Warm saline effectiveness for pain relief in office hysteroscopy: A systematic review and meta-analysis of randomized controlled trials.

AIM: To evaluate the impact of warm distension medium versus room temperature distension medium on pain control among patients undergoing office hysteroscopy. METHODS: A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI web of science from inception to October 2021. We selected randomized clinical trials (RCTs) compared warmed saline distension medium in the intervention group versus room temperature distension medium in the control group among women undergoing diagnostic and/or operative office hysteroscopy. Revman software was utilized for performing our meta-analysis. Our primary outcomes were pain scores evaluated by the visual analog scale (VAS) during and after the procedure. Our secondary outcome was the patient satisfaction between both groups. RESULTS: Five RCTs met our inclusion criteria with a total number of 441 patients. We found warm saline was linked to a significant reduction in the VAS pain score during the procedure compared to the control group (mean difference [MD] = -1.12, 95% confidence interval [CI] [-1.80, -0.45], p = 0.001). Moreover, the VAS pain score after the procedure was significantly declined among the warm saline group (MD = -0.62, 95% CI [-0.97, -0.27], p = 0.005). Interestingly, more patients were significantly satisfied with warm saline distension medium application compared to room temperature group (odds ratio [OR] = 3.71, 95% CI [2.01, 6.86], p < 0.001). CONCLUSIONS: Warm saline application in office hysteroscopy is effective in reducing pain during and after the procedure as well as improvement in patient satisfaction.

The effect of cigarette smoking on human seminal parameters, sperm chromatin structure and condensation.

Considerable debate still exists regarding the effects of cigarette smoking on male fertility. This work aimed to explore effects of cigarette smoking on semen parameters and DNA fragmentation on 95 infertile patients who were divided into infertile male nonsmokers (45) and infertile male smokers (50). Smokers were subdivided according to a number of cigarettes smoked per day into mild (≤10), moderate (11-20) and heavy smokers (≥21). Semen analysis, sperm chromatin condensation integrity with aniline blue staining and sperm viability were compared between the study groups. A significant decrease has been shown in sperm count (p = .006), progressive motility (p = <.001), percentage of normal forms (p = <.001) and viability (p = .002) between infertile nonsmoker and infertile smokers. The percentage of abnormal sperm chromatin condensation was significantly higher in smokers compared to nonsmokers (p = <.001). A linear correlation was detected between the extent of cigarette smoking and the degree of worsening in progressive motility (p = .001), total motility (p < .001), viability (p < .001) and normal morphology (p < .001). These results indicate that cigarette smoking has detrimental effects on semen parameters. It negatively affected all conventional semen parameters in addition to sperm chromatin condensation and sperm viability. These abnormalities were also proportional to the number of cigarettes smoked per day and to the duration of smoking.

Assessment of seminal mast cells in infertile men with varicocele after surgical repair.

This study aimed to assess seminal mast cells in infertile men associated with varicocele (Vx) pre- and post-surgical repair. Forty-five infertile men associated with Vx were subjected to history taking and clinical examination. In addition, semen parameters and seminal mast cells stained with 1% toluidine blue were estimated pre-varicocelectomy and three months post-varicocelectomy. Vx surgical repair revealed a significant improvement in the mean sperm concentration, progressive sperm motility, total sperm motility and sperm abnormal morphology and a significant decrement in seminal mast cells (mean ± SD, 3.56 ± 2.23 cells per high-power field (HPF) vs. 2.22 ± 1.06 cells per HPF, p = .01). The pre-operative mean mast cell count demonstrated significant increases in cases with Vx grade III compared with other Vx grades and in cases with bilateral Vx compared with unilateral Vx cases. Seminal mast cells demonstrated a significant correlation with sperm concentration, progressive sperm motility and total sperm motility and a nonsignificant correlation with age and sperm abnormal morphology. It is concluded that seminal mast cells decrease significantly in infertile men with Vx after surgical repair showing a significant negative correlation with sperm concentration, progressive sperm motility and total sperm motility.

Slope climbing challenges, fear of heights, anxiety and time of the day.

