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An integrated approach using a three-dimensional (3-D) seismic survey over the Chevron-operated Bibiyana field in Bangladesh along with petrophysical well data and cores provides new insights into the stratigraphic development of the Miocene–early Pliocene Ganges Delta. From this, a sequence stratigraphic model was constructed for the Bibiyana field that more accurately depicts the internal architecture of the reservoir units of the field. As of 2019, Bibiyana field was producing approximately 1.3 billion SCF/day of gas and accounted for more than 45% of Bangladesh’s daily gas supply. The 3-D seismic volumes covering the field area were stratigraphically flattened using multihorizon seismic flattening techniques. The well-log data were also flattened to enable the wells to be tied and visualized within the flattened domain. Core data from the field were examined, interpreted, and integrated into the stratigraphic model. Reservoirs at Bibiyana are divided into a series of sequence stratigraphic units, each recognized by a seismically defined sequence boundary at both the base and the top of the units. Two types of major reservoir sandstones were observed: (1) erosional remnants of shallow-marine, tidal sandstones below sequence boundaries and (2) channel sandstones at the base of incised canyons above sequence boundaries. The focus of this investigation was on the architecture of the main reservoir known as the BB60 series (Miocene Bokabil Formation), containing approximately 50% of the field reserves. The BB60 series reservoir is an erosional remnant below a major sequence boundary (SB60) sealed by the thick canyon-fill prodelta shale of the BB55 interval. Channelized sandstones and associated mass transport deposits are present locally at the base of the canyon and have reservoir properties that contrast with the underlying and adjacent shallow-water, tidal-dominated deltaic sandstones of the BB60 reservoir. Multihorizon flattening of the seismic and well data in concert with 3-D visualization reveals the complexly eroded canyon system, incised into the underlying tidal deltaic deposits of the BB60 series. Similar erosional patterns are present in the underlying BH series reservoirs (Miocene Bhuban Formation), and the conceptual model developed for the BB60 reservoir can be applied and aide the understanding of the deeper reservoirs that are less well imaged by the existing seismic data. The recognition that unconformities with overlying canyon-fill shales seal many of the reservoirs at Bibiyana is critical in understanding and modeling the reservoir architecture and performance over time.

There are many clinical conditions in which symptoms and signs can overlap, resulting in a real "clinical dilemma". Differential diagnosis is essential for identifying the pathology affecting a patient and consequently making the best therapeutic decisions. Herein we report a case of a young patient, with strong smoking habit, who looked for medical attention after experiencing chest pain, associated to upper airways inflammation. EKG revealed ischemic abnormalities, echocardiography showed a preserved ejection fraction (EF: 55%) and global cardiac contractility, although akinesia of the mid–segment of the inferolateral wall, and the presence of a mild inferolateral pericardial effusion. A concomitant increase in myocardial necrosis enzymes and inflammatory markers was observed in blood tests, but the coronarography showed undamaged coronary arteries. This clinical picture characterized by the young age of the patient, by the intercurrent inflammatory event, by the presence of pericardial rubbing on physical examination, by the evidence of echocardiographic end EKG anomalies in the absence of documentable epicardial lesions and by the complete symptomatic remission after anti – inflammatory therapy with acetylsalicylic acid and Colchicine was highly suggestive of pseudoinfarct–presenting myopericarditis. To confirm such diagnosis, cardiac magnetic resonance (CMR) was requested, unexpectedly, it showed oedema on the mid–basal inferolateral T2–weighted STIR sequences, but also microvascular obstruction (MVO) on early EGE contrastographic sequences mid–basal inferolateral site, and finally evidence of transmural fibrosis in the same site to the DE sequences resulting in pathognomonic lesions for acute ischemia in absence of epicardial coronaropathy. CMR imaging, which is able to analyse cardiac structure and function and simultaneously provide tissue characterization, has been an essential investigation for the diagnosis of MINOCA, as CMR can readily pinpoint many conditions responsible for myocardial damage and allow pathological discrimination of patients. Our patient‘s final diagnosis was “STEMI, MINOCA, and concomitant pericarditis” implying a consequent therapeutic modification, introducing DAPT. Making differential diagnosis in similar clinical conditions characterized by overlapping presentations, allows the use of personalized therapeutic strategies for each patient and better final results.

