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Hybrid multilevel converters using bidirectional thyristors and IGBTs have gained significant interest in recent times, as they possess important features of both voltage-source and line-commutated converter technologies. This article presents a classification of hybrid multilevel converters for HVdc applications. The methodologies to derive, evaluate, and select these converter topologies are proposed as well. The hybrid converters are classified from the power device to the system configuration based on the analogy of the voltage-source converter and the current-source converter. Derivation methods of hybrid cell, cluster, arm, phase, and converter, based on the topology tree presented in this article, are applied to derive both existing and new hybrid converters. Comparisons show that hybrid converters have functionality similar to either the modular multilevel converter or the line-commutated converter, depending on the ratio between thyristor and active switch IGBT counts employed. Several hybrid-station configurations are discussed in order to suggest the most suitable converter topology for each configuration. The presented analysis can provide a point of reference and a useful framework for the future developments of hybrid multilevel converters for HVdc applications.

This article studies a new hybrid converter that utilizes thyristors and full-bridge (FB) arms for achieving high-power capability with reduced semiconductor power rating compared to the FB modular multilevel converter. The study covers the theoretical analysis of the energy balancing, the dimensioning principles, the maximum power capability, and the limitations imposed by the discontinuous operation of the converter. Based on the analysis of these aspects, the theoretical analysis is concluded by identifying the operational constraints that need to be fulfilled for maximizing the power capability of the converter. It is concluded that the maximum power capability can be achieved for a certain range of modulation indices and is limited by both the commutation time of the thyristors and the power angle. Moreover, the P – Q capability of the hybrid converter is presented and discussed. Finally, simulation and experimental results that confirm the theoretical analysis and the feasibility of the studied converter are presented and discussed.

Despite the advances in the field of reproductive medicine, implantation failure represents a challenging condition affecting 10–30% of patients subjected to in vitro fertilization (IVF). Research has focused on the identification of molecules playing crucial roles in endometrial receptivity, with the aim of designing predictive tools for efficient detection of the implantation window. To that end, novel molecular genomic and transcriptomic approaches have been introduced as promising tools to enable personalized approaches with the aim of optimizing embryo transfer dating. However, the clinical value of these approaches remains unclear. The aim of this study is to provide a systematic review and critical analysis of the existing evidence regarding the employment of commercially available novel approaches to evaluate endometrial receptivity. An Embase and PubMed/Medline search was performed on 1 February 2022. From the 475 articles yielded, only 27 were included and analyzed. The considerable heterogeneity of the included articles indicates the uniqueness of the implantation window, showcasing that the optimal time for embryo transfer varies significantly between women. Moreover, this study provides information regarding the technical aspects of these advanced molecular tools, as well as an analysis of novel possible biomarkers for endometrial receptivity, providing a basis for future research in the field.

Antioxidants isolated from plant materials, such as phenolics, have attracted a lot of attention because of their potential uses. This contributes to the idea of the biorefinery, which is a way to produce useful products from biomass waste. Olea europaea byproducts have been extensively investigated for their large contents in phenolics. Oleuropein is a phenolic compound abundant in olive leaves, with its molecule containing hydroxytyrosol, elenolic acid, and glucose. In this work, olive leaf extracts were treated using different combinations of ultrafiltration and nanofiltration membranes to assess their capacity of facilitating the production of hydroxytyrosol-enriched solutions, either by separating the initially extracted oleuropein or by separating the hydroxytyrosol produced after a hydrolysis step. The best performance was observed when an ultrafiltration membrane (UP010, 10,000 Da) was followed by a nanofiltration membrane (TS40, 200–300 Da) for the treatment of the hydrolyzed extract, increasing the purity of the final product from 25% w/w of the total extracted compounds being hydroxytyrosol when membrane processes were not used to 68% w/w.

The objective of the study was to evaluate the psychological effect of an intervention of 8 stress-management sessions in women undergoing in vitro fertilization (IVF). Moreover, the overall IVF success was assessed against the fluctuation of the participants' stress levels. A total of 144 women participated in the study with 74 of them in the intervention group and 70 women in the control group. Demographics and medical history of all participants were recorded. The intervention group only underwent 8 weekly stress management sessions. During the 1st and 8th week of the study, both groups completed the Depression, Anxiety, Stress Scale 21 (DASS-21), the Perceived Stress Scale 14 (PSS-14) and the Fertility Problem Inventory (FPI). Following the intervention, the outcome of the IVF cycles, as defined by clinical pregnancy rates, were recorded. Our results indicated that total stress in the intervention group declined significantly (p

Introduction: We aimed to investigate the incidence of hypertension and to identify potential risk factors in healthy, non-diabetic recently postmenopausal Greek women with normal renal function.Pa...

Infertility patients are willing to travel abroad to receive the medical treatment of choice. A 2010 study reported that approximately 25,000 couples travel abroad annually seeking infertility treatment. The purpose of this review is to analyze the criteria and risks related to cross-border reproductive care (CBRC) from the perspective of the patients and explore the issues raised regarding the country of origin and the destination country. A computerized search was performed in PubMed employing respective keywords. The total number of published articles provided by our PubMed search was 1905. Criteria for selecting the destination country include: the economic status, legislation, quality of care and anonymity. Despite the fact that CBRC is becoming a familiar concept, it raises concerns for the practitioner and issues of a social and bioethical nature. Most of them stem from the fact that health care acquires a commercialization aspect. Medical tourism entails several risks, such as misconceptions regarding the destination country, and legal issues arising from differences in the judiciary systems. Larger studies evaluating all aspects of CBRC are imperative. Quality assurance, a consensus and a common platform of practice, along with a system of international governance based on human rights, are a necessity for CBRC patients.

