Pollution and health risk assessment of trace metal in vegetable field soils in the Eastern Nile Delta, Egypt.

The accumulation of trace metals in vegetable field soils is of increasing worry because of the potential health hazards and their detrimental effects on soil ecosystems. To investigate the state of trace metal pollution in vegetable field soils, 60 surface soil samples were collected from vegetable fields across the Eastern Nile Delta region, Egypt. The results concluded that the concentrations of Cu, Mn, and Ni were lesser than their corresponding background values, while the concentrations of Cd, Co, Pb, and Zn were exceeding their background values. The pollution indices showed that the studied soil experienced low to moderate contamination and the Cd and Cr contamination was serious. The hazard index values of nine trace metals signified that there was no adverse non-carcinogenic risk for adults and children. The carcinogenic risk of Cd, Co, Ni, and Pb for both age groups was within acceptable limits, while Cr had critical carcinogenic hazards for children. Overall, the quality of studied soils is relatively safe, although some samples impose serious pollution problems of Cd and Cr. Thus, properly monitored trace metals and soil management action should be applied to reduce further soil pollution in vegetable fields in the Eastern Nile Delta.

Antioxidant, antiapoptotic, antigenotoxic, and hepatic ameliorative effects of L-carnitine and selenium on cadmium-induced hepatotoxicity and alterations in liver cell structure in male mice.

L-carnitine (LC) and selenium (Se) have significant protective and antioxidant effects on several tissues. Cadmium (Cd), widely used in some industries and emitted from fossil fuels, is a heavy metal having a number of side effects, including hepatotoxicity. This study aims to assess the ameliorative function of both LC and SeCl4 on cadmium chloride (CdCl2)-induced liver toxicity. In total, 70 male mice included in this study were allocated to seven groups: control, CdCl2, LC, SeCl4, CdCl2 plus SeCl4, CdCl2 plus LC, CdCl2 plus SeCl4 and LC groups. Hepatic aminotransferase (aspartate aminotransferase [AST] and alanine transaminase [ALT]) activity and tumor necrosis factor-alpha [TNF-α] levels, as well as the antioxidant biomarkers (superoxide dismutase [SOD], glutathione reductase [GRx], glutathione-S-transferase [GST] and catalase [CAT], were examined. Histological and transmission electron microscopic [TEM] variations in the liver were used as indicators of liver damage after the administration of CdCl2-alone or CdCl2 with LC, SeCl4, or both. Genotoxic effects of CdCl2 were also evaluated and the possible roles of SeCl4 and/or LC on the expression of the antioxidant enzymes were studied. Results showed that administration of LC and SeCl4 decreased CdCl2-induced increase in ALT and AST levels and reduced oxidative stress to normal levels. In addition, LC combined with SeCl4 had a highly synergistic effect and elevated significantly the enzymatic antioxidants and decreased lipid peroxidation levels compared with those in the CdCl2-treated group. It is clear from the data that both LC and SeCl4 inhibit liver injury and improve the redox state in mice.

Preliminary molecular identification of a predatory bug, Orius albidipennis, collected from ornamental plants.

Orius albidipennis (Reuter) (Hemiptera: Anthocoridae) is a generalist predator used for biological control of insects attacking ornamental plants. Molecular identification of this species using internal transcribed spacer 1 (ITS1) of ribosomal DNA was conducted for the first time. The complete sequence of ITS1 and fragments of its flanking 18S and 5.8S rDNA genes are reported herein. The estimated length of ITS1 of O. albidipennis was 305 bp. This spacer was nearly identical to its counterpart of Orius sp-Taif strain in spite of the difference in their length. The phylogentic relationships were determined using the maximum-likelihood method supported with strong bootstrap probabilities clustering of both taxa together. Further molecular markers could be useful to identify the Taif strain and support its sister relationship to the Egyptian O. albidipennis.

Effects of biochar, zeolite and mycorrhiza inoculation on soil properties, heavy metal availability and cowpea growth in a multi-contaminated soil.

