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In stimulated cycles the endometrium could be more advanced than the embryos, with a possible negative impact on their implantation capacity. Therefore, there is an ongoing debate regarding the best transfer strategy: freeze-all versus fresh embryos transfer. Our study aimed to analyse if the frozen only embryos-transfer strategy for in vitro fertilisation (IVF) has higher clinical pregnancy rate (CPR) than the traditionally fresh transfer. We performed a retrospective study in a private centre of reproductive medicine. We included only patients who performed fresh embryo transfers (n=245) and patients with all the embryos frozen and then transferred into a non-stimulated cycle (n=117). The reasons for delayed transfer were an increased risk of ovarian hyperstimulation syndrome or the increase of late follicular phase serum progesterone level. The mean age of the study group was 34.33�b4.28 years and mean AMH was 3.68�b3.56 ng/mL. Patients with fresh transfer were significantly older (p[0.0001) and obtained significantly lower number of oocytes at egg retrieval (p[0.0001) and lower zygotes number (p[0.0001) in comparison with patients with frozen transfer. After adjustment for confounders, CPR was significantly higher in patients with fresh transfer in comparison with those with frozen transfer in total group (OR 2.7, p=0.001) and in patients with cleavage stage embryo transfer (OR 6, p=0.008), but not in patients with blastocyst transfer. Similarly, the implantation rate was significantly higher in total group and in both subgroups (p[0.0001). Our study shows that the freeze all strategy should not be performed in all the patients, being inferior to fresh transfer in the total study group and cleavage stage embryo transfers. The decision to transfer frozen embryos should take into account the availability of blastocysts for transfer and the risk benefit profile.

Pelvic masses are commonly diagnosed following clinical examination. These may be located in the genital organs or may interest other pelvic and abdominal organs. The pathology of the pelvic masses varies with age. The postmenopausal period is most commonly associated with malignant pathology while reproductive age is associated with benign pathology. The purpose of this paper is to present the experience of the Obstetrics and Gynaecology Clinic of the Sibiu County Clinical Emergency Hospital in laparoscopic myomectomy. We evaluated the patients admitted to the Obstetrics and Gynaecology Clinic of the Emergency County Clinical Hospital in Sibiu who underwent a laparoscopic myomectomy between 1.01.2015 - 06.06.2019. During this time, 14 laparoscopic myomectomies were performed in our clinic. Patients ranged in age from 29 to 57 years.

Hysteroscopy is a surgical procedure that allows a direct view of the uterine cavity and the tubular ostium. This procedure can be performed for both diagnostic and curative purposes. Hysteroscopy have several indications including the evaluation of abnormal uterine bleeding, infertility or intrauterine tumours identified by ultrasound. The purpose of this paper is to evaluate the correlation between the diagnosis at admission and the intraoperative aspect of the uterine cavity following the hysteroscopic evaluation. We evaluated the patients admitted to the Obstetrics and Gynaecology Clinic of the Sibiu County Emergency Clinical Hospital during 1.01.2019-07.06.2019 who had the following criteria: age between 15-64 years, patients with infertility, patients who had vaginal bleeding or intrauterine tumours or structure identified by ultrasound.

The revelation of situs inversus totalis by a peritoneal syndrome is an extremely rare event. The association of this condition with sigmoid diverticulitis and agenesis of the vermiform appendix has not been described in the literature. This paper aims to present the first case of this type while screening the literature on this topic. The authors present the case of a sigmoid diverticulitis associated with situs inversus totalis and agenesis of the vermiform appendix, in a 44-year-old male patient. Because of abdominal pain located in the right iliac fossa, elevated temperature (38.2°C) and biological examinations, acute appendicitis was rather simulated and considered as a presumptive diagnosis. Diagnostic accuracy was achieved during laparoscopic exploration of the peritoneal cavity, which proved the coexistence of visceral transposition, appendiceal agenesis and sigmoid diverticulitis, usually noted as a rare finding. Secondly, we performed a systematic search on PubMed® and Google Scholar® databases introducing the following terms: situs inversus totalis, acute appendicitis. Given the time span of the last 30 years, we have obtained a small number of cases in which symptoms that are specific to acute appendicitis have been found in patients with situs inversus totalis. Due to the rare number of cases, it is difficult to establish a preoperative diagnosis. Usually, this diagnosis is revealed as an intraoperative surprise. A careful clinical examination and a set of standardized paraclinical examinations can guide the diagnosis. The patient's evolution was favorable, without any other changes at the subsequent examinations.

