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Objective: To determine the normal limits of menstrual fluid volume during reproductive life, quantified by direct measurement., Methods: This was an observational, prospective clinical trial of healthy women aged 20-49 years old, with normal menstrual periods, recruited in a Natural Family Planning Unit. Women collected their menstrual fluid for at least 3 menstrual periods using a vaginal cup. Menstrual volume and different covariables were evaluated using a multilevel mixed-effects linear regression., Results: Ninety-six cycles from 28 patients between 24 and 49 years old were analyzed. The average menstrual volume was 86.7 mL with a range from 15 to 271 mL. The 50th percentile of all samples was 81 mL and the 95th percentile was 162 mL. For multiparous patients the 50th percentile was 93 mL and the 95th was 169 mL. Menstrual fluid volume was higher in multigravida (99.1 mL) than in nulliparous women (45.9 Ml; p < 0.02). No statistically significant associations were identified between different variables and menstrual volume., Conclusion: A menstrual volume over 169 mL should be considered abnormal on multiparous patients. Age was not associated with changes on menstrual fluid volume., (© 2019 S. Karger AG, Basel.)

Objective: To describe and evaluate urinary hormone profiles in the luteal phase. Setting and Patients: Twenty-five healthy fertile women, with regular ovulatory pattern cycles as assessed by temperature and cervical mucus, at a university based center. Methods: Daily urinary hormonal assessment of luteinizing hormone, estrone glucuronide, and pregnanediol glucuronide. This was done during 3 or more cycles, with 78 completed cycles. Samples were analyzed by both crude levels and levels adjusted for the hormone excretion rate. Correlation between measured parameters (LH surge, vulvar mucus) was assessed with regard to their ability to detect presumed ovulation. Results: An upper, middle, and lower tercile range for the main urinary reproductive hormones was determined and a classification system of zones proposed, considering profiles over or under the 10th percentile. Adjustment for the urine excretion rate proved useful for interpreting individual samples; this was less necessary with multiple samples over time where trends could be determined. This serial evaluation, in at least two cycles, lowered the possibility of finding an isolated luteal phase defect and helped identify the recurrence of such. Vulvar mucus findings performed well in determining the timing of ovulation. Despite the proven fertility of the study population, lower luteal phase hormones were detected in both an isolated and, in some situations, recurrent manner. Conclusion: A feasible method is proposed to accurately, thoroughly and reproducibly study the luteal phase in order to evaluate and treat identified abnormalities in a properly timed, restorative manner. This preliminary study provides the basis for future research, correlating urinary hormones with clinical findings, particularly those of luteal phase defects.

Objective: To compare dyadic (marital) functioning between users of natural family planning (NFP) and users of artificial methods of contraception (AMC)., Method: A cross-sectional study was conducted in healthy, over eighteen-year-old couples living in stable relationships recruited from primary and secondary health centers in Santiago, Chile. Participants were assessed using a structured interview on sociodemographic and sexual aspects. Primary outcome, marital functioning, was studied using the Dyadic Adjustment Scale (DAS)., Results: One hundred and thirty-eight couples were studied, sixty-nine in each user group. Both groups had a similar average time living together (124.3 vs. 126.9 months). DAS results were consistent with functional couples in both groups, but on average, the NFP group had a significantly higher DAS score than AMC. After controlling for age, socioeconomic status, time in the relationship, and religious commitment in multivariable analysis, the NFP group had a 47 percent (odds ratio = 1.47) greater possibility of having a functional marital score above the cutoff (DAS > 114) when compared with the AMC group. The AMC group reported more frequency of sexual intercourse but similar sexual satisfaction. Most (>60 percent) of the NFP couples mentioned that their methods improved their relationship., Conclusion: There are sociodemographic differences between both groups, explained partly by unequal access to NFP centers. Both groups have DAS scores within functional range, but NFP users have a higher probability of being in that functional range. This study of mentally and emotionally healthy couples highlights the importance of family planning methods on intimate relationships. Summary Marital functioning is affected by family planning methods. A structured interview and a specific inventory to address conjugal functioning were applied to a group of healthy couples who live in stable relationships and are users of natural family planning (NFP) or artificial methods of contraception (AMC). The results were consistent with functional couples in both groups, but on average, the NFP group had a significantly higher score than the AMC group. The use of NFP explained this difference. This study of mentally and emotionally healthy couples highlights the importance of family planning methods on intimate relationships., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Inherent interindividual and intraindividual variation in the length of the menstrual cycle limits the accuracy of predicting days of peak fertility. To improve detection of days of peak fertility, a more detailed understanding of longitudinal changes in cervicovaginal fluid (CVF) biomarkers during the normal menstrual cycle is needed. The aim of this study, therefore, was to characterize longitudinal changes in CVF proteins during the menstrual cycle using a quantitative, data-independent acquisition mass spectrometry approach. Six serial samples were collected from women (n = 10) during the menstrual cycle. Samples were obtained at two time points for each phase of the cycle: early and late preovulatory, ovulatory, and postovulatory. Information-dependent acquisition (IDA) of mass spectra from all individual CVF samples was initially performed and identified 278 total proteins. Samples were then pooled by time of collection (n = 6 pools) and analyzed using IDA and information-independent acquisition (Sequential Windowed Acquisition of All Theoretical Mass Spectra [SWATH]). The IDA library generated contained 176 statistically significant protein identifications (P < 0.000158). The variation in the relative abundance of CVF proteins across the menstrual cycle was established by comparison with the SWATH profile against the IDA library. Using time-series, pooled samples obtained from 10 women, quantitative data were obtained by SWATH analysis for 43 CVF proteins. Of these proteins, 28 displayed significant variation in relative abundance during the menstrual cycle (assessed by ANOVA). Statistical significant changes in the relative expression of CVF proteins during preovulatory, ovulatory, and postovulatory phases of menstrual cycle were identified. The data obtained may be of utility not only in elucidating underlying physiological mechanisms but also as clinically useful biomarkers of fertility status., (© 2015 by the Society for the Study of Reproduction, Inc.)