Heavy metal pollution of agricultural soil has become a major serious concern. The development of suitable control and remediation strategies for heavy metal contaminated soil has become critical. The outdoor pot experiment was conducted to investigate the effect of biochar, zeolite, and mycorrhiza on the bioavailability reduction of heavy metals and its subsequent effects on soil properties and bioaccumulation in plants as well as the growth of cowpea grown in highly polluted soil. Zeolite, biochar, mycorrhiza, zeolite with mycorrhiza, biochar with mycorrhiza, and soil without any modifications were the six treatments used. The experiment was conducted with a completely randomized design and four replications. The results indicated that the combination of biochar with mycorrhiza had the highest values of root and shoot dry weight and the lowest heavy metal concentrations in root and shoot as well as bioconcentration and translocation factors for all heavy metals. The highest significant reductions in the availability of heavy metals over the control were found with biochar with mycorrhiza, which were 59.1%, 44.3%, 38.0%, 69.7%, 77.8%, 77.2% and 73.6% for Cd, Co, Cr, Cu, Ni, Pb and Zn, respectively. The application of biochar and zeolite either alone or in combination with mycorrhiza increased significantly soil pH and EC compared to mycorrhiza treatment and untreated soil. It can be concluded that the combination of biochar and mycorrhizal inoculation has great potential as a cost-effective and environmentally technique for enhancing heavy metal immobilization, lowering heavy metal availability and plant uptake, and improving cowpea plant growth.

Qualitative analysis and phase of chaos control of the predator-prey model with Holling type-III.

In this study, we investigate the dynamics of a discrete-time with predator-prey system with a Holling-III type functional response model. The center manifold theorem and bifurcation theory are used to create existence conditions for flip bifurcations and Neimark-Sacker bifurcations. Bifurcation diagrams, maximum Lyapunov exponents, and phase portraits are examples of numerical simulations that not only show the soundness of theoretical analysis but also show complicated dynamical behaviors and biological processes. From the point of view of biology, this implies that the tiny integral step size can steady the system into locally stable coexistence. Yet, the large integral step size may lead to instability in the system, producing more intricate and richer dynamics. This also means that when the intrinsic death rate of the predator is high, this leads to a chaotic growth rate of the prey. The model has bifurcation features that are similar to those seen in logistic models. In addition, there is a bidirectional Neimark-Sacker bifurcation for both prey and predator, and therefore we obtain a direct correlation in symbiosis. This means that the higher the growth rate of the prey, the greater the growth rate of the predator. Therefore, the operation of predation has increased. The opposite is also true. Finally, the OGY approach is used to control chaos in the predator and prey model. which led to a new concept which we call bifurcation phase of control chaos.

Ecotoxicological assessment of toxic elements contamination in mangrove ecosystem along the Red Sea coast, Egypt.

Identifying biochemical aspects of the potentially toxic elements (PTEs) is of particular concern in mangrove ecosystems, Avicennia marina (Forssk.) Vierh., due to their importance as natural buffers in coastal areas. Nonetheless, the microbial community dynamics and potential scavenging responses of mangrove ecosystems to the phytotoxicity of PTEs remain questionable. This study assesses the ecological risk benchmarks of some PTEs, including aluminum (Al), boron (B), barium (Ba), cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), mercury (Hg), manganese (Mn), nickel (Ni), lead (Pb), and zinc (Zn), and their microbial responses in the bottom sediments of mangrove ecosystems along Egypt's Red Sea coast. In particular, we assessed the role of microbial metabolites in biochemical cycling of nutrients and scavenging against phytotoxicity hazards. We quantified a spectrum of ecological risk assessment indices, which suggested elevated levels of PTEs in sediment, particularly Cr, Hg, and Pb. Canonical correspondence analysis and generalized linear mixed effects models indicate that the spatial biodiversity of microbial taxa is impacted significantly by the physicochemical characteristics of sediments and concentrations of PTEs. Results demonstrate that the microbial communities and their metabolites exert a significant influence on organic matter (OM) decomposition and the biochemical cycling of phytoavailable nutrients including nitrogen (N), phosphorus (P), and potassium (K). Spatially, nitrogenase activities were higher (411.5 µmoL h-1 mL-1) in the southern sites of the Red Sea coast relative to the northern locations (93.8 µmoL h-1 mL-1). In contrast, higher concentrations of phytohormones, including indole-3-acetic acid (IAA) (61.5 mg mL-1) and gibberellins (534.2 mg mL-1), were more evident in northern sites. Siderophores correlated positively with Fe concentration in sediments and averaged 307.4 mg mL-1. Overall, these findings provide insights into the biochemical signals of PTEs contamination in hostile environments, contributing to a better understanding of the future prospects of PTEs bioremediation in contaminated coastal environments.

