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Objective To delineate the etiology, symptomatology, and treatment of sickle cell intrahepatic cholestasis (SCIC). Sickle cell disease (SCD) is the most frequently inherited hematologic disease, and SCIC is one rare and often fatal complication and comorbid disease. The literature contains only a small number of case reports involving SCIC and hence limited guidance can be obtained. Methods We reviewed the scientific literature to evaluate the science of SCIC to determine if there were consistencies in presentation, evaluation, treatment, and clinical outcomes. Results We reviewed 6 case reports and a limited number of clinical papers on SCIC. We reported consistencies in clinical presentation and treatment outcomes among cases as well as serological and hematological finding. Conclusions While there is some consistency in the symptom presentation of individuals with SCIC, reliable evaluation and clinical procedures were not demonstrated in what we reviewed. Further research is needed to delineate the attributes of this complicated disease that occurs within SCD.

Background: Stroke programs are often developed and implemented in well-established health care facilities. Stroke coordinators and nurse navigators are essential leaders to ensure success of a stroke program. We aimed to establish strong culture of engagement in the care of stroke patients from day one of a new 160-bed hospital, by hiring a stroke coordinator and navigator to assist with developing a stroke program prior to opening the hospital. Methods: Five months prior to opening a stroke coordinator was hired and navigator was assigned to coordinate post-acute stroke care. A multidisciplinary stroke oversight committee was formed, which guided development of the stroke program and integrated leaders from all areas involved with direct or indirect stroke patient care. In the months preceding go-live; policies and order sets were implemented, stroke alert processes, specific to each unit, with scenarios were reviewed. All nursing staff completed eight hours of stroke education, including NIHSS certification prior to go-live. Additionally, six mock stroke alerts were completed with the assistance of our simulation and training center. Results: One hundred twenty-two patients presented and were diagnosed with stroke between hospital opening on 09/30/2021 and 06/30/2022. The majority of patients were diagnosed with acute ischemic stroke (AIS) or transient ischemic attack 115 (94.3%), age was 69.1±14.8 years and median NIHSS was 1 [IQR, 0 - 2]. Two patients were recommended for and received AIS treatment; one IV thrombolysis and one endovascular stroke thrombectomy. Thirty four patients were added to the stroke care pathway and closely followed for 90 days. The hospital was 100% compliant with all Get with the Guidelines (GWTG) STK measures, with the exception of CSTK-01 NIHSS at 78%. Additionally, all GWTG achievement measures and quality measures achieved at least 93%, except for dysphagia screening which was at 86% compliance. Conclusions: Developing a stroke program by integrating a stroke coordinator and navigator prior to hospital opening facilitated best practices for stroke systems of care from day one. This allowed a brand-new hospital to achieve similar levels of compliance on key GWTG measures compared to other stroke certified hospitals.

Uterine transplant (UTx) is performed to address absolute uterine infertility in the presence of uterine agenesis, a non-functional uterus, or following a prior hysterectomy. Following the initial success of UTx resulting in a livebirth (2014) in Sweden, there are over 70 reported UTx surgeries resulting in more than 40 livebirths worldwide. Currently, UTx has been performed in over 10 countries. As UTx is transitioning from an "experimental procedure" to a clinical option, an increasing number of centers may contemplate a UTx program. This article discusses essential steps for establishment of a successful UTx program. These principles may be implemented in cis- and transgender UTx candidates.

Objective: Previous studies show good technical success rates for fallopian tube recanalization. Scarce literature exists regarding advance techniques currently used by interventional radiologists during fallopian tube recanalization procedures. This study investigates the level of intervention and tubal patency and its association with technical success and associated pregnancy outcomes. Methods: We retrospectively evaluated fallopian tube recanalization procedures performed at a single center in a 24-year period. A total of 160 couples undergoing a basic infertility evaluation were included. Hysterosalpingography with high pressure contrast injection followed by selective contrast, guidewire catheterization at the tubal ostium, and/or microcatheter/microwire recanalization were performed. Comparisons of the tubal fertilization rate by relevant characteristics were tested for statistical significance with t tests for continuous data or with Pearson chi-square tests for categorical data. Results: Technical success rate was 94% (319 of 341 tubes). High pressure contrast injection alone (184 of 341, 54%), selective catheterization (40%), and microcatheter/microwire (6%) interventions yielded technical success rates of 98%, 90%, and 73%, respectively. The overall rate of conception was 35% (17 of 48). Conclusion: Current techniques of fallopian tube recanalization offer a desirable and safe option with high technical success for patients seeking treatment for infertility due to proximal fallopian tube obstruction.

