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An abstract of the article "Measurement of the brain stem diameter at the 11-14 week scan," by B. Zmrhalova and colleagues is presented.

Objective: To demonstrate the use of a single-stapler technique during rectosigmoid resection in women with deep infiltrating endometriosis (DIE)., Design: A step-by-step video demonstration of rectosigmoid resection and end-to-end anastomosis using two circularly placed sutures and one circular stapler., Setting: Institute for the Care of Mother and Child, Prague, Czech Republic., Patient(s): A 39-year-old woman presented with primary sterility and deep infiltrating endometriosis, and an EZIAN score of A2,B2,C3. A nodule was located 9 cm from the anus and was 38 × 9 mm in size. This included an intramural fibroma of 6 cm and a left-sided ovarian endometriotic cyst of 6 cm. Her pain on the visual analogue scale were dysmenorea 6, dyspareunia 5-6, dyschezie 7, dysuria 0, and acyclic pain 5., Interventions: The primary objective was to replace the linear-stapler resection with two simple, strictly circularly placed sutures, to cut the intestinal wall between them, and to form the end-to-end anastomosis with a circular stapler. The one-stapler technique consisted of the following steps: intestinal wall cleansing as in the limited segmental resection; placement of one strictly circular suture just below the DIE nodule, without fixation; placement of the first circular suture just below the DIE nodule, ideally with at least three full-thickness "bites" of the intestinal wall; placement of the second circular stitch approximately 2 cm below the first one in a similar manner (three full-thickness "bites"); interruption of the intestinal wall with a harmonic scalpel; end-to-end intestinal anastomosis with a circular stapler; and airtightness test of the anastomosis. This results in only one incision line and therefore a lower risk of leakage. Intestinal resection time was on average 10 minutes longer compared to that for the linear stapler technique. So far, we have successfully performed the procedure in 25 women. Perioperative leakage was observed in two of these 25 patients in the classical procedure group and in none of the 25 patients in the group with the one-stapler technique. There were no differences in C-reactive protein (CRP) on third and fifth postoperative days or in other complications such as bleeding and pyrexia). The cost of procedure is lowered by the decrease in the number of staplers from 3 to 1. The patients' postoperative follow-up was uneventful, and they were discharged from the hospital at the same time as the women in whom the classical stapler technique was performed., Main Outcome Measures(s): The primary outcome was the development of a new surgical approach to resection rectosigmoid endometriotic nodules that would decrease the number of incision lines on the intestine. The secondary outcome measures were peri- and postoperative complications (i.e., bleeding, intestinal leakage, postoperative infection, CRP), length of the surgery and hospitalization, and cost of the procedure., Conclusion: Multiple incision lines following resection of the rectosigmoid colon and end-to-end anastomosis are risk factors for postoperative intestinal leakage. Therefore, a single incision line formed with two circular sutures, and one circular stapler may reduce the risk of postoperative complications and also financial expenses of the procedure. We believe that this method is suitable and easiest for nodules located less than 6 cm from the anal verge because of possible complications with angulation of linear stapler., (Copyright © 2020 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to obtain sexual and reproductive behaviour data of late adolescent women in the Czech Republic and to analyse the relationships between sexual behaviour and social, demographic, and behavioural factors., Methods: Data were obtained using the Computer-Assisted Web Interviewing method from 25 April to 2 May 2018 from a representative group of sexually active women aged 18-24 years. Results were statistically evaluated using sign schema on adjusted residuals., Results: A total of 525 women participated (median age of coitarche - 16 years, condom use with/without hormonal contraception - 65%, unprotected sex - 9.3% in the sexual debut). Anamnestic artificial abortion and sexually transmitted disease (STD) rates were 5.3% and 3.8%, respectively. Early coitarche, number of sexual partners, history of abortion, and STDs were positively correlated with current hormonal contraceptive use; the number of sexual partners and use of hormonal contraception were negatively correlated. Hormonal contraceptive users were more likely vaccinated against human papilloma virus (HPV) in comparison with women without any contraception. There was no correlation between risky sexual behaviour, contraceptive use, and socio-demographic factors., Conclusion: Women with early coitarche and a high cumulative number of sexual partners have more unwanted pregnancies and STDs; moreover, those with regular coital activity without contraception are less frequently vaccinated against HPV.