When exposed to an unfamiliar open space, animals experience fear and attempt to find an escape route. Anxiety emerges when animals are confronted with a challenging obstacle to this fear motivated escape. High anxiety animals do not take risks; they avoid the challenge. The present experiments investigated this risk avoidant behavior in mice. In experiment 1, BALB/c, C57BL/6J and CD-1 mice were exposed to a large platform with downward inclined steep slopes attached on two opposite sides. The platform was elevated 75 and 100cm from the ground, in a standard (SPDS) and in a raised (RPDS) configuration, respectively. In experiment 2, the platform was elevated 75cm from the ground. Mice had to climb onto a stand at the top of upward inclined slopes (SPUS). In experiment 3, BALB/c mice were exposed to SPDS with steep or shallow slopes either in early morning or in late afternoon. In all 3 test configurations, mice spent more time in the areas adjacent to the slopes than in the areas adjacent to void, however only C57BL/6J and CD-1 crossed onto the slopes in SPDS, and crossed onto the stands in SPUS whereas BALB/c remained on the platform in SPDS and explored the slopes in SPUS. Elevation of the platform from the ground reduced the crossings onto the slopes in C57BL/6J and CD-1, and no differences were observed between BALB/c and C57BL/6J. BALB/c mice demonstrated no difference in anxiety when tested early morning or late afternoon; they crossed onto shallow slopes and avoided the steep one.

Electric activity of the rectosigmoid canal and its relation to rectal and sigmoid electric activity: an evidence of a sphincteric function of the rectosigmoid canal.

We have previously demonstrated that the rectosigmoid junction is more than a junction: it is a segment with a mean length of 2.8 cm which we termed the 'rectosigmoid canal' (RSC). Our data support the existence of a physiologic and anatomic sphincter at the RSC which regulates the passage of stools from the sigmoid colon (SC) to the rectum (R). In view of its sphincteric action we investigated the hypothesis that the RSC has a higher electric activity than that of the SC and R. The tests were performed during repair of huge incisional hernia in 11 subjects (age 46.7(12.5 years; 8 women). The electric activity was recorded by means of 2 monopolar electrodes applied to each of the SC, RSC and R. The RSC was then anesthetized with xylocaine and the electric activity of SC, RSC and R was recorded after 10 minutes and one hour. The test was repeated using saline instead of xylocaine. The SC, RSC and R exhibited electric activity in the form of pacesetter potentials (PPs) and action potentials (APs). The PPs were monophasic in the SC and triphasic in the RSC and R. The frequency, amplitude and conduction velocity of the waves recorded from the RSC and R had higher readings (p<0.05) than those from the SC. The RSC and R showed a similar frequency and conduction velocity, but the RSC had a higher amplitude (p<0.05). Ten minutes after RSC anesthetization, electric waves were recorded from the SC but not from the RSC or R; electric activity returned one hour after anesthetization. Saline injection of the RSC did not affect the electric activity of the RSC, SC or R. The electric wave pattern and parameters of the RSC and R differed from those of the SC, suggesting that they are evoked by 2 different pacemakers. The similarity in pattern, frequency and conduction velocity of electric waves of RSC and R supposedly denotes that the rectal waves are a continuation of those of the RSC and that both are evoked by a single pacemaker located in the RSC. The higher amplitude of the RSC waves may be due to the thicker RSC musculosa in comparison to that of the SC and R and may by itself be an evidence of the sphincteric function of the RSC.

Study of the mechanism of rectal motility: the 'mass squeeze contraction'.

The motor physiology of the rectum has remained largely obscure, especially concerning the mechanism of rectal motility. In the current communication we tested the possibility of characterizing the mechanism of rectal motility during filling and evacuation through the study of the rectal electric activity in 16 healthy volunteers (mean age 43.6 +/- 10.8 years; 11 men). Two monopolar silver-silver chloride electrodes were introduced per annum and fixed to the rectal mucosa by suction. The rectum was distended in 10 ml increments of water by means of a balloon-ended catheter inserted into the rectum. The rectal pressure was measured by one catheter placed above and a second one below the rectal balloon, and the 2 catheters were connected to 2 strain gauge pressure transducers. Regular triphasic slow waves or pacesetter potentials (PPs) were recorded from the 2 electrodes at rest. PPs were superimposed or followed randomly by action potentials (APs). APs but not PPs were coupled with elevated rectal pressure. Rectal distension with 10 ml of water caused no significant changes of the rectal pressure or EMG activity. Distension with a mean volume of 27.3 +/- 4.7 ml effected a significant increase (p < 0.05) of the rectal electromechanical activity proximally to the balloon and a decrease distally (p < 0.05) to it. With progressive increase of the rectal distension, the electromechanical activity continued to increase proximally and to decrease distally to the balloon, until, at a mean distending volume of 76.3 +/- 3.7 ml, the balloon was dispelled to the exterior. In conclusion, the identification of the modality of rectal motility during defecation was feasible by recording the rectal electromechanical activity. The rectal contraction is suggested to occur in a 'mass squeeze manner' which squeezes the rectal contents aborally into the anal canal. The recognition of the rectal motor modality appears to be important for the understanding of rectal motility disorders. However, further studies are required to confirm these findings.