This systematic review aimed to investigate the inconsistency of research data concerning the contribution of systematic psychosocial interventions to infertility treatments. More specifically, the objective of this review was to investigate the cause of the contradictions in the results of contemporary research with respect to the role of systematic psychosocial interventions in the success of fertility treatments. The suspected cause of these contradictions is the heterogeneity of the relevant clinical studies with respect to their methodology. Thus, the specific aim of the current review was to evaluate the degree of heterogeneity of certain parameters in the design of the relevant clinical studies during the last decade, including sample heterogeneity, assisted reproductive technology methods, types of psychosocial interventions and methods of recording and analyzing psychometric data. This investigation may be considered imperative considering that despite the great number of relevant clinical studies and their meta-analyses, there are still no conclusive results concerning the potential of improving fertility through psychosocial support. Search for relevant studies was performed employing the PubMed and Google Scholar databases based on specific criteria. According to these criteria the selected publications have been meta-analyses of clinical studies on humans, evaluating the effect of psychosocial interventions on the success of assisted reproductive treatments during the last decade. The studies may have included all the different infertility etiologies, as well as all types of assisted reproductive treatments. The extensive search based on the specific inclusion/exclusion criteria resulted in reporting results from 6 studies in total. The clinical studies included have reported on various types of interventions for psychosocial support such as individual, couples' or group therapies performed either in facilities offering mental health services or in the form of home-based self-treatment. Moreover, these studies investigated various techniques of stress management ranging from counseling to specialized methods such as biofeedback and diaphragmatic breathing or alternative techniques such as yoga and meditation. Our results suggest that clinical studies designed specifically to evaluate the effect of systematic interventions on the efficacy of fertility treatments are limited. Moreover, their degree of heterogeneity is highly significant with respect to included participants, treatment protocols, psychosocial support techniques as well as methods for the documentation and statistical analysis of psychometric data. Consequently, the conduction of well-design clinical studies based on strict criteria aiming to investigate specific infertility causes, similar fertility treatment protocols or particular types of psychosocial interventions is necessary in order to reach definitive conclusions.

Despite recent striking advances in assisted reproductive technology (ART), poor ovarian response (POR) diagnosis and treatment is still considered challenging. Poor responders constitute a heterogeneous cohort with the common denominator of under-responding to controlled ovarian stimulation. Inevitably, respective success rates are significantly compromised. As POR pathophysiology entails the elusive factor of compromised ovarian function, both diagnosis and management fuel an ongoing heated debate depicted in the literature. From the criteria employed for diagnosis to the plethora of strategies and adjuvant therapies proposed, the conundrum of POR still puzzles the practitioner. What is more, novel treatment approaches from stem cell therapy and platelet-rich plasma intra-ovarian infusion to mitochondrial replacement therapy have emerged, albeit not claiming clinical routine status yet. The complex and time sensitive nature of this subgroup of infertile patients indicates the demand for a consensus on a horizontally accepted definition, diagnosis and subsequent effective treating strategy. This critical review analyzes the standing criteria employed in order to diagnose and aptly categorize POR patients, while it proceeds to critically evaluate current and novel strategies regarding their management. Discrepancies in diagnosis and respective implications are discussed, while the existing diversity in management options highlights the need for individualized management.

Background and Objectives: The evaluative strength of available bibliometric tools in the field of clinical embryology has never been examined in the literature. The aim is to bring insight regarding the identity of clinical embryology research, introducing concerns when solely relying on the methodology of bibliometric analysis. Methods: An all-inclusive analysis of the most bibliometrically highlighted scientific contributions regarding the cornerstones of clinical embryology was performed employing the Scopus, Web of Science (WoS) and PubMed databases, between 1978&ndash, 2018. An analysis of the number of publications, respective citations and h-index, g-index, along with m-quotient is presented. The top 30 contributing authors for each distinctive area of research are listed. An attempt at visualizing the yearly published articles, clusters, and collaborations of authors, along with the geographic origin of publications, is also presented. Results: Combining all searches and keywords yielded 54,522 results. In the Scopus database, employing the keyword &ldquo, In Vitro Fertilization&rdquo, yielded 41,292 results. The publications of the top five authors in each research field were analytically presented and compared to the total number of publications for each respective field. The research field of Preimplantation Genetic Diagnosis/Screening/Testing was allocated the highest percentage of publications produced by the top five authors. Regarding journal bibliometrics, based on the year 2017 metrics, there are only 29 journals according to WoS that refer to &ldquo, Reproductive Biology&rdquo, ranking it 187th among 235 disciplines. The USA produced the highest number of publications (12,537). Conclusion: Results indicate an explosion of interest published in the literature regarding the field of clinical embryology. Further analysis on collaborations and the trends involved should be of added value as productivity between countries varies significantly. This may guide researchers, in vitro fertilization professionals, and prospective authors during literature search, while proving useful regarding manuscript design and concurring on keywords and abstract content.

Aim of the study was to examine the accuracy of embryo transfer based on the previous measurement of cervical length and total uterine length. The study has taken place in an academic-assisted reproduction clinic. 248 patients with infertility requiring IVF/ICSI treatment have been included. All patients underwent IVF/ICSI cycles with antagonist protocol and were treated with controlled ovarian stimulation using recombinant FSH (100–400 IU/day). On the day of oocyte retrieval, all patients were given vaginally natural micronized progesterone in a dose of 200 mg/tds. All patients had transvaginal ultrasound measurement of cervical length and endometrial cavity length prior to embryo transfer and measurement of embryo distance (intrauterine air bubbles) from fundal surface of uterine cavity and internal cervical os immediately after embryo transfer. Embryo transfer was performed on days 2–3. Primary outcome was to estimate the accuracy of embryo transfer based on the measurement of the embryo distance from middle of uterine cavity after embryo transfer and secondary outcome was to assess the effect of embryo distance from uterine fundus and internal cervical os to clinical pregnancy rate. The clinical pregnancy rate was 42.7%. The mean embryo distance from the middle of endometrial cavity was 0.48 ± 0.02 cm, the mean embryo distance from the uterine fundus was 0.88 ± 0.32 cm, and from the internal cervical os was 1.67 ± 0.45 cm. Multiple regression analysis showed that the embryo distance from middle of cavity was related to endometrial cavity length and to the embryo distance from the fundus and it was not related to Cx length, total uterine length, embryo distance from internal Cx os, and embryo transfer length. Embryo transfer with the previous measurement of total uterine length and estimation of embryo transfer length can be performed with very good accuracy by a single operator.