Background Dual antiplatelet therapy (DAPT) has important implications for clinical outcomes in coronary disease. Nevertheless, the risk for bleeding often impact on the long–term administration of DAPT. The aim of this study was to evaluate the determinants of bleeding risk after ACS. Methods This was a subanalysis of the PONTE ACS study. The PONTE ACS study is a prospective, longitudinal, cohort study which enrolled patients who were discharged from HUB centres of ASL BARI after coronary revascularization and/or ACS. They underwent clinical evaluation at 30 days, 3, 6 and 1 year–follow–up. The data were collected after including the data in the electronic medical record of the PONTE ACS study. Anthropometric, clinical and pharmacological parameters, instrumental and laboratory examinations were included. Data were computed in order to evaluate the major determinants of all–cause bleeding at one–year follow–up. Results We finally enrolled 2476 patients (77.4% male, mean age: 67.2±12.0 years). Pharmacological treatments were optimized during the follow–up visits. According to anti–thrombotic therapies, 92.1% of patients persisted on DAPT at one–year follow–up. The number of patients on DAPT+anticoagulant were: 4.4%. All–cause bleeding occurred in 2.2% of patients. Anthropometric characteristics (height [β: –0.04594 ± 0.01610, p = 0.0044] and weight [β: –0.03043 ± 0.01035, p = 0.033]), male gender [β: –0.7008 ± 0.2818, p = 0.0129], and age [β: 0.02535 ± 0.01219, p = 0.0376] were the major determinants of all–cause bleeding at univariate regression analysis but they were not confirmed at multivariate regression analysis (p=ns). Kaplan Meier curve points out the impact of age on all–cause bleeding (Figure 1). Nor DAPT or triple therapy remained associated with all–cause bleeding at one year follow–up. Conclusions Long–term DAPT is not a predictor of all–cause bleeding in patients who suffered ACS and/or coronary revascularization.

Background Heart rate is able to impact on the prognosis if patients with cardiovascular diseases. The aim of this study was to evaluate the impact of heart rate at discharge of patients with ACS and/or coronary revascularization on long–term follow–up Methods This was a subanalysis of the PONTE ACS study. The PONTE ACS study is a prospective, longitudinal, cohort study which enrolled patients who were discharged from HUB centres of ASL BARI after coronary revascularization and/or ACS. They underwent clinical evaluation at 30 days, 3, 6 and 1 year–follow–up. The data were collected after including the data in the electronic medical record of the PONTE ACS study. Anthropometric, clinical and pharmacological parameters, instrumental and laboratory examinations were included. Data were computed in order to evaluate the major determinants of all–cause mortality at one–year follow–up. Results We finally enrolled 2476 patients (77.4% male, mean age: 67.2±12.0 years). Pharmacological treatments were optimized during the follow–up visits. Heart rate at discharge was 65.5 ± 11.3 bpm. At univariate regression analysis, age, systolic and diastolic arterial pressure, body mass index, smoke habit, diabetes, hypertension, high–density lipoprotein and total cholesterol, creatinine, haemoglobin, fasting glycemia, left ventricle ejection fraction, heart rate, use of ACEi/sartans, statins, dual/triple anti–thrombotics were all related to all–cause mortality. Nevertheless, at multivariate Cox regression analysis, age (β coefficient: 0.07117 ± 0.01942, p = 0.0002), history of hypertension (1.4823 ± 0.7476, p = 0.0474), and heart rate (0.04409 ± 0.01278, p = 0.0006) remained related to the primary endpoint. Conclusions Heart rate confirmed to act as a long–term predictor of all–cause death in patients with ACS.