Sex hormone status in male rats after exposure to 50 Hz, 5 mTesla magnetic field.

The question of whether extremely low frequency magnetic fields can affect biological system has attracted attention. The theoretical possibility of such an interaction is often questioned and the site of interaction is unknown. The influence of extremely low frequency magnetic field of 50 Hz, 5 mTesla on sex hormone status was studied. 60 male albino rats were divided into 6 groups and were continuously exposed to 50 Hz, 5 mTesla magnetic field generated by magnetic field chamber for periods of 1, 2 and 4 weeks. For each experimental point, sham treated group was used as a control. Assay of serum testosterone LH, FSH, and prolactin were performed. Serum testosterone showed no significant changes. FSH showed significant increase than sham exposed group after 1 week magnetic field exposure. LH showed significant increase than sham exposed group only after 4 weeks magnetic field exposure, while serum prolactin hormone level showed a significant increase in all magnetic field exposed groups than sham exposed animals. Exposure to 50 Hz, 5 mTesla magnetic field for periods of 1, 2 and 4 weeks has no effect on testosterone level, some changes on FSH and LH serum levels and increase in serum prolactin level.

Percutaneous peripheral neuromodulation in the treatment of fecal incontinence.

BACKGROUND/AIMS: To assess the results of peripheral neuromodulation for the treatment of fecal incontinence (FI) resulting from uninhibited rectal contraction (URC) or uninhibited anal sphincter relaxation (UASR). METHODS: The work comprised 32 patients (age 38.2 +/- 6.7 years; 22 women) with FI in whom conventional therapy had failed before enrollment in the study. Twenty-six had URC and 6 UASR. Peripheral neurostimulation was effected by posterior tibial nerve stimulation using a Stoller Afferent Nerve Stimulator (UroSurge, Coralville, lowa, USA). The needle was introduced into the skin cephalad to the medial malleolus. Stimulation (parameters: 0.5-10 mA, 200 micros, 20 Hz) was performed every other day for 4 weeks. Functional assessment was done by a questionnaire (incontinence score: 0-20) and physiologic studies. RESULTS: Group 1: 17 patients (13 URC, 4 UASR) had FI improvement, recording a mean score of 1.7 of 20. Group 2: 10 patients (8 URC, 2 UASR) had fair improvement (score 8.6). Group 3: 5 patients had poor results (score 14.8). Rectometric recording showed improvement in groups 1 and 2. Recurrence of symptoms occurred in 8 patients; 6 improved after retreatment. CONCLUSIONS: A percutaneous access to the S(3) spinal region was achieved through the posterior tibial nerve. Improvement of FI was achieved in 78.2%. The technique is simple, easy, without complications and cost-effective. It can be done as an outpatient procedure or by the patient at home. The results need to be reproduced on a large number of patients.

Study of the functional activity of the cecocolonic junction with identification of a "physiologic sphincter", "cecocolonic inhibitory reflex" and "colocecal excitatory reflex".