Objective To assess the long-term outcomes of tension-free vaginal tape obturator (inside-out) (TVTO) with or without anterior colporrhaphy. Methods The present prospective follow-up observational study included patients attending the 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Greece, between April 3 and December 20, 2017, for follow-up care after treatment for urodynamic stress urinary incontinence (USUI) with or without cystocele. Patients without cystocele had been treated with TVTO only; those with cystocele underwent TVTO with anterior colporrhaphy. The primary outcome was the objective cure rate assessed by the cough stress test during filling cystometry. Results Follow-up data were available for 70 patients who underwent TVTO only and 38 who underwent TVTO and anterior colporrhaphy. The mean follow-up period was 13 years. Objective cure was achieved for 57 (81%) patients in the TVTO-only group and 32 (84%) patients in the TVTO and anterior colporrhaphy group. Regarding cystocele management, objective cure was recorded for 35 (92%) patients. Conclusion At 13-year follow-up, anterior colporrhaphy demonstrated a cure rate of 92% in the management of cystocele, and 84% in the management of cystocele and USUI when combined with TVTO. TVTO alone for the management of USUI had an objective cure rate of 81%.

Assisted reproductive technology has evolved tremendously since the emergence of in vitro fertilization (IVF). In the course of the recent decade, there have been significant efforts in order to minimize multiple gestations, while improving percentages of singleton pregnancies and offering individualized services in IVF, in line with the trend of personalized medicine. Patients as well as clinicians and the entire IVF team benefit majorly from 'knowing what to expect' from an IVF cycle. Hereby, the question that has emerged is to what extent prognosis could facilitate toward the achievement of the above goal. In the current review, we present prediction models based on patients' characteristics and IVF data, as well as models based on embryo morphology and biomarkers during culture shaping a complication free and cost-effective personalized treatment. The starting point for the implementation of prediction models was initiated by the aspiration of moving toward optimal practice. Thus, prediction models could serve as useful tools that could safely set the expectations involved during this journey guiding and making IVF treatment more effective. The aim and scope of this review is to thoroughly present the evolution and contribution of prediction models toward an efficient IVF treatment.IVF: In vitro fertilization; ART: assisted reproduction techniques; BMI: body mass index; OHSS: ovarian hyperstimulation syndrome; eSET: elective single embryo transfer; ESHRE: European Society of Human Reproduction and Embryology; mtDNA: mitochondrial DNA; nDNA: nuclear DNA; ICSI: intracytoplasmic sperm injection; MBR: multiple birth rates; LBR: live birth rates; SART: Society for Assisted Reproductive Technology Clinic Outcome Reporting System; AFC: antral follicle count; GnRH: gonadotrophin releasing hormone; FSH: follicle stimulating hormone; LH: luteinizing hormone; AMH: anti-Müllerian hormone; DHEA: dehydroepiandrosterone; PCOS: polycystic ovarian syndrome; NPCOS: non-polycystic ovarian syndrome; CE: cost-effectiveness; CC: clomiphene citrate; ORT: ovarian reserve test; EU: embryo-uterus; DET: double embryo transfer; CES: Cumulative Embryo Score; GES: Graduated Embryo Score; CSS: Combined Scoring System; MSEQ: Mean Score of Embryo Quality; IMC: integrated morphology cleavage; EFNB2: ephrin-B2; CAMK1D: calcium/calmodulin-dependent protein kinase 1D; GSTA4: glutathione S-transferase alpha 4; GSR: glutathione reductase; PGR: progesterone receptor; AMHR2: anti-Müllerian hormone receptor 2; LIF: leukemia inhibitory factor; sHLA-G: soluble human leukocyte antigen G.

Surrogacy is an assisted reproduction-based approach in which the intended parents assign the gestation and birth to another woman called the surrogate mother. The drivers of surrogacy refer largely to infertility, medical conditions, same-sex couples’ parenting, and cases of diversity regarding sexual identity and orientation. Surrogacy consists of a valid option for a variety of conditions or circumstances ranging from medical to social reasons. However, surrogacy may be associated with risks during the preimplantation, prenatal, and neonatal period. It became obvious during the exhaustive literature research that data on surrogacy and its association with factors specific to the IVF practice and the options available were not fully represented. Could it be that surrogacy management adds another level of complexity to the process from the ovarian stimulation, the subsequent IVF cycle, and the techniques employed within the IVF and the Genetic Laboratory to the fetal, perinatal, and neonatal period? This work emphasizes the risks associated with surrogacy with respect to the preimplantation embryo, the fetus, and the infant. Moreover, it further calls for larger studies reporting on surrogacy and comparing the surrogate management to that of the routine IVF patient in order to avoid suboptimal management of a surrogate cycle. This is of particular importance in light of the fact that the surrogate cycle may include not only the surrogate but also the egg donor, sperm donor, and the commissioning couple or single person.