Near-field antennas have been successfully adopted in several wireless applications. To exploit the high reconfigurability of array antennas, multiple synthesis techniques for arrays operating in the near-field region have been proposed. Building upon previous works on eigenmode expansions of the radiated fields, two synthesis methods for the excitations of near-field arrays based on the definition of an inner product on the electromagnetic fields are investigated: the "maximum norm" and "minimum error field norm" methods. The "maximum norm" method computes the array excitations that maximize either the active power flow through a target surface or the electric/magnetic energy stored in an assigned volume, depending on the adopted inner product. The performance of the maximum active power flow method is compared with the one of the simpler conjugate phase method. Furthermore, the limit solution achieved when the target surface reaches the far-field region is compared against the "maximum Beam Collection Efficiency" method. The "minimum error field norm" method allows to synthesize a given target field. As an example, the latter method is used to find the optimal excitation of a Plane Wave Generator with a spherical quiet zone. The effectiveness and performance of the discussed synthesis methods are validated through numerical simulations.

Alles prufe der Mensch, sagen die Himmlischen,Das er, kraftig genahrt, danken fur Alles lern‘,Und verstehe die Freiheit,Aufzubrechen, wohin er will.Friedrich Holderlin, “Lebenslauf”Given how thorou...

A novel type of Coronavirus was identified in China in December 2019. The first cases of a form of pneumonia of unknown etiology were detected at the beginning of that month in Wuhan. The virus is believed to have emerged at the Wuhan Huanan Seafood Market, where transmission of a zoonotic pathogen to humans occurred.Some studies conducted in China during the epidemic report small numbers of pregnant women infected with SARS-CoV-2 and some pregnancy complications in patients with COVID-19. However, they fail to document the transplacental passage of the virus from mother to fetus.Following the COVID-19 outbreak, guidelines for couples who are undergoing treatments of assisted reproduction have been issued by the International Federation for Fertility Societies (IFFS), the American Society for Reproductive Medicine (ASRM), the European Society of Human Reproduction and Embryology (ESHRE) and the Latin American Network of Assisted Reproduction (REDLARA). They recommend couples to discuss assisted reproduction with their doctors while those at risk or with SARS-CoV-2 should consider freezing oocytes or embryos and retransferring them later.Other than the US, Italy is the country with the highest number of cases (197675 positives, 26644 deaths) (updated on April 26). The Italian National Transplant Centre and the Higher Institute of Health advised on March 17 to complete the cycles already started and not to start new cycles. Phase 2 will begin on 4 May with an increase in freedom of action and fertilization treatments will start again. The Society that brings together embryologists (SIERR) has issued the guidelines to be followed when this happens.

To counteract the arising problem of couple infertility, having good quality gametes is increasingly important. A molecule that seems to be useful to favor this condition is myo-inositol (MI), the most common stereoisomer of the inositol family, involved as second messenger in several cell pathways (osmoregulation, chromatin remodeling, gene expression, etc.). To evaluate this possibility, a treatment with myo-inositol in idiopathic infertile couples was performed in this randomized, placebo-controlled study.86 couples were enrolled and randomly assigned to two groups, treated either with MI (Xyminal®, Lo.Li. Pharma Srl, Rome, Italy) or placebo suppositories, to evaluate the effects on sperm motility, cervical mucus quality and pregnancy rate. Moreover, in pregnancy cases, all routine controls on gestation progress and foetal health were performed to confirm the safety of this treatment.As showed in this study, MI treatment allows an increase of total sperm motility (54.42 ± 8.72) in comparison to placebo group (46.21 ± 5.33). Moreover, MI mildly improves cervical mucus quality and increases the number of pregnancies (18.60%) in comparison to the placebo group (6.97%).MI improves sperm motility and cervical mucus quality, increasing the probability of conception. The absence of adverse events both for the mother and the foetus confirmed the safety of this molecule in pregnancy, supporting even more its use for couples seeking pregnancy.

