The coupling between peripheral microcirculation and slow breathing.

Vasomotion (rhythmic changes in arteriolar diameter) is believed to enhance tissue perfusion at low oxygenation levels. We hypothesized that slow breathing and vasomotion may correlate temporally ("coupling"), especially at low oxygenation levels. We paced down spontaneous breathing to about 5 or 6breaths/min in 14 healthy subjects using device-guided breathing (DGB), and continuously monitored respiration, transcutaneous oxygen pressure ("oxygenation"), and skin capillary blood flow ("microflow") using a laser Doppler flowmeter. The coupling was expressed by cross-correlation calculated in 1-min time windows. Our main results illustrated that: (1) coupling increased gradually upon slowing breathing down in a subgroup, in which initial oxygenation was lower than a threshold of 30mmHg (0.3±0.2 vs. 0.07±0.2, P<10-6); (2) during DGB changes in oxygenation elicited opposite (relative) changes in microflow, with 4-fold higher sensitivity for low initial oxygenation relative to high (regression slope -0.094±0.010mmHg-1 vs. -0.020±0.002mmHg-1, P<10-6); (3) at low initial oxygenation, we observed larger coupling and (relative) microflow changes in younger subjects, and greater oxygenation changes in females (P<10-6 for all); (4) pulse pressure changes from before to after DGB were reduced by increased oxygenation changes during DGB (-5.5±7.4mmHg, r=-0.73, P<0.001). In conclusion, the present methodology can provide the variation trend of respiration-vasomotion coupling during DGB that may characterize microcirculation behavior at tissue oxygenation below a measurable threshold. The potential association of these trends and thresholds with pathologies or specific conditions of the cardiopulmonary system, and the possible role played by the neural sympathetic activity in that coupling, deserve further studies.

Interleukin-1 deficiency prolongs ovarian lifespan in mice.

Oocyte endowment dwindles away during prepubertal and adult life until menopause occurs, and apoptosis has been identified as a central mechanism responsible for oocyte elimination. A few recent reports suggest that uncontrolled inflammation may adversely affect ovarian reserve. We tested the possible role of the proinflammatory cytokine IL-1 in the age-related exhaustion of ovarian reserve using IL-1α and IL-1ß-KO mice. IL-1α-KO mice showed a substantially higher pregnancy rate and litter size compared with WT mice at advanced age. The number of secondary and antral follicles was significantly higher in 2.5-mo-old IL-1α-KO ovaries compared with WT ovaries. Serum anti-Müllerian hormone, a putative marker of ovarian reserve, was markedly higher in IL-1α-KO mice from 2.5 mo onward, along with a greater ovarian response to gonadotropins. IL-1ß-KO mice displayed a comparable but more subtle prolongation of ovarian lifespan compared with IL-1α-KO mice. The protein and mRNA of both IL-1α and IL-1ß mice were localized within the developing follicles (oocytes and granulosa cells), and their ovarian mRNA levels increased with age. Molecular analysis revealed decreased apoptotic signaling [higher B-cell lymphoma 2 (BCL-2) and lower BCL-2-associated X protein levels], along with a marked attenuation in the expression of genes coding for the proinflammatory cytokines IL-1ß, IL-6, and TNF-α in ovaries of IL-1α-KO mice compared with WT mice. Taken together, IL-1 emerges as an important participant in the age-related exhaustion of ovarian reserve in mice, possibly by enhancing the expression of inflammatory genes and promoting apoptotic pathways.

Adnexal torsion.

This review provides timely information concerning clinical, surgical, and pathologic findings of adnexal torsion (AT). AT mostly occurs in the child-bearing age group, but is not uncommon in premenarchal girls or postmenopausal women. When AT is suspected, urgent surgical intervention is indicated, and is usually performed by laparoscopy. Incidence of AT is 3.5% of all benign cystic teratomas. Despite the "necrotic" appearance of the twisted ischemic ovary, detorsion is the only procedure which should be performed at surgery. Adnexectomy should be avoided as ovarian function is preserved in 88% to 100% of cases. Awareness and suspicion of the diagnosis of AT is needed in patients who present with lower abdominal pain.

Perinatal outcome of teenage pregnancies in a selected group of patients.

STUDY OBJECTIVE: To explore the effect of young age on the outcome of teenage pregnancies by studying teenage deliveries in our unique population. DESIGN, SETTING, AND PARTICIPANTS: Retrospective chart review of teenage gravidas (age 19 and younger), who had delivered in our hospital. OUTCOME MEASURES: Mode of delivery, gestational age at delivery, newborn's weight and Apgar scores and maternal and neonatal complications. RESULTS: We recruited 565 teenage delivery cases from the hospital's computerized database. Mean maternal age was 18 (14-19). Most (96%) were married. Fifty-one percent were Jewish and 44% were Muslim. Most of the girls were nulligravidas. Mean gestational age at delivery was 39 weeks (33-44 weeks). A normal vaginal delivery ensued in 72.7%, while 9% had a cesarean section and 17.4% instrumental deliveries (compared to 85.75%, 10% and 4.25% in our adult population, respectively) and 1% underwent vaginal breech delivery. Mean birth weight was 3108 g (1450-4980 g). Apgar score of 9 at 5 minutes was recorded in 97.8% of the newborns. Prenatal care included a mean of 6 prenatal visits with a range of 1-18. The main complication was anemia; 41% had hemoglobin levels of less than 11 g/dL. The rate of other complications was low. CONCLUSIONS: In our homogenous group of teenagers, there was a similar complication rate as in the adult population. The only significant complication was anemia (less than 11 g/dL). There was a higher rate of instrumental deliveries and the cesarean delivery rate was slightly lower than in our adult population. Teenage pregnancy should not be considered as a high-risk situation as long as it is planned and followed with the normal routines of prenatal care.

The effect of the homeopathic remedies Arnica montana and Bellis perennis on mild postpartum bleeding--a randomized, double-blind, placebo-controlled study--preliminary results.

OBJECTIVE: To evaluate the effect of Arnica Montana and Bellis perennis on postpartum blood loss. DESIGN: Double blind, placebo-controlled, randomized, clinical trial. SETTING: Department of Gynecology, Shaare Zedek Medical Center, Jerusalem. INTERVENTIONS: Forty parturients were randomized to one of three groups: Arnica montana C6 and Bellis perennis C6 (n=14), Arnica montana C30 and Bellis perennis C30 (n=14), or double placebo (n=12). After 48 h the Arnica/placebo was halted, and patients continued the Bellis/placebo until cessation of lochia. MAIN OUTCOME MEASURES: Hemoglobin levels (Hb) at 48 and 72 h postpartum. RESULTS: At 72 h postpartum, mean Hb levels remained similar after treatment with homeopathic remedies (12.7 versus 12.4) as compared to a significant decrease in Hb levels in the placebo group (12.7 versus 11.6; p<0.05), in spite of less favorable initial characteristics of the treatment group. The mean difference in Hb levels at 72 h postpartum was -0.29 (95% CI -1.09; 0.52) in the treatment group and -1.18 (95% CI -1.82; -0.54) in the placebo group (p<0.05). CONCLUSION: Treatment with homeopathic Arnica montana and Bellis perennis may reduce postpartum blood loss, as compared with placebo.