The objective of this study is to assess if the difference of repeated measurements of estradiol and progesterone during luteal phase predict the outcome of intrauterine insemination.Prospective study.Reproductive clinic.126 patients with infertility.Patients underwent controlled ovarian stimulation with recombinant FSH (50-150 IU/d). The day of IUI patients were given p.o natural micronized progesterone in a dose of 100 mg/tds.The area under the receiver characteristic operating curve (ROC curve) in predicting clinical pregnancy for % change of estradiol level on days 6 and 10 was 0.892 with 95% CI: 0.82-0.94. A cutoff value of change -29.5% had a sensitivity of 85.7 with a specificity of 90.2. The corresponding ROC curve for % change of progesterone level was 0.839 with 95% CI: 0.76-0.90. A cutoff value of change -33% had a sensitivity of 85 with a specificity of 75.The % change of estradiol and progesterone between days 6 and 10 has a predictive ability of pregnancy after IUI with COS of 89.2% and 83.4%, respectively. The addition of % of progesterone to % change of estradiol does not improve the predictive ability of % estradiol and should not be used.

Objective To describe two clinical cases concerning patients at risk of developing severe ovarian hyperstimulation syndrome (OHSS) during in vitro fertilization (IVF) stimulation. Design Description of clinical management and outcomes of patients using an IVF antagonist rescue protocol to prevent OHSS. Setting Reproductive medicine unit, University Hospital. Materials and methods Two infertile patients undergoing controlled ovarian stimulation (COS) for IVF/intracytoplasmic sperm injection (ICSI) presenting with high risk of OHSS. IVF/ICSI patients following COS under short protocol and high risk of OHSS were managed by withdrawing the agonist and replacing it with an antagonist and triggering ovulation with an agonist bolus. Main outcome measures included incidence of OHSS, oocytes retrieved, and pregnancy rates. Results None of the two patients developed OHSS. None of the patients had metaphase II retrieved oocytes at oocyte retrieval. Conclusions Use of COS with short protocol in an IVF/ICSI cycle carries a risk of severe OHSS. Rescuing the cycle by withdrawing the agonist and replacing it with an antagonist and triggering ovulation with an agonist bolus is not always effective and should not be used if short time interval between agonist replacement with antagonist and ovulation triggering is available.

This paper investigates the impact of the thyristor commutation time on the peak currents and the active-power capability of the hybrid alternate-common-arm converter (HACC). This converter employs director thyristors for the alternate connection of a common arm in parallel to the main arms. The parallel connection enables current sharing among the arms, which allows the HACC to transfer higher output power without increasing the peak arm current. It is shown that the active-power capability of the HACC is doubled for a certain current-sharing factor, which, however, is altered by the thyristor commutation time. Therefore, the impact of the commutation time on the active-power capability of the HACC is investigated theoretically. Finally, this analysis is verified by simulation results.

This paper compares two hybrid topologies that combine the line-commutated converter (LCC) with cascaded full-bridge (FB) converters. The latter are utilized for compensating the reactive power and filtering the current harmonics of the LCC. The method that was developed for dimensioning these hybrid topologies is presented in detail. This method is utilized for calculating the arm voltage and current waveforms, which are used to estimate other important quantities, such as conduction losses and energy variations. Finally, the studied converters are compared in terms of voltage/current ratings, semiconductor requirements, conduction losses, and energy variations.

To assess if the amount of postoperative postvoid residual of urine that is within the normal range (less than 100 mls) could predict the outcome of TVTO (Tension -free vaginal tape obturator) procedure.Second Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Greece. Patients that had been submitted to TVTO procedure between 2013 and 2017 were reviewed and outcome was assessed.The follow up assessment included cough stress test, the Patient Satisfaction Questionnaire (PSQ), the Urinary Distress Inventory-6 (UDI-6) and the Patient Global Impression of Improvement (PGI-I) questionnaire.The mean follow-up was 3.7 years (+1.35 years). Forty eight patients (40.3%) had only a TVTO procedure. Forty three patients (36.1%) had a TVTO procedure combined with anterior colporrhaphy. Twenty eight patients (23.6%) underwent a TVTO procedure and anterior colporrhaphy and posterior colpoperineorrhaphy. According to cough stress test 88% patients (105/119) were cured having a negative cough stress test. Using logistic regression analysis it was found that patient's age (p = 0.78), postoperative postvoid residual of urine ( = 0.24) or day of catheter removal (p = 0.22) had no statistically significant correlation with the medium term outcome of TVTO procedure. Also, regression analysis shows that patients' Body Mass Index (BMI) has negative correlation to the postoperative outcome.PVR 50 mls appears to be related with successful medium term outcome after TVTO procedure. Also, patients' (BMI) has negative correlation to the postoperative outcome.

Endometriosis-related infertility describes a case of deteriorated fecundity when endometriosis is diagnosed. Numerous mechanisms have been proposed in an effort to delineate the multifaceted pathophysiology that induces impairment of reproductive dynamics in patients with endometriosis. In this critical analysis, authors present the plethora of molecular events that are entailed and elaborate on how they potentially impair the oocyte’s and embryo’s competence in patients with endometriosis. Reactive oxygen species, dysregulation of the immune system and cellular architectural disruption constitute the crucial mechanisms that detrimentally affect oocyte and embryo developmental potential. The molecular level impairment of the reproductive tissue is discussed, since differentiation, proliferation and apoptosis constitute focal regulatory cellular functions that appear severely compromised in cases of endometriosis. Mapping the precise molecular mechanisms entailed in endometriosis-related infertility may help delineate the complex nature of the disorder and bring us a step closer to a more personalized approach in understanding, diagnosing and managing endometriosis-related infertility.

Mathematics rules the world of science. Innovative technologies based on mathematics have paved the way for implementation of novel strategies in assisted reproduction. Ascertaining efficient embryo selection in order to secure optimal pregnancy rates remains the focus of the in vitro fertilization scientific community and the strongest driver behind innovative approaches. This scoping review aims to describe and analyze complex models based on mathematics for embryo selection, devices, and software most widely employed in the IVF laboratory and algorithms in the service of the cutting-edge technology of artificial intelligence. Despite their promising nature, the practicing embryologist is the one ultimately responsible for the success of the IVF laboratory and thus the one to approve embracing pioneering technologies in routine practice. Applied mathematics and computational biology have already provided significant insight into the selection of the most competent preimplantation embryo. This review describes the leap of evolution from basic mathematics to bioinformatics and investigates the possibility that computational applications may be the means to foretell a promising future for the IVF clinical practice.

