Chronic endometritis and altered embryo implantation: a unified pathophysiological theory from a literature systematic review

Purpose: Chronic endometritis (CE) is a frequent hysteroscopic and histological finding which affects embryo transfer implantation during IVF-ICSI cycles. In particular, CE impairs proper decidualization and, subsequently, implantation. Although this correlation has been clearly clarified, a pathophysiological explanation assembling all the studies performed has not been elucidated yet. For this reason, we have structured a systematic review considering all the original articles that evaluated a pathological element involved in CE and implantation impairment. Methods: The authors searched electronic databases and, after screening, collected 15 original articles. These were fully scanned and used to create a summary pathway. Results: CE is primarily caused by infections, which lead to a specific cytokine and leukocyte pattern in order to prepare the uterus to fight the noxa. In particular, the immunosuppression requested for a proper semi-allogenic embryo transfer implantation is converted into an immunoreaction, which hampers correct embryo implantation. Moreover, endometrial vascularization is affected and both irregular vessel density and luminal thickening and thrombosis reduce what we have first identified as endometrial flow reserve. Finally, incorrect uterine wave propagation could affect embryo contact with decidua. Conclusion: This is the first summary of evidence on CE pathophysiology and its relationship with infertility. Understanding the CE pathophysiology could improve our knowledge in embryo transfer success

Peri-Conceptional Intake of Folic Acid Supplement to Date: A Medical-Legal Issue

Folic Acid (FA) supplementation during pregnancy represents a so widespread and established recommendation all over the world, to be taken for granted sometimes. As a matter of fact, this vitamin supplement is worldwide recommended mostly during peri-conceptional period for its proved preventive effect on Neural Tubal Defects (NTDs), like spina bifida. However, The biological and clinical potential of FA is reassessing and this represents a hot topic in scientific community, mostly in consideration of the possible medical-legal implications. An overview is mandatory in order to keep in mind FA-related possibl

Ultrasonic assessment of cesarean section scar to vesicovaginal fold distance: an instrument to estimate pre-labor uterine rupture risk

Background: The number of Cesarean sections (CS) is growing worldwide, intensifying the risk of complications in subsequent pregnancies and leading to increased maternal and fetal morbidity and mortality. In particular, the literature shows a higher risk of uterine rupture (UR) in subsequent pregnancy with trial of labor after cesarean section (TOLAC) Furthermore, there are few data about pre-labor UR in scarred uteri. Objective: Since the key factor for management is timing, the aim of this study was to evaluate the accuracy of prenatal ultrasound (US) of scars in the early determining of pre-labor UR risk in women with a previous CS during their subsequent pregnancy Methods: From April 2014 to November 2018 a retrospective analysis was performed in order to evaluate the scar to vesicovaginal fold (VVF) distance in three patients with pre-labor UR and in 60 cases of the control group. Results: The periconceptional CS scar-VVF distance in the three UR cases resulted significantly increased compared to the controls (23.7 ± 3.5 mm vs 2.3 ± 2.7 mm, p < 005); moreover, a time interval of less than 18 months and a previous pre-labor preterm CS were found as known risk factors. Conclusion: In this study, a higher uterine incision due to placenta previa or isthmic myoma seems to be correlated with a major risk of UR. Therefore, periconceptional US examination of CS-VVF distance, (which represents the level of the previous CS), seems to be a useful predictive factor of pre-labor UR in subsequent pregnancies

Active localization of virtual sounds

We describe a virtual sound display built around a 12 MHz 80286 microcomputer and special purpose analog hardware. The display implements most of the primary cues for sound localization in the ear-level plane. Static information about direction is conveyed by interaural time differences and, for frequencies above 1800 Hz, by head sound shadow (interaural intensity differences) and pinna sound shadow. Static information about distance is conveyed by variation in sound pressure (first power law) for all frequencies, by additional attenuation in the higher frequencies (simulating atmospheric absorption), and by the proportion of direct to reverberant sound. When the user actively locomotes, the changing angular position of the source occasioned by head rotations provides further information about direction and the changing angular velocity produced by head translations (motion parallax) provides further information about distance. Judging both from informal observations by users and from objective data obtained in an experiment on homing to virtual and real sounds, we conclude that simple displays such as this are effective in creating the perception of external sounds to which subjects can home with accuracy and ease