The aim of the study is to investigate the efficacy of a treatment with myoinositol plus L-tyrosine, selenium, and chromium in women with polycystic ovarian syndrome (PCOS).One hundred and eighty-six women, with diagnosis of PCOS, were divided in four groups according to their clinical features. Phenotype A: androgen excess + ovulatory dysfunction + polycystic ovarian morphology. Phenotype B: androgen excess + ovulatory dysfunction. Phenotype C: androgen excess + polycystic ovarian morphology. Phenotype D: ovulatory dysfunction + polycystic ovarian morphology. All patients were given daily for six months a compound with 2 g myo-inositol, 0.5 mg L-Tyrosine, 0.2 mg folic acid, 55 mcg selenium, 40 mcg chromium. Hormonal assessment, BMI, Ferriman-Gallway Gallway score, HOMA index, and follicular monitoring were reported before starting the therapy, three months and six months after.Phenotype A showed an improvement, consistent with restored ovulation: more regular length of the menstrual cycle, detection of periovulatory follicle at ultrasound, and rising of progesterone in the luteal phase. A total of 45 patients (65.2%) ovulated after six months. In the same period glucose and HOMA index decreased. In the phenotype B, 80% of patients ovulated after six months. An improvement of the clinical and biochemical sign of hyperandrogenism was also reported. In the phenotype C, after BMI had followed the treatment for six months, it decreased in a statistically significant manner. In the phenotype D, 49 out of 82 women (59.7%) restored their regular menstrual period and ovulated.Our study reported how the synergistic action of myoinositol, L-tyrosine, selenium, and chromium could restore normal menstrual cycle, ovulation, and decrease weight in these patients.

Granulocyte-macrophage colony-stimulation factor plays different crucial roles during embryo implantation and subsequent development. Here we aimed to evaluate the effects of embryo cell culture medium, with the inclusion of granulocyte-macrophage colony-stimulation factor (GM-CSF), on embryo development and pregnancy rate. To this end, we took advantage of our retrospective observational study to correlate the outcomes from two different culture media. We included in this study 25 unselected patient from our IVF Center that underwent heterologous IVF cycle with crypreserved oocytes. We analyze the fertilization rate, pregnancy rate, and embryo quality at different day of transfer obtained from two different media composition. Our results show that the rate of fertilization and the pregnancy rate were increased using medium added with this particular type of cytokines (GM-CSF).

This chapter focuses on Hedda’s experience of boredom and its relation to the modern condition of nihilism. While Hedda’s character has traditionally been seen as mysterious and erratic in her motivations, she in fact consistently pursues a project of existential and aesthetic autonomy as a way to overcome the alienation of modern life. In Ibsen’s play, however, her project ultimately founders through the disclosure of an ontological condition that undermines all attempts at establishing human values and meanings, whether relative or absolute.

To evaluate the efficacy of recombinant LH (r-LH) addition in the late phase of ovarian stimulation in patients with repeated implantation failure (RIF).66 infertile couples undergoing ICSI treatment due to male factor were allocated to group A (33) and to group B (33). Group A (29 subjects) received recombinant FSH (r-FSH) supplemented by r-LH in the late follicular phase starting the same day of GnRH-antagonist (GnRH-ant) administration, and group B (32 subjects) received r-FSH alone. All patients were stimulated with a GnRH-ant flexible protocol starting r-FSH on day 2 of a spontaneous or induced cycle. hCG (10000 IU) was administered by intramuscular route when at least 2 follicles reached 18 mm in diameter.Metaphase II (MII) oocytes with cytoplasmic maturation showed a significant difference in the r-LH group (89.02%) compared to the one with FSH alone (81.15%) (p0.01). The number of positive pregnancy test, 14 (48.3%) and 8 (25%), was significantly greater in the r-LH group compared to the group treated with r-FSH alone (p0.03). The number of gestational sacs was 20 in the r-LH group vs. 9 in the r-FSH group (p0.001). The implantation rate was significantly higher in the r-LH group compared to the r-FSH only group (19% vs. 7% respectively; p0.01). Also, a lower abortion rate was found in the r-LH group (21% vs. 37.5% respectively - p0.01).Ovarian stimulation should be personalized because it seems that some subgroups of patients, like those with RIF, reach a better clinical outcome with the addition of r-LH in the advanced follicular phase stimulation.