Objective: To evaluate the role of key enzymes in the methionine-homocysteine metabolism (MHM) in the physiopathology of preeclampsia (PE)., Methods: Plasma and placenta from pregnant women (32 controls and 16 PE patients) were analyzed after informed consent. Protein was quantified by western blot. RNA was obtained with RNA purification kit and was quantified by reverse transcritase followed by real-time PCR (RT-qPCR). Identification of the C677T and A1298C methylenetetrahydrofolate reductase (MTHFR) single-nucleotide polymorphisms (SNPs) and A2756G methionine synthase (MTR) SNP was performed using PCR followed by a high-resolution melting (HRM) analysis. S-adenosyl methionine (SAM) and S-adenosyl homocysteine (SAH) were measured in plasma using high-performance liquid chromatography-tandem mass spectrometry (HPLC/MS/MS). The SNP association analysis was carried out using Fisher's exact test. Statistical analysis was performed using a Mann-Whitney test., Results: RNA expression of MTHFR and MTR was significantly higher in patients with PE as compared with controls. Protein, SAM, and SAH levels showed no significant difference between preeclamptic patients and controls. No statistical differences between controls and PE patients were observed with the different SNPs studied., Conclusion: The RNA expression of MTHFR and MTR is elevated in placentas of PE patients, highlighting a potential compensation mechanism of the methionine-homocysteine metabolism in the physiopathology of this disease.

Objective: To evaluate the fetal cardiac function by modified myocardial performance index (Mod-MPI) in pregnant diabetic patients., Methods: Modified myocardial performance index was measured in fetuses of patients with diabetes (DM) between 30 and 40 weeks of gestation. The isovolumetric contraction time, isovolumetric relaxation time and ejection time were measured. Mod-MPI was calculated as (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. Results were analyzed by using one-way analysis of variance (post hoc Bonferroni correction), Chi-square and Student's test., Results: Modified myocardial performance index values of fetuses from DM mothers were significantly higher than controls (0.43 vs 0.37, P < 0.0001), and it was not different between gestational versus pregestational DM (0.42 vs 0.45, P = 0.18). Mod-MPI was also higher in the presence of polyhydramnios (0.49 vs 0.41, P < 0.0001), insulin use (0.46 vs 0.40, P < 0.05), and large for gestational age fetuses (0.49 vs 0.40, P < 0.0001). There were no significant differences in Mod-MPI between newborns with versus without neonatal complications such as hypoglycemia or polycythemia., Conclusions: In fetuses of DM mothers, evaluation of the Mod-MPI identifies those with worse maternal disease and large fetal size., (© 2012 John Wiley & Sons, Ltd.)