Anterior knee pain, as well as patellofemoral disorders, after total knee arthroplasty are important reasons for revision in total knee arthroplasty. Current prosthesis designs include patellar components for patella replacement, and together with improved rational design of the prosthesis and advancement in knee alignment these appear to reduce the incidence of anterior knee pain following total knee replacement, even if the etiology of anterior knee pain remains unclear. However, new complications related to patella resurfacing emerge with this approach. At present, there are three strategies involving patella replacement in total knee arthroplasty: There are surgeons who always replace the patella, others who never resurface the patella and a third group of surgeons who usually do not resurface the patella but replace the patella in particular situations. There are arguments to support each of these viewpoints regarding patella resurfacing but no strong arguments to favor any of them. Finally, the decision to resurface the patella or not should be based on the practice, training and experience of individual surgeons. The aim of this review was to analyze the results of different strategies for patella resurfacing in terms of functional outcome and revision rate following primary total knee arthroplasty.

Aim of the study was to analyse the relationship between Anti-M�llerian Hormone (AMH) serum level and in vitro fertilisation (IVF) with and without intra-cytoplasmic sperm injection (ICSI) outcome. We performed a retrospective study which included 1073 patients (mean age 34.68�4.28 years, mean body mass index 22.7�15.65 kg/m2) who performed IVF or IVF/ICSI between January 2013 and December 2016.We found that AMH serum level was age-independent positively related with oocytes (beta=0.329, p[0.0001) and zygotes number (beta=0.248, p[0.0001) and negatively correlated with fertilization rate (beta=-0.108, p=0.001). In multivariate regression, after adjustment for confounders, only oocytes number, but not AMH serum level, was associated with zygotes number (beta=0.814, p[0.0001) and fertilisation rate (beta=- 0.133, p=0.001). Patients with AMH in the range 1.1-5 ng/mL had significantly higher biochemical (65.3% versus 56.6%, p=0.009) and clinical pregnancy rates (57.7% versus 49.2%, p=0.014) in comparison with patients with AMH below 1.1 ng/mL and higher clinical pregnancy rates in comparison with patients with AMH above 7 ng/mL (57.7% versus 44%, p=0.011). Logistic regression analysis showed that AMH was positively associated with biochemical (OR 1.19, p=0.003) and clinical pregnancy (OR 1.16, p=0.009) independently of age and number of good embryos transferred in patients with AMH below 5 ng/mL. In turn, when only patients with normal ovarian reserve were analysed (AMH above 1.1 ng/mL), we found an age-independent negative association between AMH and clinical pregnancy (OR 0.93, p=0.014). AMH serum level is associated with both quantitative response (oocytes number) and qualitative parameters (pregnancy rate) during IVF/ICSI. We also found a bimodal relationship between AMH and pregnancy rates, which were positively associated in patients with AMH below 5 ng/mL, although higher AMH values seem to have a negative impact on pregnancy chances.

Visual analogue scale (VAS) is a psychometric scale applied to measure subjective characteristics. The purpose of our study was to evaluate the efficiency of Ulipristal acetate (UPA) compared with Dienogest for endometriomas related pain using VAS. We performed a randomized study on women with symptomatic endometriomas. The study was realized between January 2016�December 2018. The patients were randomized in two groups: Group A- that received UPA in doses of 5 mg daily for 12�13 weeks and Group B that received 2 mg Dienogest for 12�13 weeks. Each group received de VAS (Visual Analogue Scale) questionnaire before and after treatment. 70 women wereincluded in the study with 35 patients for each group. The age the mean age was 30.20 years. For Numeric Rating Scale before treatment in the group with UPA the median value was 6 (CI= 5.26, 6.51) and for group B the median was 5 (CI= 5.13, 5.66). After treatment for group A the median value was 4 (CI= 3.58, 4.29) and for group B the median value 4 (CI= 4.23, 4.6). For FRS before treatment in the group with UPA median value was 6 (CI= 5.87, 6.58) and for the group B median was 6 (CI= 6.16, 6.57). After treatment for group A the median value was 4 (CI= 4.12, 4.73) and for group B the median value 5 (CI= 4.9, 5.06). The pain significantly improved for group A. (p[ 0.05) VAS represent a good method to evaluate the quality of pain for patients with endometriomas. The UPA and Dienogest treatment improve the VAS parameters with better results for UPA in the present study.