Recently, an increased scientific interest was focused on mild approaches for ovarian stimulation in clinical practice. Milder stimulation aims to develop safer and more patient-friendly protocols which are more physiological, less drug use, less expensive and the risks of treatment are highly minimized. To investigate the efficacy and safety of a mild ovarian stimulation protocol in patients at high risk of developing ovarian hyperstimulation syndrome (OHSS), compared to conventional long down-regulation protocol. This a prospective, open, randomized study, included 349 infertile patients considered at high risk of developing OHSS, undergoing in vitro fertilization treatment in two private assisted reproduction centers. The patients were randomized into two groups: group A (n = 148) had a mild/minimal stimulation protocol of recombinant FSH (rFSH) combined with GnRH antagonist. Group B (n = 201) (control group) had a standard long protocol of rFSH combined with GnRH agonist. There was no significant difference observed between the two groups regarding the mean number of oocytes retrieved per patient, mature metaphase II oocytes, fertilization rate, and embryo cleavage rate. Significantly higher implantation rate (21.5 vs 14.5 %) (p

This paper analyzes the relation between language, reality and truth inUnder Western Eyes by exploring the way in which opposed verbal- ideological positions in the novel struggle to impose differing narrative and interpretative frameworks on an extra-discursive reality. In the course of that struggle, I argue, this extra-discursive space reveals itself as intrinsically indeterminable, and therein undermines any particular perspective's claim to interpretative authority. As such, my analysis in- evitably also challenges the tendency in the secondary literature to read Kirylo Sidorovitch Razumov's final confession as a mode of discourse that provides a positive resolution to the problem of establishing the truth-value of opposing verbal-ideological structures in the novel. As I will show, readings of this kind not only radically underestimate the ex- tent of Conrad's skepticism, but also, and more importantly, fail to see thatthenovelinfactusesthatskepticismasawaytointroduceaninter- pretative position altogether independent of the logic of such particular perspectival hegemony. Instead of simply replicating the struggle be- tweendifferentpointsofviewwithinthenovel,astraditionalinterpreta- tions do, my analysis shows how the novel's very denial of epistemic priority to any particular position lays bare a higher interpretative per- spective dependent on them all. Such a perspective does not seek to es- tablish a distinction between truth and lies, but rather, as is proper to all fictioninthemodeofplay,totelltheformerthroughthelatter.

It is one of the least challenged suppositions of Ibsen criticism that Peer Gynt offers a satirical portrait of the titular hero's escapist flights of fancy.1 According to this canonical view, Ibse...

In his brilliant and influential Theorie des modernen Dramas, Peter Szondi famously claims that Ibsen's specific role in the crisis of modern drama is his thematization of the past. The past that I...

The young stellar object MWC 297 has been observed with the VLT interferometer equipped with the AMBER instrument. MWC 297 has been spatially resolved in the continuum with a visibility of 0.50 as well as in the Br gamma emission line where the visibility decrease to a lower value of 0.33. This change in the visibility with the wavelength can be interpreted by the presence of an optically thick disk responsible for the visibility in the continuum and of a stellar wind traced by Br gamma and whose apparent size is 40% larger. We validate this interpretation by building a model of the stellar environment that combines a geometrically thin, optically thick accretion disk model consisting of gas and dust, and a latitude-dependent stellar wind outflowing above the disk surface. The continuum emission and visibilities obtained from this model are fully consistent with the interferometric AMBER data. They agree also with existing optical, near-infrared spectra and other broad-band near-infrared interferometric visibilities. A picture emerges in which MWC 297 is surrounded by an equatorial flat disk that is possibly still accreting and an outflowing wind which has a much higher velocity in the polar region than at the equator. [abridged]

Subsurface sandstone samples of the Upper Jurassic (Oxfordian) Norphlet Formation erg deposits and (Kimmeridgian) Haynesville Formation sabkha deposits were collected from wells in the eastern Gulf of Mexico for U-Pb detrital zircon provenance analysis. Norphlet Formation samples in southwestern Alabama are characterized by detrital zircon ages forming two dominant populations: (1) 265– 480 Ma, associated with Paleozoic Taconic, Acadian, and Alleghanian orogenic events of eastern Laurentia, and (2) 950–1250 Ma, associated with the Grenville orogenies of eastern Laurentia. These detrital zircon ages indicate derivation from Laurentian and Laurentian-affi nity sources, including erosion of Paleozoic strata of the remnant Alleghanian fold-and-thrust belt and Black Warrior foreland basin, as well as Laurentian cratonic rocks exposed in remnant Appalachian orogenic highlands and eastern Gulf of Mexico rift-related horst blocks. In contrast, Norphlet Formation samples from the offshore Destin Dome exhibit a major population of 540–650 Ma zircon grains, along with a small population of 1900–2200 Ma zircon grains; these ages are interpreted to indicate contribution of sediment to the Norphlet erg from periGondwanan terranes sutured to eastern Laurentian, as well as from the Gondwanan Suwannee terrane, which remained attached to North America after the rifting