Adhesion reduction agents in gynaecological procedures: can NHS aff ord it? An economic cost efficiency analysis.

We examined the total costs to the National Health Service (NHS, UK) paid to treat adhesion complications and determine the theoretical savings and cost-effectiveness incurred if anti-adhesion agents were adopted. Using Healthcare Resource Groups (HRG) codes, we calculated the costs incurred through Payment by Results (PbR) and then calculated the financial savings that could be realised through the use of anti-adhesion agents. There were 62,186 adhesion-related consultant episodes between 2004 and 2008 encountered within the NHS. If an anti-adhesion agent cost £110 per usage, and can reduce adhesions in 25% of patients undergoing surgery, assuming that 25% of patients were readmitted in the first year after the primary surgery, the financial cost to the health service is, at best, savings of more than £700,000 and at worst, cost neutral to the NHS.

Molecular, Immunomodulatory, and Histopathological Role of Mesenchymal Stem Cells and Beetroot Extract on Cisplatin Induced Testicular Damage in Albino Rats.

Cisplatin (Cis) a drug commonly used as a chemotherapeutic agent to treat various types of cancer, inducing testicular damage. The present study aimed to investigate the inhibitory potential of bone marrow-derived mesenchymal stem cells (BM-MSCs) and beetroot extract (BRE) in albino rats after testicular toxicity induced by cisplatin. Thirty adult male albino rats were grouped into: the control group, Cis group receiving a single dose of 7 mg/kg i.p. (intraperitoneal) to induce testicular toxicity, Cis plus BM-MSCs injected Cis followed by 2 × 106 of BM-MSCs; Cis plus BRE group receiving Cis followed by 300 mg/kg body weight/day of BRE, and Cis plus BM-MSCs and BRE group. In the current study, Cis reduced sperm count, serum testosterone level, and testicular activity of alkaline phosphatase (AKP), besides a marked inhibition of succinate dehydrogenase (SDH) activity. In addition, it significantly increased malondialdehyde (MDA) and along with a marked decrease in testis reduced glutathione content and total antioxidant capacity (TAC). At the same time, Cis administration resulted in a marked elevation in interleukine-6 and the iNOS and caspase-3 genes; however, it decreased the expression of steroidogenic acute regulatory protein (StAR). Combined treatment with BM-MSCs and BRE resulted in great improvement of all previous parameters. These results were also confirmed by histopathological and immunohistochemical examination. In conclusion, both MSCs and BRE were found to have potent potentials to inhibit testicular damage induced by cisplatin.

Synbiotic Effects of Saccharomycescerevisiae, Mannan Oligosaccharides, and ß-Glucan on Innate Immunity, Antioxidant Status, and Disease Resistance of Nile Tilapia, Oreochromis niloticus.

Synbiotic (SYN) additives were assessed as an antibiotic alternative on the effects on the nonspecific immune response and disease resistance of O. niloticus to P. aeruginosa. Healthy fish (n = 120, average initial weight 18 ± 2 g) were allotted randomly into four experimental groups (3 replicates for each); 1) a control group with no additives (CON), 2) basal diet complemented with 0.1 g kg-1 diets of norfloxacin, NFLX, 3) basal diet fortified with 1 mL kg-1 diet of SYN, and 4) basal diet complemented with a mixture of NFLX and SYN, which was carried out for eight weeks. Results showed a significant increase (p < 0.01) in the serum immune parameters (total protein, globulin and albumin, nitric oxide (NO), and lysozyme activity) in the SYN group and the NFLX+SYN group compared with the CON and NFLX groups. The serum glucose, cholesterol, and triglycerides were higher in NFLX and NFLX+SYN groups than the CON and SYN groups. The catalase (CAT), superoxide dismutase, glutathione peroxidase (GPX) activities were significantly augmented in the NFLX+SYN group, followed by the SYN group compared with CON and NFLX groups. The cumulative mortality rate (CMR) of O. niloticus following the P. aeruginosa challenge was decreased in the SYN group compared to other groups. The results emphasize that synbiotic could be used as a norfloxacin alternative to enhance the related immunological parameters, including antioxidant activity and disease resistance against P. aeruginosa infection of O. niloticus.