Vitamin D, a soluble steroid hormone synthesized in the skin after sun exposure, plays a crucial role in calcium metabolism and is also involved in cardiovascular pathophysiology. The aim of this review is to summarize the available evidence (a) on the association between endogenous vitamin D status and cardiovascular disease, and (b) on the effect of vitamin D supplementation on cardiovascular outcomes. Most studies have shown an inverse association between vitamin D levels and cardiovascular outcomes. Randomized controlled trials, however, do not consistently support a beneficial effect of vitamin D administration on cardiovascular health. Population characteristics, comorbid conditions such as diabetes, the overall population prevalence of cardiovascular disease, vitamin D status and the regimen of vitamin D supplementation may account for the conflicting results.

To assess the outcome of the tension-free vaginal tape (TVT) procedure in female patients with urodynamic stress urinary incontinence at 17 years follow-up. We carried out a prospective study at the 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Greece. Patients who had undergone a TVT procedure 17 years ago. The follow-up assessment included gynecological examination, urinalysis, cough stress test in the lithotomy and/or upright position, filling and voiding cystometry, and uroflow. Also, all patients were required to complete the Patient Satisfaction Questionnaire (PSQ). Out of the 61 initial patients, 56 were available for follow-up. Objective cure rate was 83.9% (47/56) at 17 years follow-up. Subjective cure rate was 78.6% (44/56), subjective improvement was 8.9%, and failure rate was 12.5%. Frequency was present in 39.3% of patients, overactive bladder symptoms were present in 30.3% of patients and urge urinary incontinence was reported by 12.5% of patients. Difficulty emptying the bladder was reported by 10 patients (17.8%) and recurrent urinary tract infection was seen in 3.5% of patients. There was one case of TVT erosion to the vaginal mucosa, which was managed conservatively. The TVT procedure for the management of stress urinary incontinence in women maintains its efficacy in the long term, having an objective cure rate of 83.9% and a subjective cure rate of 78.6% at 17 years’ follow-up, with a very low complications rate.

Growth hormone (GH) and insulin-like growth factor 1 (IGF-1) have been proposed to play a pivotal role in male infertility due to their anabolic effects. The aim of this study was to investigate possible associations between seminal plasma levels of GH and IGF-1 and sperm parameters. Fifty men participated in this study. Semen analysis was performed, while cell-free seminal plasma was collected following sperm centrifugation. Seminal plasma concentrations of IGF-1 and GH were determined by enzyme-linked immunosorbent assay (ELISA). Due to the presence of asthenozoospermia in all participants who presented with abnormal sperm parameters, the participants were further subdivided into normal (group A), asthenozoospermic (group B) and asthenozoospermic plus at least one additional abnormal parameter (group C). A marginally nonsignificant statistical difference (p = 0.063) was revealed between the GH levels corresponding to the asthenozoospermic and the normal group with the latter presenting with higher GH levels. A statistically significant positive correlation (p < 0.05) was noted between levels of GH and IGF-1 in group C. The above relationship has also been observed in men with low sperm concentration, vitality, volume and abnormal morphology. These novel findings require further investigation in order for the biological significance of those associations to be clarified.

In this paper, the cascaded H-bridge (CHB) inverter is evaluated as a PV power conversion solution for large-scale PV power plants. The advantages and disadvantages of the CHB inverter for large-scale PV power plants are discussed. Comparison between the CHB and conventional central inverters is also presented in terms of efficiency and cost. For comprehensive assessment of the CHB inverter on the system level, a system-level evaluation is also performed in this paper. The levelized cost of electricity (LCOE) is used as the evaluation metric. LCOE of PV system with either the conventional central or CHB inverters is calculated for different geographic locations and PV module technologies. The comparative evaluation demonstrates the promising benefits in using the CHB inverter for large-scale PV power plants.

Study Objective To determine whether diagnostic hysteroscopy before assisted reproduction techniques (ΑRT) in women without known disease of the uterine cavity is necessary. Design Prospective cohort clinical study. Setting Reproductive medicine clinic. Patients The study group consisted of 217 infertile women attending the Reproductive Clinic for examination before undergoing ART, either in vitro fertilization or intracytoplasmic sperm injection. Interventions Patients underwent transvaginal sonography (TVS) and hysterosalpingography (HSG) for initial evaluation. If there were no abnormal intrauterine findings, diagnostic hysteroscopy was additionally performed. Measurements and Main Results The safety and diagnostic value of hysteroscopy before ART was examined. Diagnostic hysteroscopy was performed successfully, without complications, in all 217 women. Ninety-five (43.7%) had a history of ART failures (group 1), and 122 (56.3%) had undergone no previous ART attempts (group 2). In 148 women (68.2%), findings at hysteroscopy were normal, whereas in 69 (31.8%), hysteroscopy revealed intrauterine lesions (polyps, septa, submucosal leiomyomas, or synechiae) that led to operative hysteroscopy. The most common intrauterine abnormality was the presence of endometrial polyps in 26 patients (12%). The total percentage of abnormal intrauterine findings was higher in women with a history of repeated ART failures in comparison with those with no history of ART attempts. No statistically significant difference in the outcome of in vitro fertilization or intracytoplasmic sperm injection was observed between women with normal hysteroscopic findings and patients with hysteroscopically corrected endometrial disease. Conclusion Sensitivity of diagnostic hysteroscopy is significantly higher than TVS and HSG in the diagnosis of intrauterine lesions. Diagnostic hysteroscopy should be performed before ART in all patients, including women with normal TVS and/or HSG findings, because a significant percentage of them have undiagnosed uterine disease that may impair the success of fertility treatment.