The persistent left superior vena cava (PLSVC) is a congenital heart anomaly reported in 0.3–0.5% of the general population and can be associated with congenital heart diseases in up to 8% of cases. Prenatal identification of PLSVC is important to prompt an extended cardiac and extracardiac fetal examination. We retrospectively reevaluated anomaly scans performed in our unit in a 2-year interval according to the national guidelines to evaluate the incidence of PLSVC and its association with prenatal morbidity. In our population, the incidence of PLSVC was 0.31%, and we found a low association with cardiac and extracardiac anomalies. The standard sections (three-vessel and trachea view, four-chamber view and outflow tract’s view) are insufficient to exclude cardiac anomalies whenever PLSVC is found. In our case series, only one newborn required postnatal surgery for total pulmonary vein anomaly, and at 2 years of life all babies had a normal evolution. Prenatal diagnosis of PLSVC can raise counseling issues; therefore, awareness of its good outcome when isolated and need for an extended examination to rule out other anomalies is very important.

Cucumis sativus L. is globally cultivated as an edible vegetable. Besides its nutritional benefits, it is used in traditional medicines against various ailments. The current study was designed to elucidate the multi-target mechanisms of a C. sativus seeds extract against asthma and diarrhea using network pharmacology along with a molecular docking approach. Furthermore, in-vitro and in-vivo experiments were conducted to verify the mechanistic insight of in silico studies. LC-ESI-MS/MS was performed to identify the bioactive compounds in the extract; later, some compounds were quantified by HPLC. C. sativus seed. EtOH has kaempferol in higher concentration 783.02 µg/g, followed by quercetin (693.83 µg/g) and luteolin (617.17 µg/g). In silico studies showed that bioactive compounds interfered with asthma and diarrhea-associated target genes, which are members of calcium-mediated signaling to exert a calcium channel blocker activity. The seeds extract exerted a concentration-dependent spasmolytic response on isolated jejunum, trachea, and urinary bladder preparations and caused relaxation of spastic contraction of K+ (80 mM) with suppressed calcium concentration-response curves at dose 0.3 and 1 mg/mL. It also showed antiperistalsis, antidiarrheal and antisecretory activity in animal models. Thus, C. sativus seeds have therapeutic effects by regulating the contractile response through a calcium-mediated signaling pathway.

Pentalogy of Cantrell (POC) is a rare condition characterized by complete or partial expression of 5 types of congenital birth defects originating in (1) the lower sternum, (2) the anterior diaphragm, (3) the diaphragmatic pericardium, (4) the midline/ventral supraumbilical abdominal wall region, and (5) the heart. POC can be diagnosed antenatally by means of ultrasonography (US), the task being difficult if defects are minor. Advances in the field of US and the introduction of the first morphology trimester as state-of-the-art pregnancy monitoring, facilitate the early diagnosis of this condition. We performed a systematic review on 67 reported cases of POC diagnosed in the first trimester of pregnancy (published from January 1980 to July 2019). The aim of our systematic review was twofold: to assess the main US findings in the first trimester of pregnancy and to increase awareness of early diagnostic possibilities. Our study showed that POC can be diagnosed in the first trimesterof pregnancy based on key US findings such as the association between omphalocele and ectopia cordis. When these two anomalies are present, increased nuchal translucency can also be considered a marker of POC in the first trimester.

Throughout history, nature has been acknowledged for being a primordial source of various bioactive molecules in which human macular carotenoids are gaining significant attention. Among 750 natural carotenoids, lutein, zeaxanthin and their oxidative metabolites are selectively accumulated in the macular region of living beings. Due to their vast applications in food, feed, pharmaceutical and nutraceuticals industries, the global market of lutein and zeaxanthin is continuously expanding but chemical synthesis, extraction and purification of these compounds from their natural repertoire e.g., plants, is somewhat costly and technically challenging. In this regard microbial as well as microalgal carotenoids are considered as an attractive alternative to aforementioned challenges. Through the techniques of genetic engineering and gene-editing tools like CRISPR/Cas9, the overproduction of lutein and zeaxanthin in microorganisms can be achieved but the commercial scale applications of such procedures needs to be done. Moreover, these carotenoids are highly unstable and susceptible to thermal and oxidative degradation. Therefore, esterification of these xanthophylls and microencapsulation with appropriate wall materials can increase their shelf-life and enhance their application in food industry. With their potent antioxidant activities, these carotenoids are emerging as molecules of vital importance in chronic degenerative, malignancies and antiviral diseases. Therefore, more research needs to be done to further expand the applications of lutein and zeaxanthin.

Antibiotherapy is the treatment of choice for the urinary tract infections in hospitalized urological patients. Antibiotic associated diarrhea (ADD) caused by the Clostridium difficile cytotoxin producer represents one of the most severe side effects of the antibiotic treatment. It is important to evaluate the risk factors for a hospitalized patient to develop a C. difficile healthcare associated infection during hospitalization in order to put in practice effective preventive measures. The aim of the study is to analyzed the risk factors associated with the demographic status: age, sex, and also risk factors related to healthcare conditions: use of antibiotics (number, type, duration of treatment), other significant medication taken prior to the onset of diarrhea (histamine-2-receptor antagonists and proton-pump inhibitors, comorbidities, possible contamination from other in-patients who developed ADD in the same period and data about in-hospital mortality.

Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection of the renal parenchyma, produced by gas-forming Gram-negative bacilli. Even though only few cases are reported in the literature, the disease is not so rare and can become life-threatening if the diagnose is not quick and the therapeutic messures efficient. The biochemical analysis are the first line diagnostic, indicating the severity of the infection. The aim of our study was to to evaluate the importance of biochemical parameters, as first line diagnosis and also of the microbiological parameters, as etiologic diagnosis, in severe renal infections produced by gas forming bacili mainly in diabetic patients, predominantly women, with obstructive nephrolithiasis.

Since the time of their introduction into medical practice, biomesh were criticized for their lack of tissue integration and the rejection due to the organism reaction for an element that is not autologous. The mechanisms by which these changes of contact between the tissue and the foreign material were produced were initially incompletely understood, but over time the involvement of the immune system mediated by the cellular or humoral local inflammatory reaction was established.

We are reporting a case of a 36 year-old Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) positive hypertensive primigravida with postpartum uterine atony that required emergency subtotal hysterectomy at Saint John Hospital Bucur Maternity Bucharest. The maternity was designated as the Coronavirus Disease 2019 (COVID-19) Maternity for Bucharest and Ilfov County since March 2020. The patient was mildly symptomatic for SARS-CoV-2, infection confirmed with reverse transcription polymerase chain reaction (RT-PCR). The caesarean section was performed and a live male fetus was born, 2630 g and Apgar Score of 9 (the male fetus was negative for SARS-CoV-2). Postpartum hysterectomy with adnexal preservation was performed because of uterine atony. The postoperative evolution was favorable. The patient was discharged with her baby 10 days after birth. Given the limited resources, the placenta, the umbilical cord and the uterus were not tested for SARS-CoV-2. The pathology exam revealed that on the maternal side there were specific uterine atony lesions as well as endometrial and miometrial ischaemia. The placenta had nonspecific findings: chronic ischemic lesions with small villi, fibrin deposits in the materno-fetal interface. The peculiarity of the case is that we report the morphological findings of the placenta and uterus resulted from intrapartum uterine atonia in a patient with gestational arterial hypertension, premature birth and COVID-19. Further studies are required to characterize the pattern of such intricate conditions.

Anorectal atresia (ARA) is a common congenital anomaly, but prenatal diagnosis is difficult, late, and unspecific. Utilizing a case of a 46 year old primipara with an egg donation In Vitro Fertilization (IVF) pregnancy, diagnosed at the first trimester scan with an anechoic isolated structure, which indicates anal atresia, we performed a systematic literature review in order to evaluate early prenatal ARA diagnosis. A total of 16 cases were reported as first trimester ARA suspicion, and only three had no associated anomalies. The most frequent ultrasound (US) sign was the presence of a cystic, anechoic pelvic structure of mainly tubular shape, or a plain abdominal cyst. In the majority of cases, structures were thin-walled and delimitated from the bladder. The presence of hyperechoic spots signifying enterolithiasis and peristaltic movements were helpful in order to establish the bowel origin of the lesion. Considering the high eventuality that the lesion is transitory, meaning later in pregnancy the fetus looks normal, early detection of such a sign should prompt further structural detailed evaluation, karyotyping, and appropriate pregnancy and postnatal counselling.

Open spina bifida, also known as spina bifida aperta is a neural tube defect involving the lack of closure of vertebral arches and associated meninges and/or spinal cord abnormalities.Ultrasound examination is the gold standard for the diagnosis of spina bifida aperta. It represents the main imaging tool used to ascertain this diagnosis early in gestation. Three-dimensional ultrasound is necessary to detect the level and the size of the defect. Magnetic resonance imaging (MRI) represents a more sensitive tool, giving specific information of the defect and associated anomalies, playing an important role in ruling out differential diagnosis. Due to the advent of MRI use, it is possible today to achieve in utero treatment of fetuses with this pathology. The aim of the current review is to provide an update of literature regarding the role of ultrasound and MRI in the prenatal diagnosis of spina bifida aperta.