Objective: To determine if maternal plasma ffDNA is increased early in pregnancies which subsequently develop preeclampsia (PE) and intrauterine growth restriction (IUGR)., Methods: Blood was obtained at 11-14 weeks and plasma stored. Among those who delivered a male infant and had a birth weight under the tenth centile and/or PE, we divided them into those who delivered before 35 weeks (9) and those who delivered after this gestation (15). A third group with uncomplicated pregnancies was used as controls (24). Real time-polymerase chain reaction (RT-PCR) was carried out to detect the multi-copy Y chromosome associated DSY14 gene., Results: There were no differences between the ffDNA levels in the group delivered after 35 weeks and the control group (2.23ge/mL-1.61ge/mL p = 0.39). However, the levels of ffDNA at 11-14 weeks were statistically, significantly higher in patients that delivered before 35 weeks (4.34ge/mL-1.61ge/mL p = 0.0018). A logistic regression analysis shows that for every unit (1ge/mL) in which ffDNA increases, the likelihood of having PE or a fetus growing under the tenth centile delivered before 35 weeks increases by 1.67 times (CI 1.13-2.47)., Conclusion: The concentration of ffDNA is significantly higher even during early pregnancy, in patients who subsequently develop PE and/or IUGR and are delivered before 35 weeks.

Background: The factors involved in oocyte survival and transition from quiescence to the growing phenotype remain unknown. Herein we report genes that are differentially expressed in the primordial oocyte revealed by DNA arrays., Methods: Primordial oocytes were captured selectively in rhesus monkey ovary sections using laser capture microdissection. The RNA was extracted and amplified in two rounds by T7-based linear RNA amplification, fluorescence labelled and then hybridized to human cDNA arrays containing 7680 elements. RNA from human placenta served as a reference sample., Results: Ninety-five genes were found to be consistently expressed at a higher level in primordial oocytes. Expression of several of these genes in the oocyte has been reported before, e.g. deleted in azoospermia (DAZ), prohibitin and transglutaminase 2. Oocyte expression of several novel transcripts revealed on array hybridization, such as gene 33, ubiquitin-conjugating enzyme E2A, G1 to S phase transition 1, growth arrest and DNA damage-inducible (GADD), and dendritic cell-derived ubiquitin-like protein (DC-UbP) was confirmed by in situ hybridization. Some array-identified gene products [integrin beta3, alpha-tubulin, regulatory telomere elongation protein (RAP1) and cellular repressor of EIA-stimulated genes (CREG protein)] were detected in human oocytes by immunofluorescence. Bioinformatic analysis of the oocyte-enriched transcripts reveals a functional profile summarized as follows: cell cycle (14%); transporter (13%); signal transduction (10%); cytoskeletal (7%); transcription factor (5%); immune response (5%); apoptosis-related (5%); RNA processing (5%); and the remainder of miscellaneous categories., Conclusions: These observations may contribute to the elucidation of molecular pathways involved in oocyte survival and maturation.

It has been suggested that locally produced insulin-like growth factor binding protein 4 (IGFBP4) inhibits ovarian follicular growth and ovulation by interfering with IGF action. According to this hypothesis, IGFBP4-expressing follicles should demonstrate atresia, whereas healthy dominant follicles should be devoid of IGFBP4. Alternatively, according to this view, there could be constitutive expression of the inhibitory IGFBP4 but selective expression of an IGFBP4 protease in dominant follicles, allowing the follicle to mature and ovulate because of degradation of the binding protein. To examine these views concerning the role of IGFBP4 in primate follicular selection, we analyzed cellular patterns of IGFs 1 and 2, IGFBP4, and the IGFBP4 protease (pregnancy-associated plasma protein A [PAPP-A]) mRNA expression in ovaries from late follicular phase rhesus monkeys using in situ hybridization. The IGF1 mRNA was not detected, but the IGF2 mRNA was abundant in theca interna and externa of all antral follicles and was present in the granulosa of large preovulatory and ovulatory follicles. The IGFBP4 mRNA was selectively expressed by LH receptor (LHR) mRNA-positive theca interna cells of healthy antral follicles (defined by aromatase and gonadotropin receptor expression) and by LHR-expressing granulosa cells found only in large preovulatory and ovulatory follicles (defined by size and aromatase expression). The PAPP-A mRNA was abundant in granulosa cells of most follicles without obvious relation to IGFBP4 expression. Ovarian IGFBP4 mRNA levels were markedly increased after treatment with the LH analog, hCG, whereas IGF2 and PAPP-A mRNAs were not significantly altered. In summary, IGFBP4 expression appears to be associated with follicular selection, not with atresia, in the monkey ovary. The IGFBP4 is consistently expressed in healthy theca interna and in luteinized granulosa cells, likely under LH regulation. The IGFBP4 protease, PAPP-A, is widely expressed without apparent selectivity for IGFBP4-expressing follicles or for dominant follicles. These observations suggest that IGFBP4 or an IGFBP4 proteolytic product may be involved with LH-induced steroidogenesis and/or luteinization rather than with inhibition of follicular growth.