Background Urethro-vaginal fistulae (UVF) occur usually as infrequent complications of a variety of gynecological surgical procedures. The aim of this study was to present an interesting case of a complicated UVF diagnosed after gynaecological surgery. Case A 61-year-old gravida-2, para-2, post-menopausal woman was referred with a complaint of urine loss through the vagina. She had undergone anterior and posterior vaginal wall repair due to cystocele and stress urinary incontinence (SUI). Transvaginal repair was performed 20 weeks after primary surgery. However, a second transvaginal reconstructive surgery using Martius-flap originating from the bulbocavernosus muscle was necessary due to persistent urine leakage in the vagina. Thirty-two months after successful urethro-vaginal treatment, the patient self-referred for persistent SUI. Burch colposuspension was performed and at 16 months follow-up the patient remains continent. Discussion Surgical repair of complicated UVF seems to be more successful with Martius flap interposition than with no interposition.

Intracytoplasmic sperm injection (ICSI) is the most frequently applied method for fertilization making the process of identifying the perfect spermatozoon fundamental. Herein we offer a critical and thorough presentation on the techniques reported regarding (i) handling and preparing semen samples, (ii) identifying and ‘fishing’ spermatozoa, and (iii) improving key factors, such as motility for a successful ICSI practice. These approaches are suggested to make the process easier and more effective especially in atypical and challenging circumstances. Furthermore, we present an epigrammatic opinion-where appropriate-based upon our collective experience. Techniques such as intracytoplasmic morphologically selected sperm injection, hyaluronic binding, polarized light microscopy, and annexin V agent identification for comparing sperm cells and their chromatin integrity are analyzed. Moreover, for the demanding cases of total sperm immotility the use of the hypoosmotic swelling test, methylxanthines, as well as the option of laser assisted immotile sperm selection are discussed. Finally, we refer to the employment of myoinositol as a way to bioreactively improve ICSI outcome for oligoasthenoteratozoospermic men. The diversity and the constant development of novel promising techniques to improve ICSI from the spermatozoon perspective, is certainly worth pursuing. The majority of the techniques discussed are still a long way from being established in routine practices of the standard IVF laboratory. In most cases an experienced embryologist could yield the same results. Although some of the techniques show great benefits, there is a need for large scale multicenter randomized control studies to be conducted in order to specify their importance before suggesting horizontal application. Taking into consideration the a priori invasive nature of ICSI, when clinical application becomes a possibility we need to proceed with caution and ensure that in the pursuit for innovation we are not sacrificing safety and the balance of the physiological and biological pathways of the spermatozoon’s dynamic. Abbreviations: ICSI: intracytoplasmic sperm injection; IVF: in vitro fertilization; PGD: reimplantation genetic diagnosis; IVM: in vitro maturation; HCV/HIV: hepatitis C virus/human immunodeficiency virus; IMSI: intracytoplasmic morphologically selected sperm injection; DGC: density gradient centrifugations; S-U: swim-up; ART: assisted reproduction technology; IUI: intrauterine insemination; PVP: polyvinylpyrrolidone; HA: hyaluronic acid; MSOME: motile sperm organelle morphology examination; ZP: zona pellucida; MACS: magnetic activation cell sorting; HOST: hypo-osmotic swelling test; TESE: testicular sperm extraction; MMP: mitochondrial membrane potential; OAT: oligoasthenoteratozoospermic

Pelvic organ prolapse (POP) is a common multifactorial condition. Matrix metalloproteinases (MMPs) are enzymes capable of breaking down various connective tissue elements. Single-nucleotide polymorphisms (SNPs) in regulatory areas of MMP-encoding genes can alter their transcription rate, and therefore the possible effect on pelvic floor supporting structures. The insertion of an adenine (A) base in the promoter of the MMP-3 gene at position -1612/-1617 produces a sequence of six adenines (6A), whereas the other allele has five (5A). The aim of the present study was to investigate the possible association of MMP-3 gene promoter SNPs with the risk of POP. The patient group comprised 80 women with clinically significant POP [Stage II, III or IV; POP quantification (POP-Q) system]. The control group consisted of 80 females without any or important pelvic floor support defects (Stages 0 or I; POP-Q system). All the participants underwent the same preoperative evaluation. SNP detection was determined with whole blood sample DNA analysis by quantitative polymerase chain reaction (PCR) in LightCycler® PCR platforms, using the technique of sequence-specific hybridization probe-binding assays and melting temperature curve analysis. The results showed there was no statistically significant difference between 5A/5A, 5A/6A and 6A/6A MMP-3 gene promoter variants in the two study groups (P=0.4758). Therefore, MMP-3 gene promoter SNPs alone is insufficient to increase the genetic susceptibility to POP development.

This paper presents two concepts for enabling the operation of a line-commutated converter (LCC) at leading power angles. The concepts are based on voltage or current injection at the ac side of an LCC, which can be achieved in different ways. However, this paper focuses on the voltage and current injection by series-connected full-bridge cells that can generate voltages that approximate ideal sinusoids. Thus, hybrid configurations of an LCC connected at the ac side in series or in parallel with fullbridge cells are presented. Finally, these hybrid configurations are compared in terms of voltage and current rating. QC 200161212. QC 20191018

Intracytoplasmic sperm injection (ICSI) has become an indispensable procedure of every assisted reproduction unit. This has created as much controversy as it has awe. As this is a multistep invasive technique, every part of the procedure has become subject to investigation. We contribute this review aspiring to offer the embryologist insight into all available approaches of securing an effective ICSI practice. Herein we present all the different approaches with respect to handling of the human oocyte, taking into consideration the important steps of the technique such as the oocyte positioning, timing of performing ICSI, the option of viewing the meiotic spindle and further individual action such as artificial oocyte activation, rescue ICSI and in vitro maturation. We enrich this by including our view based on our collective experience and current practice. Published studies have led to various options for performing ICSI, resulting in in vitro fertilization units around the world adopting different approaches. The steps that ICSI technique entails discussed from the oocyte perspective are still a long way from being organized into one secure and optimal protocol. Our stressing of the need to secure an efficient ICSI protocol could be the trigger for further well-designed larger scale studies with all the latest technological advantages. We aim to approach this subject in categories and assess them separately. However, ICSI is a multifaceted procedure involving several consecutive steps and when evaluating one we cannot exclude the end effect of the previous, or the overall effect of the different practitioners involved form beginning to end.