Boswellia serrata Resin Extract in Diets of Nile Tilapia, Oreochromis niloticus: Effects on the Growth, Health, Immune Response, and Disease Resistance to Staphylococcus aureus.

The influences of Boswellia serrata resin extract (BSRE) as a feed additive on the growth performance, immune response, antioxidant status, and disease resistance of Nile tilapia, Oreochromis niloticus L. were assessed. One hundred-forty four fingerlings (initial weight: 21.82 ± 0.48 g) were randomly allotted into four groups with three replicates where they were fed on one of four treatments with four levels of Boswellia serrata resin extract 0, 5, 10, or 15 g kg-1, BSRE0, BSRE5, BSRE10, BSRE15, respectively for eight weeks. After the end of the feeding trial, the fish were challenged with Staphylococcus aureus, and mortalities were noted. The final body weight, total body weight gain, and the total feed intake were quadratically increased in BSRE5 treatment (p < 0.01). The protein productive efficiency (PPE) was linearly and quadratically increased in all BSRE supplemented treatments (p < 0.01). Dietary addition of BSRE raised the fish crude protein content and reduced the fat content in a level-dependent manner (p < 0.01). The ash content was raised in the BSRE15 group (p < 0.01). Dietary BSRE supplementation decreased the serum levels of glucose, total cholesterol, triglycerides, and nitric oxide. It increased the serum levels of total protein, albumin, total globulins, α1 globulin, α2 globulin, ß globulin, É£ globulin, Catalase, and SOD (superoxide dismutase) activity, GSH (reduced glutathione), lysozyme activity, and MPO (myeloperoxidase) in a level-dependent manner (p < 0.05). The BSRE15 diet increased the serum level of ALT (alanine aminotransferase) and decreased creatinine serum level (p < 0.05). Dietary BSRE supplementation increased the relative percentage of survival % (RPS) of S. aureus challenged fish. The histoarchitecture of the gills and kidney was normal in the BSRE5 treatment and moderately changed in BSRE10 and BSRE15 treatments. The splenic lymphoid elements were more prevalent, and the melano-macrophage centers (MMC) were mild to somewhat activated in BSRE supplemented treatments. Dietary BSRE supplementation improved the intestinal histomorphology. It can be concluded that BSRE addition can enhance the antioxidant activity, immune status, and disease resistance of O. niloticus to S. aureus infection. The level of 5 g kg-1 BSRE can improve fish growth without causing harmful effects on fish health. The highest levels of BSRE are not recommended as they badly affected the histoarchitecture of many vital organs.

Gross and microscopic pathological changes associated with parasitic infection in European eel (Anguilla anguilla, Linnaeus 1758).

The gross pathological and histopathological changes associated with parasitic infection in the European eel (Anguilla anguilla Linnaeus, 1758) was investigated. A total of 65 eels collected from three sampling localities in Eastern Delta, Egypt were examined over the period of January-May 2008. The fish were subjected to standard procedures for parasitological and pathological examinations. Overall, 22 (33.8%) of the 65 fish examined were found to have parasitic infections. The eels harbored a total of six parasite species; among them, the nematode Anguillicoloides crassus was the most prevalent species (10.7%), followed by the Monogenea Pseudodactylogyrus anguillae (7.7%) and Dactylogyrus species (6.1%), the ciliate Trichodinella epizootica (4.6%), the Myxozoa Myxidium giardi (3.1%), and the cestode Proteocephalus macrocephalus (1.5%). Affected fish showed varying levels of tissue damage and pathological alterations including mild to severe degenerative, necrotic, and inflammatory changes in the affected organs.