IGFs and IGF-binding proteins (IGFBPs) are thought to play important roles in ovarian follicular growth and selection. To elucidate the role of IGFBPs in primate ovarian function, we analyzed IGFBP mRNA expression patterns in ovaries from mid-cycle rhesus monkeys using in situ hybridization. IGFBP-1 mRNA was concentrated in theca-interstitial cells and was present at low levels in granulosa cells of atretic follicles. IGFBP-2 mRNA was expressed in the ovarian surface epithelium and granulosa cells of all antral follicles, including obviously atretic as well as dominant follicles. IGFBP-3 mRNA was localized in oocytes and in the ovarian vascular endothelium; this mRNA was also concentrated in the superficial cortical stroma in which it was distinctly more abundant in the nondominant ovary. Granulosa cells of mature dominant and ovulatory follicles selectively expressed IGFBP-5 mRNA. IGFBP-5 mRNA was also widely expressed in the ovarian stroma, in which, in contrast to IGFBP-3, it was distinctly more abundant in dominant, compared with nondominant, ovary. IGFBP-6 mRNA was present at low levels in the ovary interstitium and theca externa and was more abundant in the ovary surface epithelium. These novel data reveal distinctive cellular expression patterns for IGFBPs 1, 2, 3, 5, and 6 in the nonhuman primate ovary, suggesting distinct roles for each binding protein in ovarian function.

Insulin-like growth factor-I (IGF-I) expression is highly correlated with ovarian follicular growth and granulosa cell proliferation in both pre-pubertal and mature murine ovaries. Igf1 gene deleted mice are infertile, with ovarian follicles arrested at an early stage of development. To elucidate the cause of follicular dysfunction in Igf1 null mice, this study compared granulosa cell proliferation at baseline and in response to exogenous oestradiol (E2) in prepubertal Igf1 null and wild-type (WT) littermate mice. The basal granulosa cell mitotic index was 3.8+/-0.48 in WT and 1.3+/-0.7 in Igf1 null mice (P=0.03). After E2 treatment, WT granulosa mitotic index was 12.7+/-0.0 vs 5.5+/-0.8 for Igf1 null mice (P<0.001). Granulosal BRDU incorporation was also significantly reduced as were cyclin D2 and B1 immunoreactivities in Igf1 null compared with WT mice. The incidence of apoptosis was not increased in Igf1 null follicles, although BAX immunostaining was increased. These data suggest that IGF1 is essential for normal basal and oestrogen-induced granulosa cell proliferation and follicular growth., (Copyright 2001 Harcourt Publishers Ltd.)

The epithelium of the human oviduct expresses the major histocompatibility complex (MHC) class II and shows endocytic properties towards luminal antigens. Therefore, the epithelial cells might behave as antigen-presenting cells, inducing a local immune response. The activation of antigen-specific T cells not only requires presentation of the peptide antigen by MHC class II, but also the presence of co-stimulatory molecules in the antigen-presenting cells. Therefore, the expression of the intercellular adhesion molecule 1 (ICAM-1) was examined in the epithelium of the human oviduct. Most oviducts showed epithelial ICAM-1 expression, as assessed by immunocytochemistry, western blot analysis and RT-PCR assay, and the expression was restricted to the luminal border of ciliated and secretory cells. Interferon gamma, interleukin 1 and lipopolysaccharide treatments increased the percentage of ICAM-1-positive cells in primary cultures, indicating that the expression of ICAM-1 in the oviduct might be upregulated in vivo by inflammatory cytokines or bacterial infections. Binding assays between allogenic phytohaemagglutinin-activated lymphocytes and epithelial monolayers expressing ICAM-1 demonstrated that this molecule stimulated lymphocyte adherence. The presence of ICAM-1, in addition to MHC class II, supports the putative role of the oviductal epithelium in antigen presentation. The exclusive apical distribution of ICAM-1 indicates that T-cell activation would occur in a polarized manner. Binding of lymphoid cells to the surface of the oviductal epithelium may help to retain these immune cells that are required for the clearance of pathogens.