To evaluate the efficacy of pre-treatment of idiopathic oligozoospermic patients with r-hFSH to improve the clinical results of ICSI.82 infertile couples due to male factor who attended our center were included in the study. Thirty-six were randomized to the treatment group (group A) and forty-six to the control group (group B). The male partners in group A were treated with recombinant human FSH (r-hFSH; Gonal F®) 150 IU subcutaneously three times a week for a 3-months period. The control group (group B) did not receive any treatment. After the treatment couples of both groups underwent a cycle of ICSI.The fertilization rate was comparable in both groups. However, in the treatment group (group A), the clinical pregnancy rate was significantly higher (42%) compared to the control group (group B) (20%) (p0.02). Also, the implantation rate was significantly higher in treatment group (26%) compared to the control (15%) (p0.04). Miscarriage rate was lower (15.7%) in the treatment group than in the control (43.7%), and this difference was statistically significant (p0.05).Treatment of idiopathic male factor infertility with r-hFSH before ICSI improves clinical pregnancy rate, increases implantation rate and decreases the early pregnancy loss.

Aims. We study the geometry and kinematics of the circumstellar environment of the Be star Kappa CMa in the Br gamma emission line and its nearby continuum. Methods. We use the VLTI/AMBER instrument operating in the K band which provides a spatial resolution of about 6 mas with a spectral resolution of 1500 to study the kinematics within the disk and to infer its rotation law. In order to obtain more kinematical constraints we also use an high spectral resolution Pa beta line profile obtain in December 2005 at the Observatorio do Pico do Dios, Brazil and we compile V/R line profile variations and spectral energy distribution data points from the literature. Results. Using differential visibilities and differential phases across the Br gamma line we detect an asymmetry in the disk. Moreover, we found that kappa CMa seems difficult to fit within the classical scenario for Be stars, illustrated recently by alpha Arae observations, i.e. a fast rotating B star close to its breakup velocity surrounded by a Keplerian circumstellar disk with an enhanced polar wind. Finally we discuss the possibility for kappa CMa to be a critical rotator with a Keplerian rotating disk and try to see if the detected asymmetry can be interpreted within the "one-armed" viscous disk framework.

To evaluate the efficacy of two doses of recombinant (r)LH, 75 IU (recommended) or 37.5 IU, for follicular stimulation and outcomes in a randomized cohort of IVF patients.Randomized, prospective analysis.Private hospital incorporating an established IVF center.Women undergoing IVF who had a body mass index18 or35 and no abnormal karyotype, anovulation, oligomenorrhea, or any known endocrinopathy/illness.Pituitary desensitization was achieved with triptorelin (0.1 mg SC), and gonadotropin stimulation was performed with either rFSH alone (group A) or in combination with rLH in one of two doses: 37.5 IU (group B) or 75 IU (group C), daily.A range of endocrinologic, embryologic, clinical, and outcome parameters were evaluated.With rLH supplementation there was a significant increase in the incidence of implantation (9% for rFSH only [group A] vs. 11% and 16% with 37.5 IU rLH and 75.0 IU rLH [groups B and C], respectively) and clinical pregnancy (19% vs. 23% and 31%) (P.01 and P.04, respectively), whereas there was no difference in the multiple pregnancy rates. There was a significant (P.001) increase in the total units of rFSH used in proportion to the amount of rLH supplementation (2,645 U vs. 3,475 U and 3,681 U) and in the level of peripheral E(2) on the day of hCG administration (1,049 pg/mL vs. 1,640 pg/mL and 1,226 pg/mL) (P.001). There was no significant between difference in mean age, numbers of oocytes recovered, basal and downregulation hormone levels, or the incidence of fertilization in the absence or presence of rLH supplementation, but a higher incidence of grade 1 to 2 embryos was observed when rLH was supplemented.After pituitary desensitization, there was an increase in the incidence of implantation, clinical pregnancy, and delivery rates in patients stimulated with rFSH supplemented with rLH.