An RCT of metformin versus orlistat for the management of obese anovulatory women.

BACKGROUND: Treatment of obesity-related anovulation poses a significant clinical challenge. Occasionally, the use of antiobesity medications such as orlistat or insulin sensitizing agents such as metformin is sometimes indicated in these patients. This study aimed to compare the effects of metformin and orlistat for improving ovulation in obese anovulatory women. METHODS: This was an open-label RCT. A total of 40 women were randomized to receive either metformin (n = 20) or orlistat (n = 20). BMI as well as the androgen profile and the ovulatory status were assessed at baseline and at four weekly intervals for 3 months. Different anthropometric and endocrine parameters were also assessed as possible predictors of ovulation. RESULTS: There was no significant difference between the two study arms regarding the ovulation rate for metformin and orlistat [40% (n = 8/20) and 25% (n = 5/20), respectively, P = 0.31]. Both arms showed a significant drop in the BMI, testosterone and androstendione concentrations (P < 0.05), but there was no difference between the two arms. Patients who ovulated had significantly lower concentrations of baseline LH, androstendione, dehydroepiandrosterone and free androgen index (P < 0.05). Among these factors, a low baseline LH was found to be the only independent predictor of ovulation (area under curve, 0.85). CONCLUSIONS: Both metformin and orlistat show a similar effect on weight loss, ovulation rates and androgen concentrations. However, the effects on ovulation rates need to be confirmed in larger studies. The presence of a low baseline serum LH was found to be the most important predictor of ovulation. The study was registered at clinicaltrials.gov. NCT00292799.

Randomized controlled trial comparing laparoscopic ovarian diathermy with clomiphene citrate as a first-line method of ovulation induction in women with polycystic ovary syndrome.

BACKGROUND: Laparoscopic ovarian diathermy (LOD) is currently accepted as a successful second-line treatment for ovulation induction (OI) in clomiphene citrate (CC)-resistant women with polycystic ovary syndrome (PCOS). The aim of this study was to test the hypothesis that LOD may be superior to CC as a first-line treatment. METHODS: The study included 72 anovulatory women with PCOS who were randomized to LOD (n = 36) or CC (n = 36). Women who remained anovulatory after LOD were offered CC. Similarly, women receiving CC who failed to ovulate or conceive were offered LOD. Pregnancy rates were compared between the two groups using chi(2) and odds ratio with 95% confidence interval (OR, 95% CI). RESULTS: After randomization, six women conceived before starting treatment and another patient postponed treatment. The remaining 65 women received the treatment (33 underwent LOD and 32 received CC). After the primary treatment, more pregnancies (44%) occurred in women receiving CC than in those undergoing LOD (27%), although the difference did not reach statistical significance [P = 0.13, OR 2.1 (0.7 - 5.8)]. After adding the second treatment, the pregnancy rate was still higher, but to a less extent, in the CC group [63% versus 52%, P = 0.2, OR 1.6 (0.6 - 4.2)]. CONCLUSIONS: LOD is not superior to CC as a first-line method of OI in women with PCOS. The trial is registered with ClinicalTrials.gov with an identifier number NCT00220545.

How common is polycystic ovary syndrome in recurrent miscarriage?

The association between polycystic ovary syndrome (PCOS) and recurrent miscarriage (RM) has been long established, but the relative importance of this condition as a cause of RM is far from clear. Previous studies on the prevalence of PCOS in RM have been hampered by a lack of objective and universally accepted criteria for the diagnosis of PCOS, resulting in considerable controversy. However, the Rotterdam criteria have since been accepted as the gold standard for diagnosis of PCOS, and therefore these criteria have been used to produce a much clearer and more objective assessment of the prevalence of PCOS in RM. Three hundred women with recurrent miscarriage were studied. A diagnosis of PCOS was established via measurement of cycle length and day 21 serum progesterone, determination of the free androgen index and pelvic ultrasonography. All ultrasound reports prior to publication of the Rotterdam criteria were reviewed, ensuring consistency in the diagnosis of a polycystic ovary. Ultrasound scans of 27 patients confirmed polycystic ovaries with a further 10 scans suggestive of polycystic ovaries, but with insufficient information for the Rotterdam criteria to be applied. Hence, 27-37 (9.0-12%) patients presented with ultrasonographic polycystic ovaries. Using the Rotterdam criteria, 25-30 (8.3-10%) patients had PCOS. It is concluded that the prevalence of PCOS in RM is considerably lower than has previously been accepted.

