Pediatric Foley Catheter Placement After Operative Hysteroscopy Does Not Cause Ascending Infection.

STUDY OBJECTIVE: To determine the incidence of postoperative ascending infection without antibiotics with the use of a pediatric Foley catheter (PFC) after operative hysteroscopy for intrauterine pathology. DESIGN: Retrospective case series (Canadian Task Force classification III). SETTING: University-affiliated outpatient medical center. PATIENTS: Patients who underwent operative hysteroscopy for uterine septum, arcuate uterine anomaly, or multiple submucosal myomas between 1992 and 2015. INTERVENTIONS: In all patients, a PFC was placed in the endometrial cavity at the conclusion of operative hysteroscopy and left in place for 7 days to reduce intrauterine adhesion formation. MEASUREMENTS AND MAIN RESULTS: A total of 1010 patients who underwent operative hysteroscopy for uterine septum (n = 479), arcuate uterine anomaly (n = 483), or multiple submucosal myomas (n = 48) were studied. All patients presented with infertility, recurrent pregnancy loss, or excessive uterine bleeding (in patients with submucous myomas). In all patients, a PFC was placed at the conclusion of the procedure and left in place for 7 days. An 8Fr PFC was used after hysteroscopic division of uterine septum or arcuate uterine anomaly, and a 10Fr PFC was used after hysteroscopic myomectomy. Patients with a history of pelvic inflammatory disease were excluded. Following PFC placement, patients were prescribed estrogen for 6 weeks and progestogen for the last 10 days of the estrogen course. No prophylactic antibiotic therapy was provided. All patients were discharged to home on the same day. Postoperative pain was well controlled with oral pain medication in 98.5% of the patients. There were no reported postoperative infections, and all patients had an uneventful recovery. CONCLUSION: In 1010 consecutive operative hysteroscopies followed by temporary (7-day) PFC placement, no clinically significant uterine infection was observed.

The effect of milling time on the preparation of an aluminum matrix composite reinforced with magnetic nanoparticles.

Powder metallurgy methods, particularly ball milling, are up-and-coming in tuning metal matrix composite (MMC) properties. This study uses ball milling at various milling times to create an aluminum matrix composite (AMC) reinforced with magnetite nanoparticles. The milling time was optimized to create an AMC with favorable mechanical and magnetic properties, and its effect on magnetism, microstructure, and hardness was studied. The AMC displayed the highest magnetic saturation of 11.04 emu/g after 8 h of milling. After compaction and sintering, characterization of the final composite material using Energy Disperse Spectroscopy and X-ray diffraction (XRD) showed the presence of Al2O3 and Fe3Al phases leading to enhanced mechanical properties in terms of Vickers hardness that reached a value of 81 Hv corresponding to an increase of 270% compared to unreinforced aluminum.

Mobile technology features and technostress in mandatory online teaching during the COVID-19 crisis.

Technostress is defined as any unhealthy condition caused by dealing with modern technology in various harmful ways; examples of technostress include addiction and stress. Even though technostress has been extensively studied in the literature, little attention has been paid to investigating technostress among academics who work in exceptional circumstances, such as crises, and who might be experiencing different psychological states due to those circumstances. To fill the gap, this study aims to explore the factors influencing technostress among school teachers. The study examined technostress's level and factor graphics structure among 692 academics from different Arab countries during COVID-19. The technostress factors and their stories were explored and measured using sequential mixed methods and confirmatory and exploratory factor analysis. The study discusses various factors' direct and indirect effects on mobile technology integration in education and the theoretical and practical implications of managing technostress in online classes. A model of techno-stressors among Arab academics was found to include: schedule overload, complexity, uncertainty, uselessness, invasion, and compulsion. The direct effect of various factors on mobile technology integration in education is mainly positive, while indirect effects are more varied. The theoretical and practical implications of managing technostress in online classes include: considering the psychological and physiological impact of technostress on students' learning performance, decreasing overall satisfaction with the learning experience, and improving the overall quality of online courses. As a result of this study's findings, a new perspective is provided on how academics in particular circumstances (in this study, the occupation of Palestine) may behave and feel toward technology in teaching.

Early initiation of gonadotropin-releasing hormone antagonist in polycystic ovarian syndrome patients undergoing assisted reproduction: randomized controlled trial ISRCTN69937179.