Twelve patients (17 cycles) who needed >3000 IU of recombinant FSH (rFSH) on previous follicular stimulation attempts for IVF using rFSH (group A) underwent further attempts (a total of 12 cycles) using rFSH supplemented with rLH from day 7 of stimulation (group B). There was no significant difference in the total quantitative administration of rFSH (mean: 4759 versus 4800 IU rFSH), days of stimulation (14.0 versus 12.6), number of M2 oocytes per patient (3.76 versus 4.17) or embryo morphology between group A and group B respectively. However, there was a significant increase in the incidence of fertilization (60.9 versus 86.0%; P = 0.006) and clinical (ongoing) pregnancies (1 versus 6; P = 0.022). The higher incidence of fertilization increased the mean number of embryos transferred per patient, although in this small group the data was not significant (1.75 versus 2.71). This preliminary clinical trial suggests that in poor responders superimposing rLH upon a down-regulated cycle stimulated with rFSH improves relevant outcome data; and this preliminary trial has encouraged the need for a larger and more detailed study.

In all, 1210 treatment cycles were divided into three categories for retrospective analysis according to the period of delay between oocyte retrieval (occurring at a fixed time after human chorionic gonadotrophin) and intracytoplasmic sperm injection (ICSI) of3 h, 3-5 h,5 h (referred to as 'delayed ICSI'). Three stages from oocyte to the birth of a live baby were identified for statistical analysis, (i) fertilization (2PN zygotes), (ii) cleavage of 2PN zygotes, (iii) transferred embryo to live birth. Stages 1, 2 and 3 were analysed statistically for the three time periods. Chi-square analysis showed no significant effect of delayed ICSI on fertilization (chi(2) = 3.615, P = 0.65), and embryo transfer to birth (chi(2) = 1.840, P = 0.399). The effect on cleavage was significant (chi(2) = 9.625, P = 0.008). However, shorter incubation times produced results which were better than the traditional longer ones. The success rate at the cleavage stage was so high that the marginal advantage had very little effect on the overall process. This study of a substantial patient sample establishes that ICSI on a peri-ovulatory oocyte (3 h after oocyte retrieval) does not compromise outcome parameters, and that longer periods of incubation (5 h) do not offer a statistically significant advantage.

The objective of this study was to examine different clinical scenarios of in-vitro conception, viz. fertilization with conventional IVF, IVF with high insemination concentration (HIC) and intracytoplasmic sperm injection (ICSI), and assess on a sibling oocyte comparison the hypothesis that ICSI should be performed in all cases requiring in-vitro conception. ICSI with husband's spermatozoa had a higher incidence of fertilization as compared with IVF or IVF with HIC with donor spermatozoa (if previous failure of fertilization had occurred) for unexplained infertility. Similarly, ICSI with husband's spermatozoa had as high an incidence of fertilization as IVF with donor spermatozoa for patients with severe oligozoospermia, asthenozoospermia and/or teratozoospermia, even when the spermatozoa were not selected for their morphology. Two studies were performed to assess ICSI in potential oocyte-related failure of IVF, viz. when fertilization occurred in >50% of oocytes for one group of patients, and in

Human reproductive evolution, involving a complex interaction of the hypothalamic-pituitary-ovarian axis, the release of pulsatile and threshold concentrations of gonadotrophins and positive and negative feedback systems, has ensured the release of a single viable egg and functioning corpora lutea in the natural menstrual cycle. The use of follicular stimulation regimens to obtain multiple eggs has resulted in a compromise - in terms of the risk of ovarian hyperstimulation, cost, multiple pregnancies, wastage of or the need for cryopreservation of surplus embryos. Even some women with apparently normal menstrual cycles might become 'poor responders' when administered with follicular stimulants, and we still do not know if the incidence of oocyte aneuploidy is artificially raised after stimulation. After the advent of recombinant FSH and LH, the precise roles of these hormones individually needs to be elucidated to understand the physiological requirements for successful ovarian stimulation in each woman undergoing IVF, to maximize her chance and minimise attendant risks. One of the key debates is the role of LH, which in the natural cycle is significant, but may be redundant during ovarian stimulation for IVF. Current outcome indicators are crude when attempting to understand the physiology, and more basic research and randomized, focused clinical trials are needed.