A STAT4 variant increases liver fibrosis risk in Caucasian patients with chronic hepatitis B.

BACKGROUND: Host genetic modifiers of the natural history of chronic hepatitis B (CHB) remain poorly understood. Recently, a genome-wide association study (GWAS)-identified polymorphism in the STAT4 gene that contributes to the risk for hepatocellular carcinoma (HCC) was shown to be associated with the full spectrum of hepatitis B virus (HBV) outcomes in Asian patients. However, the functional mechanisms for this effect are unknown and the role of the variant in modulating HBV disease in Caucasians has not been investigated. AIMS: To determine whether STAT4 genetic variation is associated with liver injury in Caucasian patients with CHB and to investigate potential mechanisms mediating this effect. METHODS: STAT4 rs7574865 was genotyped in 1085 subjects (830 with CHB and 255 healthy controls). STAT4 expression in liver, PBMCs and NK cells, STAT4 phosphorylation and secretion of interferon-gamma (IFN-γ) according to STAT4 genetic variation was examined. RESULTS: STAT4 rs7574865 genotype was independently associated with hepatic inflammation (OR: 1.42, 95% CI: 1.07-2.06, P = 0.02) and advanced fibrosis (OR: 1.83, 95% CI: 1.19-2.83, P = 0.006). The minor allele frequency of rs7574865 was significantly lower than that in healthy controls. rs7574865 GG risk carriers expressed lower levels of STAT4 in liver, PBMCs and in NK cells, while NK cells from patients with the risk genotype had impaired STAT4 phosphorylation following stimulation with IL-12/IL-18 and a reduction in secretion of IFN-γ. CONCLUSION: Genetic susceptibility to HBV persistence, hepatic inflammation and fibrosis in Caucasians associates with STAT4 rs7574865 variant. Downstream effects on NK cell function through STAT4 phosphorylation-dependent IFN-γ production likely contribute to these effects.

The impact of obesity on female reproductive function.

Obesity may be described as the new worldwide epidemic, and its serious impact on morbidity and mortality are well known. As more and more women become obese, the reproductive problems associated with obesity present an ever-growing challenge to physicians involved in their fertility care. The spectrum of reproductive problems associated with obesity encompasses a wide range of disorders including infertility problems, miscarriage and pregnancy complications. In this review, we aim to discuss the impact of obesity on the various aspects of female reproductive function with focus on the clinical aspects of fertility problems in obese women. We finally comment on the available therapeutic options available to this group of women.

Involvement of alpha-receptors and potassium channels in the mechanism of action of sildenafil citrate.

Modulation of the adrenergic activity and interfering with channels such as potassium channels may affect relaxation and contraction of the corpus cavernosum. Sildenafil is a selective phosphodiesterase-5 inhibitor, proven effective in treating erectile dysfunction. In this study, the effect of sildenafil citrate on alpha-receptors modulation and potassium channels was tested. The direct relaxant effect of sildenafil citrate was studied by measuring changes in isometric tension in isolated strips of rabbit corpus cavernosum and rat aortic ring precontracted with phenylephrine or KCl compared to that of diazoxide in the presence and absence of tetraethylammonium. The inhibitory effect of sildenafil on electrical field stimulation-induced contraction of rabbit corpus cavernosum and rat anococcygeus muscle was also studied compared to that of phentolamine. Muscle relaxant effect of sildenafil (1 x 10(-9)-1 x 10(-6) M on phenylephrine-precontracted rabbit corpus cavernosum strips was not attenuated by N(G)-nitro-L-arginine (3 x 10(-5) M). Cumulative addition of sildenafil (1 x 10(-9)-1 x 10(-6) M) and phentolamine (1 x 10(-9)-1 x 10(-6) M) to the organ bath dose-dependently inhibited electrical field stimulation-induced contraction of rabbit corpus cavernosum and rat anococcygeus muscle, with almost similar EC(50) values. Sildenafil (1 x 10(-7) M) also inhibited phenylephrine-induced contraction of rat aortic rings by 39.83+/-3.01%. In addition, tetraethylammonium (1 x 10(-3) M) significantly attenuated the muscle relaxant effect of sildenafil (1 x 10(-9)-1 x 10(-6) M) on phenylephrine-precontracted strips of rabbit corpus cavernosum. Sildenafil citrate is capable of producing cavernosal smooth muscle relaxation by an additional mechanism that may involve alpha-receptors and potassium channel opening.