Background/Aims: To investigate the reproductive outcome after hysteroscopic resection of uterine septum in women with septate uterus and otherwise idiopathic primary infertility. Methods: Sixty-eight patients with septate uterus and idiopathic primary infertility were included in this prospective observational study. All patients underwent hysteroscopic metroplasty with scissors under general anesthesia. Main outcome measures were clinical pregnancy rate, live birth and abortion rate at 12 months’ follow-up and at mean follow-up time. Results: At 12 months’ follow-up, the clinical pregnancy rate, the live birth rate and the abortion rate were 44% (30/68), 36.8% (25/68) and 16.6% (5/30), respectively. At total follow-up time, the overall pregnancy rate, the live birth rate and the abortion rate were 53.8% (35/65), 41.5% and 14.2% (7/35), respectively, while the stillbirth rate was 2.8% (1/35). Conclusion: Hysteroscopic metroplasty in women with septate uterus and unexplained infertility could improve clinical pregnancy rate and live birth rate in patients with otherwise unexplained infertility. If such a patient is looking for a spontaneous pregnancy, this is more likely to occur during the first 15 months following the procedure.

Objective To assess whether the clinical pregnancy rate of patients treated with recombinant FSH and IUI can be improved by the addition of a GnRH antagonist. Design Prospective, controlled study. Setting Reproductive medicine clinic. Patient(s) Ninety-three patients with primary or secondary infertility. Intervention(s) Patients were allocated to controlled ovarian stimulation with recombinant FSH (50–150 IU/d) only (control group, n=45) or to recombinant FSH (50–150 IU/d) plus ganirelix (0.25 mg/d, starting when the leading follicle was ≥16 mm; n=48). A single insemination was performed 36 hours after hCG was given (10,000 IU, IM) in both groups. Both groups were allowed at least three cycles. Main Outcome Measure(s) Clinical pregnancy rate, premature luteinization rate, and follicular development. Result(s) Clinical pregnancy rate (22% vs. 11%), cumulative pregnancy rate (52% vs. 31%), and number of mature follicles (2.1 ± 1.08 vs. 1.4 ± 0.95) were statistically significantly higher in the ganirelix group compared with the control group. The premature luteinization rate was significantly lower in the ganirelix group (1.7% vs. 17.5%). Conclusion(s) The use of a GnRH antagonist in conjunction with controlled ovarian stimulation and IUI significantly increases pregnancy rates and reduces the incidence of premature luteinization.

Objective: To investigate whether a preoperative pessary test could be used to identify patients with occult stress incontinence and if simultaneous anti-incontinence surgery with a midurethral sling could prevent postoperative incontinence. Study design: Eighty-two patients with a positive pessary test and severe genital prolapse participated in the study: 43 patients underwent prolapse surgery and transobturator tension-free vaginal tape (TVT-O) insertion and 39 patients underwent prolapse surgery only. Results: The objective cure rate for TVT-O and prolapse surgery was 90.7% at three months follow up and 88.4% at two years follow up. The objective cure rate for prolapse surgery only was 74.4% at three months and 58.9% at two years follow up. Conclusion: The pessary test can be used preoperatively in patients with significant genitourinary prolapse to identify those with occult stress urinary incontinence. The TVT-O procedure in this context could be a useful optional procedure as it appears to be very effective and safe in patients with occult stress incontinence.

Postpartum nephrotic syndrome in a pregnant woman with rheumatoid arthritis in long-standing remission is rare. Systemic lupus erythematosus can remain undiagnosed, especially in the absence of clinical manifestations. We present the case of a 34-year-old woman (gravida 2, para 1) who underwent a lower-segment cesarean section at 34 weeks and 6 days of gestation because she had developed preeclampsia and nephrotic syndrome. The concomitant presence of significant hypoproteinemia, hypoalbuminemia, uremia, elevated creatinine serum levels, hyperuricemia and hypertriglyceridemia is indicative of impaired renal function and nephrotic syndrome. This woman was diagnosed with systemic lupus erythematosus nephritis. It is imperative for clinicians to investigate the exact pathophysiological causes of nephrotic syndrome with onset in the puerperium and implement the appropriate therapeutic regimens., Highlights • New onset of systemic lupus erythematosus rarely leads to postpartum nephrotic syndrome in women with rheumatoid arthritis. • Lupus flares can also occur in the puerperium and often involve renal function.

Objective To investigate whether patients who were treated with TVT-O procedure for urodynamic stress incontinence had a significant improvement in their urodynamic findings and their post-operative symptoms (frequency, urgency, nocturia) if they were treated post-operatively with vaginal oestradiol for 6 months compared to the non-treated group. Methods Prospective randomised study. 190 patients were asked to participate in our study. Finally, a total of 92 patients in group 1 and 91 patients in group 2 completed the study. In group 1, which was the treatment group, patients having the TVT-O procedure for urodynamic stress incontinence were instructed to use post-operatively oestradiol tablets, 25 micrograms (Vagifem, Novo Nordisk) vaginally, once daily, nocte, for 2 weeks and then twice weekly for 6 months. The patients in group 2 (control group) had the TVT-O procedure only. All patients were reviewed in 2 months and again in 6 months time. Results There was no statistically significant difference between the two groups concerning pre-operative and post-operative haemoglobin, operative time, hospital stay or return to work. The within group analysis did not show significant differences between pre-operative and post-operative urodynamic data in both groups. Patients treated with vaginal estradiol post-operatively showed a statistically significant reduction in relation to the symptoms of urgency and frequency but not in relation to nocturia and urge incontinence compared to the non-treated group. There is no difference in relation to the efficacy of TVT-O procedure between the groups at 6 months follow-up. Conclusion It appears that vaginal oestradiol treatment could be offered to postmenopausal patients after a TVT-O procedure having the symptoms of frequency and urgency provided they are aware of the lack of evidence regarding long term benefit.