PURPOSE: To compare the implantation rates in two groups of women with Polycystic Ovary Syndrome (PCOS) after embryo transfer based on the initiation time of GnRH antagonist. Secondary outcome measures included clinical pregnancy, delivery and miscarriage rates. METHODS: This is a prospective, randomized trial in which 140 PCOS patients underwent ICSI, with 122 having ET performed. GnRH-antagonist was started on day 1 of stimulation in 69 patients (Group 1) or day 5 in 71 patients (Group 2). RESULTS: The overall implantation rate in Group 1 (46.2 %) was clinically higher than Group 2 (35.5 %), although not statistically significant (p = 0.075). For blastocysts transfer, the implantation rate in Group 1 was 55.1 %, compared to 40.4 % in Group 2 (p = 0.051). There was a clinically, but not statistically, higher clinical pregnancy rate (68.3 % vs. 56.5 %) and delivery rate (60.0 % vs. 53.2 %) per transfer in Group 1 compared to Group 2, respectively. There was a statistically significant lower biochemical pregnancy rate in Group 1 (2.4 %) compared to Group 2 (18.6 %) [p = 0.015]. There was no difference in miscarriage rates between the two groups. CONCLUSION: Our data suggest that early initiation of GnRH antagonist on day 1 of ovarian stimulation in PCOS patients undergoing ICSI-ET may improve implantation rates, especially after blastocyst transfer.

Use of the aromatase inhibitor letrozole for ovulation induction in women with polycystic ovarian syndrome.

Clomiphene citrate (CC) is the most commonly used oral agent for the induction of ovulation. It is a nonsteroidal selective estrogen receptor modulator that has predominant antiestrogenic action resulting in long-lasting estrogen receptor depletion. Side effects include antiestrogenic effects systemically and on the endometrium and cervical mucous. Letrozole is a potent, nonsteroidal, aromatase inhibitor, originally used for postmenopausal breast cancer therapy, at present its only registered indication. We hypothesized that letrozole could mimic the action of CC without depletion of estrogen receptors. As there is no estrogen receptor antagonism, antiestrogenic effects such as poor cervical mucus and thin endometrium are not expected with aromatase inhibitor treatment. In addition, because estrogen receptors in the brain are not depleted, normal negative feedback occurs with letrozole and generally results in monoovulation. We and others have demonstrated the success of aromatase inhibition in inducing ovulation in women with polycystic ovarian syndrome. Letrozole may be very effective for ovulation induction and pregnancy in cases of CC resistance. When used together with follicle-stimulating hormone (FSH) injections, letrozole resulted in a significant reduction in the FSH dose needed for controlled ovarian hyperstimulation. Aromatase inhibitors likely increase ovarian sensitivity to FSH, and may be useful in poor responders and in women undergoing ovarian stimulation for in vitro fertilization. The safety of letrozole in pregnancy outcome studies has been demonstrated by examination of spontaneous pregnancy loss, multiple pregnancy rates, and congenital anomalies compared with a control group of infertility patients treated with CC. In addition, new data suggest that CC may result in cardiac anomalies and other birth defects and in low birth weight babies. We believe aromatase inhibitors are acceptable alternatives to CC as first line oral agents for ovulation induction or controlled ovarian stimulation.

Aromatase inhibitor letrozole: a novel treatment for ectopic pregnancy.

OBJECTIVE: To study the use of the aromatase inhibitor letrozole for treatment of ectopic pregnancy compared with methotrexate. DESIGN: Nonrandomized prospective cohort study. SETTING: University hospital. PATIENT(S): A series of 42 consecutive patients with undisturbed ectopic pregnancy. INTERVENTION(S): Counseling on treatment options, including surgical treatment (control group) versus medical treatment with methotrexate (group 1) or letrozole (group 2). MAIN OUTCOME MEASURE(S): Primary outcome: complete resolution of ectopic pregnancy determined by serum human chorionic gonadotropin (ß-hCG) levels below laboratory immunoassay detection. SECONDARY OUTCOMES: changes in the biochemical parameter of ovarian reserve, antimüllerian hormone (AMH), and hematologic changes associated with the two medical treatments compared with surgical treatment. RESULT(S): Each treatment group included 14 patients, and each patient made her own treatment choice. Complete resolution of ectopic pregnancy occurred in an equal number of patients: 12 out of 14 (86%) in each of the two medical treatment groups. Methotrexate treatment was associated with statistically significantly higher liver enzymes and lower blood platelets count. The decline in ß-hCG levels was faster in the letrozole group when compared with the methotrexate group. Three months after treatment, AMH levels were lower in the methotrexate group when compared with the letrozole and the surgery groups. However, the decline in ß-hCG and AMH levels was not statistically significant. CONCLUSION(S): To our knowledge, this is the first report in the literature on the success of letrozole for the medical treatment of ectopic pregnancy. The promisingly high resolution rate and better safety profile that letrozole has compared with a chemotherapeutic agent such as methotrexate should encourage further studies.

Swimming Back and Forth Using Planar Flagellar Propulsion at Low Reynolds Numbers.

Peritrichously flagellated Escherichia coli swim back and forth by wrapping their flagella together in a helical bundle. However, other monotrichous bacteria cannot swim back and forth with a single flagellum and planar wave propagation. Quantifying this observation, a magnetically driven soft two-tailed microrobot capable of reversing its swimming direction without making a U-turn trajectory or actively modifying the direction of wave propagation is designed and developed. The microrobot contains magnetic microparticles within the polymer matrix of its head and consists of two collinear, unequal, and opposite ultrathin tails. It is driven and steered using a uniform magnetic field along the direction of motion with a sinusoidally varying orthogonal component. Distinct reversal frequencies that enable selective and independent excitation of the first or the second tail of the microrobot based on their tail length ratio are found. While the first tail provides a propulsive force below one of the reversal frequencies, the second is almost passive, and the net propulsive force achieves flagellated motion along one direction. On the other hand, the second tail achieves flagellated propulsion along the opposite direction above the reversal frequency.