The purpose of the present study was to assess providers' perceptions of fertility preservation (FP) options for female cancer patients and factors that influence decision making. Pediatric Physician and Nurse Oncologists (N = 167) were recruited from the Children's Oncology Group Hospitals to complete an online survey. Results showed that providers were comfortable discussing FP options and were able to identify experimental FP options and infertility risk of five cancers. Disease progression was the most influential factor in considering FP; survival and cost were least influential. Despite providers' self-reported comfort, barriers exist to FP for female patients. Improvements in multidisciplinary communication and access to reproductive specialists are needed to improve uptake.

Objective We evaluated the effects of menstrual types inclusive of PMS on reports of chronic pain intensity and psychopathology in twenty-eight women (mean age 38.93 ± 13.51) with Sickle Cell disease (SCD). Methods Using the Menstrual Symptoms Questionnaire, we compared women with PMS to those with less distressing spasmodic cycle types. Results Thirty-four percent of the sample used oral contraception; there were no significant effects of birth control use on reports of pain. Women with PMS characterized the sensory (p = .04) and affective (p = .04) experiences of their SCD-related chronic pain, including their current pain intensity (p = .03), as significantly greater than women with primary spasmodic menstrual type. Further, there was a trend towards significance for women with PMS to report greater levels of overall pain intensity (p = .07) and average pain intensity over the past month (p = .08). Conclusions The authors interpret these results to suggest that there may be a complex interaction of neurohormonal, biological, and psychological factors associated with PMS that influence manifestation and experience of chronic pain in patients with SCD.

1. Desiree Sierra, MD* 2. Mary Wood, MD* 3. Sneha Kolli, MD* 4. Lina Maria Felipez, MD† 1. *Department of Medical Education and 2. †Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nicklaus Children’s Hospital, Miami, FL * Abbreviations: H2RA: : histamine 2 receptor antagonist IBD: : inflammatory bowel disease NSAID: : nonsteroidal anti-inflammatory drug PPI: : proton pump inhibitor PUD: : peptic ulcer disease Providers should be able to identify the signs and symptoms of peptic ulcer disease in children, select the proper diagnostic tests needed to confirm the diagnosis, and describe adequate treatment regimens to start once the diagnosis is confirmed. After completing this article, readers should be able to: 1. Understand the mechanism and pathogenesis of gastritis, gastropathy, and peptic ulcer formation. 2. Recognize the symptoms of and risk factors for gastritis, gastropathy, and peptic ulcer disease. 3. Understand which patients warrant referral to a gastroenterologist for possible endoscopy. 4. Review the role of Helicobacter pylori in peptic ulcer disease. 5. Review the treatment of peptic ulcer disease with and without the presence of H pylori. Gastritis, gastropathy, and peptic ulcer disease (PUD), collectively known as acid peptic disease, are often described as a spectrum of the same disease. Although these conditions are more common in adults, their incidence in the pediatric population is clinically significant. Left untreated, gastritis can progress to PUD, which can result in serious complications such as perforation, bleeding, bowel strictures, and obstruction. Studies describing the role of Helicobacter pylori , nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and other causes have helped to further expand our understanding of gastritis and PUD in children. Direct visualization and the ability to biopsy with endoscopy have revolutionized the diagnosis and treatment of these diseases. The incidence of PUD in children is lower than that in adults. Based on several international studies, the incidence in children varies from 2% to 8%. (1)(2) The incidence of bleeding ulcers is lower and is estimated to be between 0.5 and 4.4 of 100,000 individuals. (3) These rates …

Pain, psychosocial issues and impaired activities of daily living (ADLs) are common in sickle cell disease (SCD). Improved longevity may be leading to increases in body mass index (BMI). We both describe an SCD clinic population and determine if BMI, psychosocial distress, and pain predict impairments in ADLs. Archival data from 252 adult African American SCD clinic patients were examined (ie gender, BMI, SCD type, psychosocial status via Symptom Checklist-90-Revised; pain via Short-form McGill Pain Questionnaire: Sensory Pain, Affective Pain (AP), Present Pain Intensity and ADLs. In total, 44% of the sample was overweight (BMI ≥ 25 kg/m2). Depression, anxiety, and Symptom Checklist-90-Revised Global Severity Index were in the clinical range. Patients with HbSβ+-thalassemia and hemoglobin SC disease had higher BMIs than those with HbSS (P < 0.001). AP and age-predicted impaired ADLs. In an OW/OB subsample, AP, age, and SCD severity predicted impaired ADLs. The consistent relationship of AP to ADL impairment suggests targeting AP via behavioral pain management may improve functioning.