Background Data about the use of tension-free vaginal tape (TVT) in the management of recurrent urodynamic stress incontinence (RUSI) after previous failed midurethral sling procedure (MUSP) are limited. Objective Assessment of the efficacy and the indications of the TVT procedure in the management of patients with RUSI after failed previous MUSP. Design, setting, and participants Thirty-one patients with RUSI after previous failed MUSP were prospectively enrolled at a single tertiary academic center. Measurements Preoperatively and postoperatively, patients were assessed with physical examination, urinalysis, urine culture, bladder diary for 2–3 d, Q-tip test, uroflow, filling and voiding cystometry, urethral profilometry, and 1-h pad test. Mean follow-up was at 18.6mo (range: 12–28mo). Results and limitations Overall, the objective cure rate based on the pad test findings was 74%, the improvement rate was 6.5%, and the failure rate was 19.5%. The objective cure rate based on cough stress test during filling cystometry was 77.4%, and the subjective cure rate based on patients' answers was 71%. The study could have some limitations. The relatively small number of patients enrolled could affect the findings of study to some degree. Additionally, because urethral pressure profiles show a significant degree of directional dependence when side-hole microtip transducers are used, as in the present study, the orientation of the transducer could affect the values measured. Conclusions The TVT procedure as a second operation could provide an overall cure rate of 74% with a low complication rate in female patients with RUSI after previous failed midurethral tape procedures.

The objective of the study was to obtain a prospective assessment of the efficacy and the complications associated with the use of tension-free vaginal tape (TVT) for the management of urodynamic stress incontinence at 5- and 7-year follow-up. Sixty-five female patients with stage I cystocele or less who have been operated with TVT procedure for management of urodynamic stress incontinence have been included in the study. At 5-year follow-up, the objective cure rate was 83% and failure rate 9.4%. At 7-year follow-up, the objective cure rate was 80% and the failure rate 13.5%. De novo detrusor overactivity was seen in 9.4% and 11.4% of patients at 5- and 7-year follow-up, respectively. TVT operation is an effective and safe minimally invasive procedure for the management of urodynamic stress incontinence in women without significant cystocele in the long-term follow-up. The 10- and 20-year results are awaited.

To assess whether the levels of anti-Mullerian hormone (AMH) are related to outcome of intrauterine insemination (IUI) in patients treated with gonadotropins.A total of 195 patients underwent controlled ovarian stimulation (COS) with recombinant follicle stimulating hormone (rFSH) (50-150 IU/d). All patients were submitted upto three cycles of IUI.Primary outcome was the ability of AMH levels to predict clinical pregnancy at first attempt and the cumulative clinical pregnancy probability of upto three IUI cycles. Secondary outcomes were the relation of AMH, LH, FSH, BMI, age, parity and basic estradiol levels with each other and the outcome of IUI.The area under the receiver operating characteristic (ROC) curve in predicting clinical pregnancy for AMH at first attempt was 0.53 and for cumulative clinical pregnancy was 0.76. AMH levels were positively correlated with clinical pregnancy rate at first attempt and with cumulative clinical pregnancy rate, but negatively correlated with patient's age and FSH levels. Patient's FSH, LH levels were negatively correlated with cumulative clinical pregnancy rate.AMH levels seem to have a positive correlation and patient's age and LH levels had a negative correlation with the outcome of IUI and COS with gonadotropins. AMH concentration was significantly higher and LH was significantly lower in patients with a clinical pregnancy after three cycles of IUI treatment compared with those who did not achieve pregnancy.

Current technology developments in energy storage and PV systems raise new possibilities for combining them, in order to deal with grid integration of PV systems. This paper studies the operation of a very large scale PV power plant, which includes an energy storage system for capacity firming. The energy storage is distributed in the PV plant, i.e. many energy storage units are connected in parallel with each PV array before the central solar inverter. The benefits of this configuration are explained in the paper, whose scope is to evaluate the complete system. A tool has been created in order to perform the sizing of the energy storage, according to a desired operation and evaluate the system using the LCOE.

The aim of this study was to investigate the contribution of the gonadal steroid receptors expression to the pathophysiological pathways of pelvic organ prolapse (POP) and urodynamic stress urinary incontinence (USUI) after menopause.This was a prospective closely-matched controlled clinicopathological study. Immunohistochemistry for estrogen receptor isoform α (ER-α) and β (ER-β), as well as for progesterone receptor (PR), was performed on formaline-fixed and paraffin-embedded sections of specimens coming from the pubocervical fascia of postmenopausal women who were allocated into three groups: patients with synchronous POP and USUI (Group A), patients diagnosed with only POP (Group B), and patients without POP or USUI who underwent gynecological surgery for another benign indication (control group, Group C).There was no statistically significant difference among the three groups for age, parity, body mass index, or smoking. The expression of ER-α receptors was found significantly reduced among samples of Group B when compared with control group. Statistically significant reduction not only for ER-α, but for ER-β, as well, was noticed among samples of Group A, compared to the other two groups. No remarkable differences concerning the density of PR receptors were observed among the three groups.Alterations of ER-α in the pubocervical fascia and around the urethra in postmenopausal women may play an important role in the pathophysiology of POP. In addition, the risk for developing USUI among POP patients seems to be strongly associated with the reduction of both estrogen receptors (ER-α and ER-β) expression.