The selective precipitation from aqueous solutions of goat polyclonal anti-biotin antibody (pABA) by complexation with ligand-modified phospholipids (LMPs) is described. In this study, the effect of varying the acyl chain length of the LMP from six to 18 carbon atoms on the rate and yield of precipitation is detailed. As the acyl chain length increases, the hydrophobic driving force for interaction of ligand-bound antibody molecules also increases, resulting in a larger yield of precipitated antibody. The rate of selective precipitation, however, is observed to pass through a sharp maximum at an acyl chain length of 10-12 carbon atoms. In the range of target antibody and LMP concentrations studied (1-10 IM), the maximum rates of precipitation are observed for those LMPs in sufficiently low concentrations in aqueous solution to be below their critical micelle concentration (CMC). The longer chain length LMPs (12-18 carbon atoms at concentrations of 5-10 IM) gave considerably slower rates of precipitation and were all observed to be micellar solutions. The yield of target antibody as a percentage of antibody precipitated was not observed to pass through a maximum, rather all LMPs with acyl chain lengths longer than 12 carbon atoms were observed to give the maximum yield. Thus the optimal structure of an LMP for precipitation of a target antibody corresponds to the maximum chain length (10 carbon atoms) at a concentration level (5-10 IM) which still falls below its CMC. The kinetics of precipitation, as monitored by measuring turbidity, are well modelled by a theory which combines the Mie theory of light scattering with the Smoluchowski theory for the kinetics of precipitation. The maximum rate constants corresponding to Smoluchowski kinetics for precipitating pABA were approximately 25 000-30 000 M -1 s -1 , while the maximum yields were 65-70%. The molecular picture which emerges is one in which the optimal rate is obtained by maximizing hydrophobic driving force for interaction of LMP acyl chains while still maintaining a submicellar state of aggregation.

Human spermatids from ejaculate and testicular tissue have been utilized for evaluating human fertilization by intracytoplasmic sperm injection (ICSI) and, where possible, compared with spermatozoa utilizing sibling oocytes. Round and elongated spermatids obtained from ejaculates were either prepared through Percoll gradients or isolated and washed individually using subzonal insemination needles (SUZI; 10-14 microm internal diameter). Seminiferous tubules obtained after biopsy were placed into HEPES-buffered Earle's medium and dissected using 21-gauge needles. Spermatogenic cells and spermatozoa were isolated and washed individually using SUZI needles. Spermatozoa were subsequently injected into the ooplasm using 5 microm (internal diameter) ICSI needles, whereas 8-9 microm (internal diameter) needles were used for spermatid injection. Only metaphase II oocytes (n = 207) were injected: 64 with round spermatids, 92 with elongated spermatids and 51 with spermatozoa; the fertilization rate was 30, 24 and 67% respectively. There was a significant (P < 0.001) increase in the fertilization rate using spermatozoa compared with spermatids. The fertilization rate was not different between round and elongated spermatids, although the fertilization rates for round and elongated spermatids in the ejaculate were 33 and 18% respectively, compared with 22 and 38% respectively when testicular spermatids were utilized. In three patients sibling oocytes were used to compare round and elongated spermatids found in the ejaculate with spermatozoa extracted from seminiferous tubules. The fertilization rate was 24% for spermatids and 79% for testicular spermatozoa. This result suggests that, should only spermatids be available in the ejaculate, a testicular biopsy in the hope of obtaining testicular spermatozoa would be worth while.

^To whom correspondence should be addressed An ultrasonograp hic evaluation of the endometrium was performed in 158 patients undergoing ovarian stimulation for an in-vitro assisted reproduction programme. Endometrial thickness was evaluated in 109 patients undergoing in-vitro fertilization (TVF) for female indications and in 49 patients undergoing intracytoplasmic sperm injection (ICSI) for male indications. The maximal endometrial thickness was measured on the day of human chorionic gonadotrophin (HCG) administration by longitudinal scanning of the uterus on the frozen image using electronic callipers placed at the junction of the endometriummyometrium interface at the level of the fundus. Cases in which the endometrial thickness was 2*10 mm were included in group A; cases in which the endometrial thickness was