Global health is an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasizes transnational health issues, determinants, and solutions;involvesmanydisciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population-based prevention with individual

Traduire les pieces de Moliere pour les presenter sur la scene anglaise a toujours pose probleme. Un critique theâtral va jusqu'a dire : ... Moliere, for all his universal wit, has been the indirect cause of more financial failures on the London stage than any backer cares to remember. Unselfish artists have allowed themselves to be pilloried in mangled versions of almost anglicized Moliere for years. En ecrivant l'histoire du Theâtre de l'Abbaye, Lady Gregory note : We wanted to put on some ...

Quels outils pouvons-nous fournir à nos étudiants pour les aider à traduire les fonctions sémantique et implicative des structures grammaticales qui n'ont pas d'équivalent dans la langue d'arrivée ? Cet article propose un exercice où une description énonciative et une approche pragmatique sont appliquées à la traduction en français d'un dialogue anglais comportant de nombreux exemples de be + ing. How can every element of meaning and implication be conveyed when the structures of source and target languages do not overlap ? How can we equip students who have not yet acquired an intuitive sense of both languages ? This article proposes an exercise applying an enunciative description and a pragmatic approach to the translation into French of an English dialogue containing numerous examples of the progressive form.

Objective To quantitatively describe women's priorities for pain assessment and qualitatively explain unique features of women's pain experiences. Design Mixed-methods study that included a three-round Delphi study followed by in-depth interviews. Setting Clinical research study. Participants Twenty-three women with chronic pain recruited from three women's pain treatment facilities and one interdisciplinary chronic pain clinic. Methods Phase 1 (Delphi) involved completion of a questionnaire that rated agreement with the importance of 32 commonly used pain assessment measures. Answers were compiled, and controlled feedback was provided after each round. This iterative process continued until acceptable stability was reached. Stability was defined as proportion agreement for each response that reached the a priori cutoff score of 75%. Phase 2 (qualitative) involved one-to-one telephone interviews that followed a semistructured interview guide partially informed from phase 1 findings. A descriptive approach summarized and described participants' perspectives while avoiding abstractions. Textual data were analyzed using content analysis. Results Phase 1 identified 15 pain assessments as important. Some commonly used pain assessment measures such as the numeric pain intensity rating scale did not reach agreement as important. However, no pain assessments reached agreement as unimportant. Ten additional women completed face-to-face interviews, and an overall theme of stigmatization emerged that highlighted the importance of soliciting the pain narrative and why some aspects of psychosocial pain assessment did not reach agreement. Conclusions Priorities identified by women for the assessment of pain were largely consistent with expert recommendations; however, important differences were raised that merit consideration for clinicians to reduce stigma.

Currently little is known of postpartum depression (PPD) screening and referral for refugee and immigrant women in Northern New England where the foreign born population has been rapidly expanding in the past decade. Research on PPD has focused largely on the general population leaving a large gap in our understanding of PPD in this vulnerable group. A retrospective chart review was conducted from a tertiary medical center with 1,160 births per year. Total sample n = 126, 28 % scored at risk for PPD. 39 % of women at risk had follow up documented as a phone call alone, however 43 % of that at risk group did not speak English. Focuses on the suitability of tools that have not been psychometrically tested for this population and may be culturally inappropriate for non western women. Lack of appropriate follow up is challenged and who is best placed to perform screening is considered.

preceding generations. We value relationships, look for meaning in our work, and hope to make a difference in the world. We like to be engaged and inspired. We value role models who demonstrate integrity, resourcefulness, and insight. Despite our generational differences, we have many similarities. Many questions about the needs and desires of our generation can be answered by asking, “What would I want?”