Background: There is an urgent need to develop better materials to provide anatomical support to the pelvic floor without compromising its function., Objective: Our aim was to assess outcomes after simulated vaginal prolapse repair in a sheep model using three different materials: (1) ultra-lightweight polypropylene (PP) non-degradable textile (Restorelle) mesh, (2) electrospun biodegradable ureidopyrimidinone-polycarbonate (UPy-PC), and (3) electrospun non-degradable polyurethane (PU) mesh in comparison with simulated native tissue repair (NTR). These implants may reduce implant-related complications and avoid vaginal function loss., Design, Setting, and Participants: A controlled trial was performed involving 48 ewes that underwent NTR or mesh repair with PP, UPy-PC, or PU meshes (n=12/group). Explants were examined 60 and 180 d (six per group) post-implantation., Intervention: Posterior rectovaginal dissection, NTR, or mesh repair., Outcome Measurements and Statistical Analysis: Implant-related complications, vaginal contractility, compliance, and host response were assessed. Power calculation and analysis of variance testing were used to enable comparison between the four groups., Results: There were no visible implant-related complications. None of the implants compromised vaginal wall contractility, and passive biomechanical properties were similar to those after NTR. Shrinkage over the surgery area was around 35% for NTR and all mesh-augmented repairs. All materials were integrated well with similar connective tissue composition, vascularization, and innervation. The inflammatory response was mild with electrospun implants, inducing both more macrophages yet with relatively more type 2 macrophages present at an early stage than the PP mesh., Conclusions: Three very different materials were all well tolerated in the sheep vagina. Biomechanical findings were similar for all mesh-augmented repair and NTR. Constructs induced slightly different mid-term inflammatory profiles., Patient Summary: Product innovation is needed to reduce implant-related complications. We tested two novel implants, electrospun and an ultra-lightweight polypropylene textile mesh, in a physiologically relevant model for vaginal surgery. All gave encouraging outcomes., (Copyright © 2018. Published by Elsevier B.V.)

Objective: The aim of the study is to analyse the musculo-fascial component of the pelvic floor in symptomatic group of woman with pelvic organ prolapse before planned vaginal reconstruction using synthetic vaginal mesh., Design: Observational cohort study., Setting: Department of Obstetrics and Gynaecology, Hospital in Frýdek-Místek; GONA Ltd, Prague; Institute for Care of Mother and Child, Prague; 3rd Faculty of Medicine CHU Prague., Methodology: The study involved 285 female volunteers (6 nulliparous, all other patients gave birth vaginally at least once) that in the period 2008-2015 before the planned reconstructive vaginal operations have undergone a comprehensive urogynaecology examination supplemented by magnetic resonance imaging (MRI) of the pelvic floor. Assessed was musculofascial component of the pelvic floor containing -musculus levator ani (MLA), endopelvic fascia (EF) and sacrouterine ligaments (SUL). MLA and EF were evaluated at two levels. The first level corresponds to the puborectalis muscle (evaluation of MRI trauma stage and avulsion), the second level correspondes to the iliococcygeus muscule (evaluation only avulsion injury to the muscle)., Results: Normal appereance of musculus puborectalis (level 1) was captured only in 25 (8.8) women. In 117 (41.1%) of women were present MRI minor trauma, 143 (50,2%) women were present with MRI major trauma. Avulsion of the muscle was captured in 85 cases (29.8%) at level 1 and in 165 cases (57.9%) in level 2. Preserved architecture of the EF was caught only 99 (34.7%) of the cases in level 1 and in 47 cases (16.5%) in level 2. Sacrouterine ligaments showed normal morphology in 100 cases (35.1%).Conslusion: Defects of musculofascial component of the pelvic floor is found frequently in women with symptomatic pelvic organ prolapse. Often a combination of defects MLA, EF and SUL are found. These comprehensive pelvic floor defects require careful urogynecological examination and planing operating methods with a view to minimizing the likelihood of recurrence of the descent. In indicated cases the use of the synthetic vaginal mesh is as a method of first choice.

Objective: The aim of the study is to compare the results of five years follow-up prospective study of vaginal prolapse repaired by prolift total mesh surgery or sacrospinous fixation., Study Design: A single-center prospective, cohort study, in patients with defect grade II and more by POP-Q., Setting: The Institute for the Care of Mather and Child; 3rd Medical Faculty Charles university, Prague., Methods: Comparison of the preoperative state and the five years after the operation according POP Q, ICIQ-SF, PISQ 12, VAS. Comparison of intraoperative and postoperative complications., Results: The study was attended by 142 patients; 75 patients underwent surgery Prolift Total and 67 patients sacrospinous fixation by Amreich Richter. On clinical examination at 5-year follow-up, we observed 15 (20.0%) case of anatomical failure in the Prolift group and 30 (44.8%) in the SSF group. Anatomic failure was defined clinically as Ba, C or Bp at the hymen or below. In assessing the overall condition before and five years after surgery using a VAS occurred in patients in the cohort Prolift Total decrease to 2.9 (± 1.9) from the original 7.8 (± 1.8). VAS in SSF group decreased after 5 years to 4.2 (± 2.7) of the original 7.8 (± 1.4). Values ICIQ-SF, analyzing the state of voiding PT group showed a decline from the original 6.7 (± 6.9) to 5.5 (± 5.3). A similar trend was evident even after the SSF. Parameters questionnaire PISQ-12 showed a positive increase from the original 28.6 (± 9.5) to 31.8 (± 7.9) points. PISQ-12 was improved from 28.7 (± 9.8) to 32.2 (± 7.5)., Conclusion: Recurrences were observed more frequently in patients after sacrospinous fixation, while the quality of life questionnaires yielded comparable postoperative results. Quantity of intraoperative complications is low and both groups do not differ.