Enseñanza introductoria de la programación : Un estudio curricular por competencias

La programación puede aparecer referida en textos académicos tanto como fácil y divertida como difícil y frustrante. Los trabajos analizados revelan la complejidad inherente al estudio de este problema. Una de las variables del problema es la ubicación curricular de la enseñanza de la programación que, por razones históricas y de motivación para los alumnos, se incluye generalmente de manera temprana en los planes de estudios. Ubicar la enseñanza de la programación en los primeros módulos curriculares lleva a una visión eminentemente práctica de la programación, distanciada de los desarrollos teóricos. En la literatura específica se ha referido a esta separación entre teoría y práctica como una posible causa de que los alumnos cometan errores clásicos difícilmente superables sin conocimiento teórico. Este proyecto se propone realizar un estudio curricular basado en competencias que permita organizar las prácticas relacionadas con la enseñanza y la evaluación de la programación cuando dicha enseñanza está ubicada tempranamente en el plan de estudios. Se producirá un modelo curricular por competencias, se obtendrán requisitos funcionales para el diseño de aplicaciones didácticas que induzcan a relacionar la experiencia en la práctica con la teoría de la disciplina. En calidad de prueba de concepto, se desarrollará por lo menos una aplicación didáctica.Eje: Innovación en Educación Informática.Red de Universidades con Carreras en Informátic

Metaplasia ossea diagnosticata su leiomioma uterino

Riportiamo un caso di metaplasia ossea in un leiomioma uterino scoperto casualmente in una donna di 53 anni operata di isterectomia totale per una neoformazione annessial

Framework para la construcción de estrategias didácticas para la enseñanza inicial de la programación de computadoras

El proyecto que se describe tiene por objetivo principal la definición de un framework de herramientas didácticas que facilite la construcción de estrategias de enseñanza para los cursos introductorios de programación. Entendemos por herramientas didácticas a todo concepto, técnica, instrumento o procedimiento que permita hacer efectiva la enseñanza. Por estrategia de enseñanza, a la planificación específica, que hace el docente, del procedimiento a seguir y herramientas a utilizar para lograr los objetivos pedagógicos. El framework en cuestión estará compuesto por herramientas didácticas, tanto conceptuales como tecnológicas, un conjunto de requerimientos para el diseño de nuevas herramientas y ejemplos de su aplicación para el diseño de estrategias de enseñanza de contenidos y desarrollo de competencias específicos. De entrevistas a docentes, se obtendrán descripciones de estrategias y métodos que serán categorizados y organizados en estilos de enseñanza, así como recursos conceptuales y tecnológicos utilizados en la práctica de la enseñanza; se elicitarán requerimientos para el diseño de nuevas herramienta. Los resultados permitirán construir un modelo conceptual sobre el que se fundará el diseño del framework. Se construirá un prototipo que permita validar los resultados de este proyecto.Eje: Innovación en Educación en Informática.Red de Universidades con Carreras en Informática (RedUNCI

Unusual and severe peripartum cardiomyopathy: A case report

Peripartum cardiomyopathy (PPCM) is a relatively rare cardiac disease that manifests in the final stage of pregnancy and in the first months after delivery in women with no preexisting heart disease. Many etiological processes have been suggested: viral myocarditis, abnormal immune response to pregnancy, excessive prolactin excretion, prolonged tocolysis and a familiar predisposition to PPCM. Its diagnosis is often delayed because its symptoms, which include fatigue, dyspnea and palpitations are nonspecific. For this reason the diagnosis of PPCM is still made by exclusion of other etiologies. The long-term prognosis, once the acute phase is over, is a function of myocardial damage, this varies from complete functional recovery to chronic HF. The outcome of PPCM is highly variable with an alevated risk of fetomaternal morbidity and mortality. We report a serious case of a 40 years old female with biamniotic bicorionic twin pregnancy (PMA) who delivered by caesarean section and developed acute PPCM on post-operative. Symptoms occurred two hours after an intramuscular injection of two vials of methylergonovine the same day of cesarean delivery. These manifested in sudden tachypnoe, tachycardia and the appearance itchy maculopapular rash on her chest. On further evaluation, ECHO revealed cardiomegaly with reduced ejection fraction (< 15%). The case was successfully managed by a multidisciplinary team, using drugs like levosimendan and cabergoline, which rapresent emerging strategy in this clinical context