Objective: The polyglutamine diseases, including Huntington's disease (HD) and multiple spinocerebellar ataxias (SCAs), are among the commonest hereditary neurodegenerative diseases. They are caused by expanded CAG tracts, encoding glutamine, in different genes. Longer CAG repeat tracts are associated with earlier ages at onset, but this does not account for all of the difference, and the existence of additional genetic modifying factors has been suggested in these diseases. A recent genome-wide association study (GWAS) in HD found association between age at onset and genetic variants in DNA repair pathways, and we therefore tested whether the modifying effects of variants in DNA repair genes have wider effects in the polyglutamine diseases. Methods: We assembled an independent cohort of 1,462 subjects with HD and polyglutamine SCAs, and genotyped single-nucleotide polymorphisms (SNPs) selected from the most significant hits in the HD study. Results: In the analysis of DNA repair genes as a group, we found the most significant association with age at onset when grouping all polyglutamine diseases (HD+SCAs; p = 1.43 x 10(-5)). In individual SNP analysis, we found significant associations for rs3512 in FAN1 with HD+SCAs (p = 1.52 x 10(-5)) and all SCAs (p = 2.22 x 10(-4)) and rs1805323 in PMS2 with HD+SCAs (p = 3.14 x 10(-5)), all in the same direction as in the HD GWAS. Interpretation: We show that DNA repair genes significantly modify age at onset in HD and SCAs, suggesting a common pathogenic mechanism, which could operate through the observed somatic expansion of repeats that can be modulated by genetic manipulation of DNA repair in disease models. This offers novel therapeutic opportunities in multiple diseases.

Sickle cell disease (SCD) affects developmental maturation causing a delay in secondary sex characteristics associated with puberty. There is little data on the impact of SCD on body image, a well-established risk factor for eating disorders among young women. Body dissatisfaction combined with environmental stressors and negative affect may place some men and women with SCD at a higher risk problematic eating behaviors or body change strategies in an attempt to achieve a more idealized body type. The present exploratory study examined the potential associations between SCD, body image, and eating disorders, and provided preliminary data to guide the directions of future investigations.

H yperglycemia in hospitalized patients has been associated with poor outcomes in retrospective studies.1,2 This association has been found in patients admitted to medical, surgical, intensive care, and neurological care units. The association of poor outcomes and hyperglycemia upon admission to the hospital is usually stronger in patients without a prior diagnosis of diabetes, but it also extends to patients with known diabetes.1,2 Although such retrospective data cannot prove causality, it is generally agreed that hyperglycemia in patients who are significantly ill is detrimental to recovery and healing.3-5 As a partial explanation for this, in vitro data indicate poor immune cell and inflammatory cell function in a hyperglycemic environment.6-8 Intervention studies in surgical intensive care units have suggested improved outcomes when hyperglycemia is controlled.9 However, there have been no randomized trials of in-hospital, noncritical care intensive management to demonstrate better outcomes from improved control. Based primarily on intervention studies in critical care units,9-12 two major professional organizations and many review articles in influential journals have recommended that blood glucose control in the hospital be maintained between 90 and 130 mg/dl before meals and < 180 mg/dl 2 hours after meals, with care to avoid hypoglycemia.13-15 A recent meta-analysis of tight glucose control in intensive care units has called these recommendations into question, finding small benefits and a high risk of hypoglycemia.16 Nonetheless, no study to date has suggested that higher glucose levels during illness confer any advantage to patients, and good control of glucose (blood glucose levels consistently < 150 mg/dl) without hypoglycemia is likely to constitute optimal care.15 Many medical centers have adopted the recommendations of professional societies for inpatient glucose control. These targets have often been achieved …

Gerald Frankel, Janine Mauzeroll, Geoffrey Thornton, Hendrik Bluhm, Jonathan Morrison, Vincent Maurice, Trevor Rayment, David Williams, Angus Cook, Gaurav Joshi, Alison Davenport, Simon Gibbon, Denis Kramer, Matthew Acres, Markus Tautschnig, Hiroki Habazaki, Philippe Marcus, David Shoesmith, Clara Wren, Tom Majchrowski, Rob Lindsay, Mary Wood, Mira Todorova, John Scully, Frank Renner, Anton Kokalj, Christopher Taylor, Sannakaisa Virtanen and Julian Wharton