Esophageal atresia (EA) is the most frequent and severe congenital anomaly of the esophagus, occurring in 1:2500-1:4500 live births. Five types of EA have been described, EA with tracheoesophageal fistula (TEF) being the most frequent.The aim of this paper is to evaluate epidemiological aspects, malformative associations, and prenatal diagnosis in an unusual case series of EA with distal TEF.The authors are analyzing a series of seven cases of EA with distal TEF. The seven cases of EA with TEF presented occurred during a period of two years, resulting in an unusually increased rate - 1.1:1000 live births. Except a late suspicion of EA (one day before delivery), EA was not diagnosed during prenatal scans despite association with polyhydramnios in two cases and single umbilical artery in four cases. None of the two cases of unilateral renal agenesis or anorectal malformations were diagnosed on prenatal ultrasound scans. In two of the cases, EA was part of VACTERL (vertebral defects, anorectal malformations, heart defects, EA with or without TEF, renal anomalies/dysplasia, and limb defects) association. Despite lack of prenatal diagnosis, postnatal diagnosis of EA was suspected at birth in four cases, at two hours in one case.An increased index of suspicion for congenital structural defects, particularly for EA, should be maintained in the presence of a single umbilical artery and÷or polyhydramnios on prenatal ultrasound scan. Prenatal diagnosis of EA offers the chance for parental counseling, planned birth and transfer for corrective surgery and decreases the risk for postnatal aspiration pneumonia associated with early feedings.

In IVF procedures, endometrial function is a limiting factor of the pregnancy rate and the aims of this study is to determine whether seminal plasma insemination at ovum pick-up in IVF has any effect on pregnancy rate.We designed a single center, 2 parallel groups, randomized pilot study. All couples undergoing an IVF procedure in our clinic between January 2010 and December 2011 were considered for enrollment in the study. The patients who met the inclusion criteria were randomized into two groups by simple randomization: the seminal plasma group (SP group) and the reference group (noSP group). We applied seminal plasma into the cervix and vaginal vault at the time of the OPU in the patients of the SP group. The primary outcome was the clinical pregnancy rate in the SP group compared with the noSP group and the secondary outcome measure was the implantation rate.400 patients met the inclusion criteria and were randomized. 54 patients were excluded from the study mainly because they didn't undergo the embryo transfer. Finally, 164 patients were included in the SP group and 182 patients in the noSP group and analyzed. We found a statistically non-significant increase in the pregnancy rate in the SP group (55.5 % versus 44 %, p=0.09) and a statistically significant increase in the implantation rate (34.7 % versus 27.5 %, p=0.026).Our results support the idea that SP insemination may have the potential to increase pregnancy rate in IVF procedures but further studies must be carried out.

The human serum albumin is a protein and the size of the object is less than the visible light wavelength, therefore it can not be imaged using optical microscopy. The Atomic Force Microscopy (AFM) is a technique that is currently used to reveal details on surfaces by means of different scanning techniques. This article presents details and results on using AFM for imaging human serum albumin (HSA).

Highlights • We experience a case of relatively rare small bowel obstruction caused by terminal ileum endometriosis. • Multiple lesions were also located in Douglas pouch, causing partial rectal stenosis. • Correct surgical and medical approach is required., Introduction We report our experience involving a rare case of ileum endometriosis complicated with small bowel obstruction. Presentation of case 33 years old female patient, admitted to emergency service with abdominal pain, abdominal distension, and vomiting. Abdominal X-ray showed dilated small bowel loops. Computerized tomography scan showed dilated small intestine segments excepting last ileum loop, gastric distension, enlarged ovaries. Emergency laparotomy was performed, showing acute bowel obstruction due to a stenotic tumor placed on the terminal ileum, cecum tumors, multiple tumors in Douglas pouch, multiple mesenteric enlarged lymph nodes. Right colectomy is performed with an ileo-transverso stomy placed in right hypochondrium. Postoperative evolution without complication, patient discharged after 13-days hospitalization. After hormonal treatment, she returned for a second look and ileotransverso anastomosis. Discussion Gastrointestinal involvement of endometriosis has been found in 3%–37% of menstruating women. Ileum localization is very rare (1%–7%), causing intestinal obstruction 7%–23% of cases. Intraoperative differential diagnosis is difficult, predisposing at confusion with other types of tumors. In the absence of fast microscopic exam, the tumor was considered malignant and imposed a right hemicolectomy. Conclusion Intestinal obstruction due to ileum endometriosis is a rare condition, however, it should always be considered in the differential diagnosis in women of reproductive age.

Synthetic polypropylene materials are increasingly being used in surgery to repair parietal defects in perineal floor curing surgery, in genital prolapse and stress urinary incontinence. The tissue response to contact with these materials varies, and the inflammatory tissue response may be a prognostic marker of success in surgical interventions that involve contact between tissues and polypropylene materials.