Objective: To analyse the results of the long-term prospective follow-up study of vaginal prolapse reconstructed using a Prolift Posterior., Study Design: Prospective, cohort study., Setting: Institute for the Care of Mother and Child, Prague., Methods: Over a 5-year period (I/2006 - XII/2011) we prospectively followed a cohort of patients with posterior vaginal wall defect who underwent surgical reconstruction using a monofilament polypropylene implant Prolift Posterior (Gynecare, Ethicon, Inc., Piscataway, NJ, USA). Patients were invited for review at six weeks, three months, six months, 12 months and then yearly up to five years. Postoperative follow-up included the clinical examination and subjective evaluation using VAS, PISQ 12 and ICIQ SF., Results: One hundred twenty-four women were included in the study, of which 14 (11.3%) had no prolapse surgery in their health history. There were no concomitant vaginal procedures such as hysterectomy or another implant surgery. The average operation time and blood loss were 64.25 min (min. 10, max. 205 min) and 115 ml (min. 10 ml, max. 1000 ml), respectively. Only one patient had a blood loss 1000 ml. There were no injuries of the urinary bladder or intestines during the needle insertion of the mesh. In the five-year period, the recurrence of posterior vaginal wall defect was observed in 4 cases (3.3%). The average time to the posterior vaginal wall recurrence prolapse was 19.5 months (min. 6, max. 36). De novo prolapse in the anterior compartment was observed in 25 patients (20.5%)., Conclusion: In this prospective single centre study, we observed anatomical improvement in the implanted compartment with low recurrence rate. During five years follow-up period there was de novo anterior vaginal wall defect observed in 20.5% cases. The question of implant employment in urogynecology remain to be answered, however, our results show that implants have their position in reconstructive surgery.

Introduction and Hypothesis: During vaginal delivery, the levator ani muscle (LAM) undergoes severe deformation. This stress can lead to stretch-related LAM injuries. The objective of this study was to develop a sophisticated MRI-based model to simulate changes in the LAM during vaginal delivery., Methods: A 3D finite element model of the female pelvic floor and fetal head was developed. The model geometry was based on MRI data from a nulliparous woman and 1-day-old neonate. Material parameters were estimated using uniaxial test data from the literature and by least-square minimization method. The boundary conditions reflected all anatomical constraints and supports. A simulation of vaginal delivery with regard to the cardinal movements of labor was then performed., Results: The mean stress values in the iliococcygeus portion of the LAM during fetal head extension were 4.91-7.93 MPa. The highest stress values were induced in the pubovisceral and puborectal LAM portions (mean 27.46 MPa) at the outset of fetal head extension. The last LAM subdivision engaged in the changes in stress was the posteromedial section of the puborectal muscle. The mean stress values were 16.89 MPa at the end of fetal head extension. The LAM was elongated by nearly 2.5 times from its initial resting position., Conclusions: The cardinal movements of labor significantly affect the subsequent heterogeneous stress distribution in the LAM. The absolute stress values were highest in portions of the muscle that arise from the pubic bone. These areas are at the highest risk for muscle injuries with long-term complications., Competing Interests: Compliance with ethical standards Conflicts of interest All authors declare that they have no conflicts of interest related to the study presented.

Objective: A short literature review of ewe as an experimental model in research of effects of pregnancy, delivery and urogynecological surgical procedures on the pelvic floor., Design: Literature overview., Setting: Institute for the Care of Mother and Child, Third Faculty of Medicine, Prague., Methods: This is an overview of recent literature on experiments using ewes as a model for biomechanical and morphological changes of the vagina induced by pregnancy, delivery and transvaginal graft implantation., Results and Conclusion: The ovine pelvic floor and vagina have comparable morphology to human. Its biomechanical and biochemical properties get changed during the pregnancy and postpartum similarly to clinical findings. Sheep could be used for testing of urogynaecological implants vaginally and simultaneously implanted in the abdominal wall to provide better understanding of anatomical environment differences. The size of the ovine vagina gives the opportunity to perform comprehensive biomechanical, histological and biochemical testing. Experiments and observation may improve our understanding of pathology and physiology of vaginal wall changes induced by hormones, prolapse or surgery.