Sickle cell disease (SCD) is the most common genetic disorder of the blood. The disease produces significantly abnormal hemoglobin (Hgb) molecules in red blood cells (RBCs). The sickling of RBCs occurs when partially or totally deoxygenated Hgb molecules distort their normal disk shape, producing stiff, sticky, sickle-shaped cells that obstruct small blood vessels and produce vasoocclusion as well as the disruption of oxygen to body tissues. Because tissue damage can occur at multiple foci, patients with SCD are at risk for other medical complications including, but not limited to, delayed growth and sexual maturation; acute and chronic pulmonary dysfunction; stroke; aseptic necrosis of the hip, shoulders, or both; sickle cell retinopathy; dermal ulcers; and severe chronic pain. The chronicity of the illness combined with frequent hospitalizations for pain and other medical management can contribute significantly to impaired psychosocial functioning, altered intra- and interpersonal relationships, and reduced quality of life. Unlike previous qualitative reviews of SCD, this article describes the relevant clinical and research data on the relation between psychosocial functioning and SCD in adult and child populations. The authors discuss the significant role of psychosocial issues in the trajectory and management of the disease and conclude that understanding the pathophysiology of SCD without thoroughly understanding the equally important psychosocial influences is misunderstanding SCD.

Objectives: To understand the features of child abuse/neglect (CA/N) allegations in cases with emotional maltreatment (EMT) allegations, as well as the features of the EMT allegations themselves, and to describe any associations of EMT with distinct impairments of children's behavior, emotion and functioning. Method: The sample consisted of 806 high-risk children, 545 with one or more maltreatment reports to CPS. The Maltreatment Classification System was used to record the number and severity levels of maltreatment allegations, which compared cases with and without EMT. Multiple regression analyses were conducted using 10 outcome scales from the Child Behavior Checklist, Vineland Screener, and Trauma Symptom Checklist. Successive blocks of predictor variables included demographics, maltreatment classification variables, maternal and family characteristics, and study site. Results: When there were allegations of EMT as well as CA/N in a CPS case-record (by age 8), the CA/N allegations tended to be either more frequent or less severe than those kinds of allegations in cases without EMT. When neglect was alleged to occur with EMT, neglect allegations outnumbered allegations of EMT. However, when sexual abuse allegations were accompanied by EMT allegations, there were more EMT allegations than sexual abuse allegations in the cases. Higher severity ratings for EMT allegations than for physical abuse occurred when cases included any abuse. Distinctive effects of EMT subtypes were found between problems of safety/restriction and self-reported anger symptoms, and between problems of self-esteem/autonomy and posttraumatic stress. Conclusion: Differences exist between the CA/N allegations in cases with and without EMT. Having few cases containing only EMT allegations made it difficult to assess distinctive harm associated with EMT. Certain types of EMT allegations were associated with increases in children's anger and posttraumatic stress.

Religion/spirituality has been identified by individuals with sickle cell disease (SCD) as an important factor in coping with stress and in determining quality of life. Research has demonstrated positive associations between religiosity/spirituality and better physical and mental health outcomes. However, few studies have examined the influence religiosity/spirituality has on the experience of pain in chronically ill patients. Our aim was to examine three domains of religiosity/spirituality (church attendance, prayer/Bible study, intrinsic religiosity) and evaluate their association with measures of pain. We studied a consecutive sample of 50 SCD outpatients and found that church attendance was significantly associated with measures of pain. Attending church once or more per week was associated with the lowest scores on pain measures. These findings were maintained after controlling for age, gender, and disease severity. Prayer/Bible study and intrinsic religiosity were not significantly related to pain in our study. Positive associations are consistent with recent literature, but our results expose new aspects of the relationship for African American patients. We conclude that religious involvement likely plays a significant role in modulating the pain experience of African American patients with SCD and may be an important factor for future study in other populations of chronically ill pain sufferers.

Anecdotal evidence suggests that new graduate nurses are ill prepared for their experiences with death. This study explores death anxiety and coping skills in registered nurses during their first year of practice. Participating nurses were undertaking a transition support program; the subject group attended a Death Issues Workshop while the control group did not receive any formal education on death issues during their program. Data collection was by semi-structured interviews and use of the Nurses’ Attitude to Death Scale, a questionnaire developed by the researchers. Results indicate that the control group showed a greater reduction in death anxiety while the subject group demonstrated better coping skills in caring for themselves and their colleagues and were better equipped in providing care to patients and relatives. Recommendations are made for death issues to be explored more extensively during both undergraduate and postgraduate nurse education.