Persistent or Recurrent Diabetic Macular Edema After Fluocinolone Acetonide 0.19 mg Implant: Risk Factors and Management

Purpose: To investigate baseline characteristics of patients undergoing additional antivascular endothelial growth factor (VEGF) injections for residual or recurrent diabetic macular edema (DME) in the first year after 0.19-mg fluocinolone acetonide (FAc) implant. Design: Prospective cohort study. Methods: Ninety-four eyes of 66 patients received an FAc implant. Eyes with persistent or recurrent DME were managed with pro re nata anti-VEGF agents. Demographic data and medical history were collected at baseline. Best-corrected visual acuity and central macular thickness were measured every 2 months. The 3 outcomes explored were 1) the risk factors for administration of additional anti-VEGF agents, 2) the interval from FAc to first anti-VEGF injection; and 3) the number of anti-VEGF doses required to maintain regression of DME. Results: Eighteen eyes (19.1%) of 13 patients received 1.3 ± 0.6 anti-VEGF injections. These eyes had significantly thicker central macular thickness at baseline and over the entire follow-up period (P < .001); best-corrected visual acuity was similar at every time point to eyes that were not receiving extra DME treatments. Eyes without preexistent panretinal photocoagulation (PRP) had a higher risk to undergo supplemental treatments (hazard ratio 1.5 [95% confidence interval 1.1-2.5, P = .03). The interval between FAc implant and the first anti-VEGF had a significant linear positive relationship with the number of dexamethasone implants before FAc implant (P = .002, R2 = 0.47). No association was found between baseline factors and the number of injections given. Conclusion: Anti-VEGF agents are efficient treatment to maintain visual acuity in residual/recurrent DME after FAc. Patients with higher baseline central macular thickness and with no previous central macular thickness are more likely to require additional treatments to control DME

Chronic Endometritis Due to Common Bacteria Is Prevalent in Women With Recurrent Miscarriage as Confirmed by Improved Pregnancy Outcome After Antibiotic Treatment

Recurrent miscarriage (RM) is defined as 3 or more miscarriages before 20 weeks' pregnancy. In recent years, interest has been focused on chronic endometritis (CE), a subtle inflammation thought to be associated with RM. We aimed to evaluate the relationships between CE and RM. The records of 360 women with unexplained RM were retrospectively analyzed. Data from hysteroscopy, endometrial histology, endometrial culture, and polymerase chain reaction for chlamydia, performed before and after antibiotic treatment for CE, were analyzed. The occurrence of successful pregnancies within 1 year after treatment was also evaluated. Results showed that 208 (57.8%) women with RM showed CE at hysteroscopy; 190 (91.3%), positive at hysteroscopy, were also positive at histology, and 142 (68.3%) had positive cultures. Common bacteria were found in 110 (77.5%) patients. Mycoplasma and Ureaplasma were found in 36 (25.3%) patients and Chlamydia in 18 patients (12.7%). In 102 (71%) women, antibiogram-based antibiotic treatment normalized hysteroscopy, histology, and cultures (group 1); while in 40 (28.2%) patients, CE was still present at hysteroscopy (group 2). In 16 of the 66 patients positive at hysteroscopy, but not at cultures, the hysteroscopy becomes normal (group 3) after a Centers for Disease Control and Prevention-based therapy; while in 50 women, CE was still present (group 4). One year after treatment, group 1 showed a significantly higher number of pregnancies (78.4%) compared to group 2 (17.5%; P < .001) and group 4 (15.3%; P = .005). The CE is frequent in women with RM. Antibiotic treatment seems to be associated with an improved reproductive outcome