Purpose: Serious complications can develop with the mesh implants used for stress urinary incontinence and pelvic organ prolapse surgery. We evaluated 2 materials currently in clinical use and 2 alternative materials using a rabbit abdominal model to assess host response and biomechanical properties of the materials before and after implantation., Materials and Methods: Poly-L-lactic acid and polyurethane meshes were electrospun to be compared to commercially available polypropylene and polyvinylidene fluoride meshes. A total of 40 immunocompetent full-thickness abdominal wall defect rabbit models were used, including 8 in each of the poly-L-lactic acid, polyurethane, polyvinylidene fluoride and polypropylene experimental groups, and sham controls. Two 20 mm defects were created per animal and primarily repaired. The experimental groups then underwent onlay of each repair material while sham controls did not. Four rabbits per group were sacrificed at days 30 and 90. Abdominal wall specimens containing the defect with or without repair material were explanted to be assessed by histology (hematoxylin and eosin staining, and immunohistochemistry) and biomechanical testing at 30 and 90 days., Results: At 90 days of implantation tissues repaired with all 4 materials showed biomechanical properties without significant differences. However, polypropylene and polyvinylidene fluoride meshes demonstrated a sustained chronic inflammatory response profile by 90 days. In contrast, poly-L-lactic acid and polyurethane meshes integrated well into host tissues with a decreased inflammatory response, indicative of constructive remodeling., Conclusions: Poly-L-lactic acid and polyurethane alternative materials achieved better host integration in rabbit models than current synthetic repair materials., (Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

With ongoing evolution of advanced ultrasound diagnostic in prenatal care the trend is to detect potential fetal anomalies in the first trimester if possible. Complex knowledge of normal fetal anatomy, embryology and ultrasound anatomy is important to be able to identify subtle abnormalities. In this review we demonstrate the possibilities of ultrasound imaging of fetal brain at late first trimester and describe normal central nervous system development week by week. Original images are presented.

Objective: The aim of this article is to review current options of prenatal diagnosis and management of fetuses with congenital diaphragmatic hernia at the Institute for the Care of Mother and Child., Setting: Institute for the Care of Mother and Child, 3. LF UK, Prague., Methods: Review of the literature., Results: Prenatal diagnosis of congenital diaphragmatic hernia based on 2D ultrasound. Measurement of the lung-to-head ratio (LHR), observed to expected lung to head ratio (O/E LHR), side of the diaphragmatic defect, assessment of the liver position and presence of associated anomalies (negative prognostic factors) are used for prediction of outcome. Prenatal diagnosis can be suplemented by 3D ultrasonography and magnetic resonace imaging. An important part of succesful management of CDH is the referal of cases to a specialised center.

Objective: The aim of this article is to review the current options of prenatal diagnosis in congential diaphragmatic hernia (CDH)., Subject: Systematic review., Setting: Institute for the Care of Mother and Child, 3rd Medical Faculty, Prague., Subject and Method: Review of recent published data., Conclusion: The basic method for prenatal diagnosis of congenital diaphragmatic hernia is 2D ultrasonography: measurement of lung-to-head ratio (LHR), observed to expected lung to head ratio (observed to expected LHR - O/E LHR), localization of diaphragmatic defect, assessment of liver position and presence of associated anomalies (negative prognostic factors). Prenatal diagnosis can be supplied with 3D ultrasonography and magnetic resonace (imaging methods for valid measurement of fetal lung volume and/or presence of associated congenital defects confirmation). The reactivity of intrapulmonary arteries are evaluated by hyperoxygenation test and measurement of arterial Doppler parameters. Isolated diaphragmatic hernia is not an indication for invasive prenatal diagnostic methods. Important part of succesful prenatal diagnosis and therapy of CDH is concentration of cases in specialized centre.

Cytokinin (CK) has been known to inhibit primary root elongation and suggested to act as an auxin antagonist in the regulation of lateral root (LR) formation. While the role of auxin in root development has been thoroughly studied, the detailed and overall description of CK effects on root system morphology, particularly that of developing lateral root primordia (LRPs), and hence its role in organogenesis is still in progress. Here we examine the effects of conditional endogenous CK overproduction on root architecture and consider its temporal aspect during the early development of Arabidopsis thaliana. We employed the pOp/LhGR system to induce ectopic ipt overexpression with a glucocorticoid dexamethasone at designated developmental points. The transient CaMV 35S>GR>ipt transactivation greatly enhanced levels of biologically active CKs of zeatin (Z)-type and identified a distinct developmental interval during which primary root elongation is susceptible to increases in endogenous CK production. Long-term CK overproduction inhibited primary root elongation by reducing quantitative parameters of primary root meristem, disturbed a characteristic graded distribution pattern of auxin response in LRPs and impaired their development. Our findings indicate the impact of perturbed endogenous CK on the regulation of asymmetric auxin distribution during LRP development and imply that there is cross-talk between auxin and CK during organogenesis in A. thaliana.