Objective. To investigate whether living in a 3-generation household (grandmother-mother-child) is associated with fewer behavior problems and better cognitive development among preschool children of mothers who gave birth during adolescence and whether it protects children from the behavior and developmental problems associated with maltreatment and maternal depression.Design. Cohort study.Setting. Participants included low-income families recruited from 4 sites: East, Northwest, Midwest, and South, who are part of LONGSCAN, a longitudinal study of children’s health, development, and maltreatment.Participants. One hundred ninety-four mothers who were adolescents (less than age 19) at delivery. Data were gathered when children were 4 to 5 years of age. Twenty-six percent of the children lived in 3-generation households, 39% had a history of maltreatment, and 32% of the mothers had depression scores in the clinical range.Main Outcome Measures. Child behavioral problems were measured with the Child Behavior Checklist, completed by the mother, and child developmental status was assessed with the Battelle Developmental Inventory Screening Test, administered by research assistants.Results. Multiple regression analyses revealed that children who had been reported for maltreatment and had mothers with depressive symptoms had more externalizing behavior problems, compared with children who experienced neither risk or only 1 risk. However, when residential status was considered, children with the greatest number of externalizing behavior problems were those who experienced both maltreatment and maternal depressive symptoms and lived in 3-generation households. Children who had been reported for maltreatment or had mothers with depressive symptoms were more likely to have internalizing problems, compared with children with neither risk. Residential status was not related to children’s internalizing behavior problems or cognitive development.Conclusions. Living in a 3-generation household did not protect preschool children from the behavior problems associated with maltreatment and depression. In contrast, living in a 3-generation household was associated with more behavior problems among the highest risk group of children—those who had been maltreated and had mothers with symptoms of depression. Although 3-generation families may provide an important source of support and stability for adolescent mothers and their infants early in the parenting process, it may not be advisable to rely on 3-generation households as young mothers enter adulthood, particularly among those with a history of maltreatment or depression. Children with the fewest number of behavior problems were living with their mothers in their own household (often with the father), had not been maltreated, and had mothers with few symptoms of depression.

Differentiating somatic from emotional influences on the experience of chronic pain has been of interest to clinicians and researchers for many years. Although prior research has not well specified these pathways at the anatomical level, some evidence, both theoretical and empirical, suggest that emotional reactions influence the experience of disease and non-disease-related pains. Other studies suggest that treatments directed at negative emotional responses reduce suffering associated with pain. The current study was conducted to explore the influence of emotional reactions to pain as a predictor of psychological distress in a sample of adult Blacks with Sickle Cell Disease (SCD). Using cross-sectional survey data, we evaluated whether negative emotional reactions to the experience of pain were predictive of psychological distress after controlling for the somatic dimension of pain and age in n = 67 Black patients with Sickle Cell Disease (SCD). Results showed that greater negative emotion associated with pain predicted Somatization ( p < .01), Anxiety ( p < .05), Phobic Anxiety ( p < .05), and Psychoticism ( p < .05). Increased negative emotion associated with pain was also predictive of the General Symptoms Index ( p < .05) and the Positive Symptoms Total from the SCL-90-R ( p < .01). We believe the current study demonstrates that negative emotional reactions to the experience of pain in adults with SCD are predictive of psychological distress above and beyond the influences of age and the direct nociceptive experience. We also believe these data to be valuable in conceptualizing the allocation of treatment resources toward a proactive approach with early identification of patients who are responding poorly for the purpose of potentially reducing later psychopathology. A deeper understanding of the ways that subpopulations cope with chronic disease-related pain may produce models that can be ultimately generalized to the consumers of the majority of healthcare resources.

Co-culture with numerous cell lines has been shown to improve in-vitro embryo development. It is usually performed in open culture without an oil overlay, or in relatively large volumes of medium (e.g. 0.5 ml) under oil. We compared the efficacy of open and microdrop co-culture systems using human endometrial and tubal cell lines and mouse zygotes. Although the mean pH values of the media from the tubal cell cultures (both open and oil-covered) decreased significantly over 5 days of culture, this did not appear to impair embryo development. Both co-culture and microdrop culture significantly improved blastocyst and hatching blastocyst formation rates. The combination of the two techniques (microdrop and co-culture) demonstrated the highest blastocyst formation and hatching blastocyst formation rates, as well as the highest mean cell numbers in hatching blastocysts. Co-culture in a microdrop is a superior system for mouse embryo culture.