The ectopic endometriosis in the perineum is very rare (0.2% of ectopic endometriosis). We studied 16 cases of vaginoperineal endometriosis. Fifteen of them were localized in the site of an episiotomy scar and in one there was another focus of a severe endometriosis of multiple localizations. All the patients were submitted to anamnesis, physical, gynecologic and proctologic examination, surgical excition, histopathologic study of the lesion and control. All the patients are asymptomatic after treatment. To cure definitively the disease it is necessary to make a complete ablation of the endometrial lesion. Eventually, hormonal treatments could be use in case there were other endometrial localizations besides the vaginoperineal one.

Introduction: In the clinical practice there is an increasing number of patients with a previous cesarean section., Objective: 1. The description of the evolution of patients with previous cesarean section and the possibility of a vaginal delivery. 2. To compare, in patients in labor, a pharmacological approach (ocitocic conduction and peridural anesthesia) vs a spontaneous evolution., Method: -a clinical, random and prospective study. We analyze: age, parity, cause of previous cesarean section, obstetrical conditions at the moment of hospitalization, route of delivery, maternal and neonatal complications and days of hospitalization., Analysis: univariable with single frequency and bivariable with contingency table (chi2) and comparison of means (T test)., Results: Incoming to the study of 81 cases. Sixteen per cent were operated on without labor. Eighty four per cent (n-68) were separated randomly into two groups: 26 pharmacologically managed and 42, with a spontaneous approach. Within the first group, 84.6% delivered vaginally; the latter group, 88.1%, delivered vaginally. The only variable with a statistically significant difference was the greater cervical dilatation in the spontaneous grop at the moment of hospitalization., Conclusion: The probability of vaginal birth after cesarean section is 72.8%, which increases to 86.7% in labor spontaneously initialized. The active management doesn't differ in this study, which has a 10% of power, of spontaneously management.

In order to automate a simultaneous visual discrimination system, a Sutherland jumping-stand box was modified by adding two lateral alleys which connect the feeder compartment with the starting box. By means of a digital interface, this modified box was connected to an Apple IIe PC. A group of rats (n = 8) was trained. All subjects learned. Advantages relevant to the apparatus design, as well as the benefits derived from the automated procedure are discussed.

The coexistence of non-Hodgkin lymphoma and pregnancy is extraordinarily rare. A clinical case is presented and also the description of the epidemiology, the clinical features, the diagnostic methods and the staging. The current guidelines for its managements are analyzed.

In order to assess the behavioural effects of environmental stimulation at different stages of development, two groups of rats were exposed to multisensory enrichment on days 10-24 (preweaning) or 25-39 (postweaning). Both groups had four 25-min sessions per day in a large cage with a variety of stimuli, in addition to 3 min of handling before each session. The mother of the preweaning group remained in the home cage during the stimulation sessions. A third group was maintained in a social condition. Testing in a Hebb-Williams maze started when the rats of the 3 groups were 100 days old. Error, latency and running time scores were lowest in the preweaning group.

Non phylloides sarcomas of the breast are infrequent malignant tumors that can be identified only at histologic examination since clinical presentation may not differ from the more frequent phylloides type. In addition to fibrosarcoma, leiomyosarcoma, rhabdomyosarcoma, angiosarcoma and liposarcoma, the stromal sarcoma of the breast has been recently identified. We report 3 such cases with heterologous components of osteosarcoma, chondrosarcoma and liposarcoma. A third case with an anti-sarcoma appearing post radiotherapy for breast carcinoma is also reported.

We surveyed 300 randomly selected presumable healthy adults for previously defined gastrointestinal and esophageal symptoms. Heartburn was the most common symptom, more frequent in females than in males (p less than 0.01). An association of esophageal symptoms to heartburn but not to smoking habit was found. Constipation was frequent in females and diarrhea in males. We conclude that esophageal symptoms are frequent in presumable healthy individuals.