Radiologic, endoscopic and histomorphologic studies have suggested the presence of a sphincter at the cecocolonic junction (CCJ), while some investigators have denied its existence. To investigate the physiologic activity at the CCJ, the right colon was exposed during right hemicolectomy for early colonic cancer in 11 patients (mean age 43.6+/-12.3 years; 8 men). Three manometric catheters were introduced through colotomy to be separately located in the cecum, CCJ and ascending colon. We determined the CCJ pressure response to cecal and colonic distension by means of a balloon filled with saline in increments of 10 ml. The test was repeated after individual anesthetization of cecum, CCJ and ascending colon. The CCJ measured 1.6+/-0.6 cm in length and had a higher pressure ( p<0.05) than the cecum or colon. Large-volume cecal distension effected a significant CCJ pressure reduction which was augmented as the distension increased. Latency decreased upon increase of the distending volume. In contrast, the CCJ responded to large-volume colonic distension by pressure elevation which increased upon increase of the distending volume. Latency diminished with increased distension. Small-volume cecal or colonic distension effected no CCJ pressure response. The anesthetized CCJ did not respond to distension of the cecum or colon. Likewise, the CCJ did not exhibit a pressure response to distension of the anesthetized cecum or colon. The CCJ is a high-pressure zone which reacts to cecal or colonic distension by dilatation or narrowing, respectively. These data presumably denote the existence of a physiologic sphincter at the CCJ. We suggest that the CCJ pressure response to cecal or colonic distension is reflex and mediated through the cecocolonic inhibitory and colocecal excitatory reflexes, respectively. The role of the CCJ and related reflexes in colonic motility disorders needs to be studied.

Study of the effect of straining on the bulbocavernosus muscle with evidence of a straining-bulbocavernosus reflex and its clinical significance.

The bulbocavernosus muscle (BCM) surrounds the vaginal introitus and covers the vestibular bulb. Its role in erection is known. However, as it surrounds the vaginal introitus, it may also have a role in intravaginal pressure regulation and in the pathogenesis of uterovaginal prolapse. We investigated the effect of increased intra-abdominal pressure (IAP) on the BCM, aiming to assess its possible function in supporting the uterus, vagina and anorectum. The intrarectal (representative of the IAP) and intravaginal pressures were measured by manometric catheters in 19 healthy women volunteers (mean age 46.2 +/- 10.4 years). The EMG activity of the BCM and its response to straining at different pressures were recorded by a concentric needle electrode. Two types of straining were tested: sudden momentary and slow sustained. The procedure was repeated in 11 of the women after individual anesthetization of the BCM, rectum and vagina. Sudden straining (coughing) produced a significant increase in intrarectal ( P<0.0001) and intravaginal ( P<0.0001) pressure as well as BCM EMG activity. Slow straining effected a similar but lower response: the BCM responded gradually with pressure elevation, whereas the latency exhibited a gradual decrease. The BCM did not react to straining after individual anesthetization of the BCM, vagina and rectum, but did respond to saline administration. The results were reproducible. BCM contraction on straining postulates a reflex relationship, which we call the 'straining-bulbocavernosus reflex'. We hypothesized that this reflex is evoked by straining and results in BCM contraction and closure of the vaginal introitus. The vagina is believed to become a closed cavity, counteracting the increased intra-abdominal pressure and the uterine tendency to prolapse. The high pressure in the closed vaginal cavity presumably supports the rectovaginal septum against the high intrarectal pressure, and is suggested to share in the prevention of rectocele. The role of BCM in the pathogenesis of uterovaginal prolapse and rectocele needs further study.

Marked suppression of gastric ulcerogenesis and intestinal responses to stress by a novel class of drugs.

When exposed to prolonged stress, rats develop gastric ulceration, enhanced colon motility with depletion of its mucin content and signs of physiological and behavioral arousal. In this model, we tested whether antidepressants (fluoxetine and bupropion), anxiolytics (diazepam and buspirone) or the novel nonpeptide corticotropin-releasing hormone (CRH) type-1 receptor (CRH-R1) antagonist, antalarmin, modify these responses. Fluoxetine, bupropion, diazepam and antalarmin all suppressed stress-induced gastric ulceration in male Sprague-Dawley rats exposed to four hours of plain immobilization. Antalarmin produced the most pronounced anti-ulcer effect and additionally suppressed the stress-induced colonic hypermotility, mucin depletion, autonomic hyperarousal and struggling behavior. Intraperitoneal CRH administration reproduced the intestinal but not the gastric responses to stress while vagotomy antagonized the stress-induced gastric ulceration but not the intestinal responses. We conclude that brain CRH-R1 and vagal pathways are essential for gastric ulceration to occur in response to stress and that peripheral CRH-R1 mediates colonic hypermotility and mucin depletion in this model. Nonpeptide CRH-R1 antagonists may therefore be prophylactic against stress ulcer in the critically ill and therapeutic for other pathogenetically related gastrointestinal disorders such as peptic ulcer disease and irritable bowel syndrome.