Laparoscopy or laparotomy for distal tubal surgery? A meta-analysis.

Of couples with subfertility, 25% have complete or partial blockage of the fallopian tube. Since the advent of in vitro fertilization (IVF), the role of tubal surgery has diminished. However, this type of surgery continues to be undertaken on selected patients with mild tubal disease, and in those with severe tubal disease, in centres where IVF is not available. This systematic review was undertaken to compare pregnancy outcomes after laparoscopic surgery with that of open microsurgical technique. Studies comparing laparoscopic techniques with conventional microsurgery requiring laparotomy for treatment of distal tubal disease were included. The relevant trials were identified from Cochrane Menstrual Disorders and Subfertility Groups of Specialised Register of Controlled Trials (searched up to July 2005). The following strategies were adapted using the OVID platform, MEDLINE (1966 to July 2005), Cochrane Central Register of Control Trials, CENTRAL, and EMBASE (1980 to July 2005). Outcomes analysed were: 'take home baby' rate, intrauterine pregnancy rate and ectopic pregnancy rate per pregnancy. Subgroup analysis was carried out to compare intrauterine pregnancy rate in the laparoscopy and conventional microsurgery groups according to the extent of tubal damage. Six relevant studies were identified. Overall, no significant difference was observed in the intrauterine pregnancy rate between the two groups, combined OR 1.32 (95% confidence interval [CI], 0.58 - 3.02). For patients with mild tubal disease, there was no significant difference in the intrauterine pregnancy rate between treatment and control group, OR 1.06 (95% CI, 0.42 - 2.70). For patients with severe tubal disease, there was a significantly increased intrauterine pregnancy rate in the laparotomy group, OR 0.34 (95% CI, 0.14 - 0.86). Appropriate patient selection is the main factor affecting outcome in terms of fertility. These data do not indicate a significant difference in pregnancy rates between open and laparoscopic techniques for lesser degrees of tubal damage. Other factors, such as costs and hospital stay, will come into the decision making, and are likely to favour laparoscopic techniques. If a decision is made to open the badly damaged tubes of a patient, then an open microsurgical technique should be employed.

Non-local means filter denoising for DEXA images.

Dual high and low energy images of Dual Energy X-ray Absorptiometry (DEXA) suffer from noises due to the use of weak amount of X-rays. Denoising these DEXA images could be a key process to enhance and improve a Bone Mineral Density (BMD) map which is derived from a pair of high and low energy images. This could further improve the accuracy of diagnosis of bone fractures, osteoporosis, and etc. In this paper, we present a denoising technique for dual high and low energy images of DEXA via non-local means filter (NLMF). The noise of dual DEXA images is modeled based on both source and detector noises of a DEXA system. Then, the parameters of the proposed NLMF are optimized for denoising utilizing the experimental data from uniform phantoms. The optimized NLMF is tested and verified with the DEXA images of the uniform phantoms and real human spine. The quantitative evaluation shows the improvement of Signal-to-Noise Ratio (SNR) for the high and low phantom images on the order of 30.36% and 27.02% and for the high and low real spine images on the order of 22.28% and 33.43%, respectively. Our work suggests that denoising via NLMF could be a key preprocessing process for clinical DEXA imaging.