferricyanide by far lower than, the concentration of the substrates used, i.e. 0.1 and 0.2 mmol/l, respectively. The diaphorase activity determination method, described in the present communication, has been used in 19 healthy adults and children. Diaphorase activity was found to be 7.29 +/- 3.69 1 SD mumol NADH2 oxidized/ml packed cells per min, at 25 degrees C, and pH 7.00.