Safety and efficacy of two techniques of temporary ovarian suspension to the anterior abdominal wall after operative laparoscopy.

BACKGROUND: This retrospective study compares the safety and efficacy of temporary ovarian suspension (TOS) to the anterior abdominal wall using absorbable versus non-absorbable suture after operative laparoscopy to elevate the ovaries away from the ovarian fossa to reduce postoperative adhesion development. METHODS: Patients (n=152) underwent TOS to the anterior abdominal wall at the conclusion of surgery between 1998 and 2017. One hundred forty-two patients underwent operative laparoscopy for advanced stages of endometriosis (93.4%) and 10 patients for other indications (6.6%). In 78 patients the ovaries were suspended to the fascia using absorbable 3-0 plain catgut sutures (Group 1). In 74 earlier patients non-absorbable 3-0 mono-lamentous nylon was used to suspend the ovaries to the anterior abdominal (Group 2). RESULTS: In both groups there was no reported incidence of any major intra-operative complications such as bleeding, or late complications such as infection, hematoma or bowel herniation through the suture loop and its sequalae (bowel obstruction or strangulation). In all patients in both groups the ovaries were present in its anatomical location on transvaginal ultrasound scan, one week after surgery following absorption or removal of the TOS suture. There was no significant difference in clinical pregnancy (34.3% vs 44.2%) and delivery (31.3% vs 36.5%) rates in patients who conceived with non-IVF methods between Group 1 and Group 2 respectively. CONCLUSIONS: TOS to the anterior abdominal wall, using absorbable or non-absorbable sutures, in an attempt to reduce postoperative adhesion development between the ovary and ovarian fossa, is simple, safe, easy to learn, and has potential effectiveness.

An Investigation of the Sensing Capabilities of Magnetotactic Bacteria.

We investigate the sensing capabilities of magnetotactic bacteria (Magnetospirillum gryphiswaldense strain MSR1) to MCF-7 breast cancer cells. Cancer cells are allowed to grow inside a capillary tube with depth of 200 $\mu \mathrm {m}$ and motion of magnetotactic bacteria is investigated under the influence of oxygen gradient and geomagnetic field. The influence of cancer cells is modeled to predict the oxygen gradient within the capillary tube in three-dimensional space. Our experimental motion analysis and count of motile magnetotactic bacteria indicate that they migrate towards less-oxygenated regions within the vicinity of cancer cells. Bands of magnetotactic bacteria with average concentration of 18.8±2.0% are observed in close proximity to MCF-7 cells $(h = 20~ \mu \mathrm {m})$, whereas the concentration at proximity of $190~ \mu \mathrm {m}$ is 5.0 ± 6.8%.

Review: aromatase inhibitors for ovulation induction.

CONTEXT: For the last 40 yr, the first line of treatment for anovulation in infertile women has been clomiphene citrate (CC). CC is a safe, effective oral agent but is known to have relatively common antiestrogenic endometrial and cervical mucous side effects that could prevent pregnancy in the face of successful ovulation. In addition, there is a significant risk of multiple pregnancy with CC, compared with natural cycles. Because of these problems, we proposed the concept of aromatase inhibition as a new method of ovulation induction that could avoid many of the adverse effects of CC. The objective of this review was to describe the different physiological mechanisms of action for CC and aromatase inhibitors (AIs) and compare studies of efficacy for both agents for ovulation induction. EVIDENCE ACQUISITION: We conducted a systematic review of all the published studies, both controlled and noncontrolled, comparing CC and AI treatment, either alone or in combination with gonadotropins, for ovulation induction or augmentation, identified through the Entrez-PubMed search engine. EVIDENCE SYNTHESIS: Because of the recent acceptance of the concept of using AIs for ovulation induction, few controlled studies were identified, and the rest of the studies were pilot or preliminary comparisons. Based on these studies, it appears that AIs are as effective as CC in inducing ovulation, are devoid of any antiestrogenic side effects, result in lower serum estrogen concentrations, and are associated with good pregnancy rates with a lower incidence of multiple pregnancy than CC. When combined with gonadotropins for assisted reproductive technologies, AIs reduce the dose of FSH required for optimal follicle recruitment and improve the response to FSH in poor responders. CONCLUSIONS: Preliminary evidence suggests that AIs may replace CC in the future because of similar efficacy with a reduced side effect profile. Although worldwide experience with AIs for ovulation induction is increasing, at present, definitive studies in the form of randomized controlled trials comparing CC with AIs are lacking.