Weaknesses in the case against prepatterning in the mouse

Serious weaknesses are exposed regarding recent claims to have demonstrated that there is no prepatterning of axes in the mouse. That the orientation of the axis of polarity of the blastocyst is dictated by the shape of the zona pellucida is contradicted by systematic observations on living conceptuses. Moreover, this 'mechanical constraint' hypothesis fails to account for key findings on which the case for prepatterning is based.     

Cyclosporine in transplantation of the liver in the dog

Orthotopic hepatic transplantation was performed upon 29 dogs. Four dogs received no immunosuppressant, 12 received cyclosporine and 13 received azathioprine. Dogs treated with cyclosporine at a dose of 20 milligrams per kilogram yielded histologic and functional data indistinguishable from those of the dogs in the sham transplant group. Histologic evidence of rejection consistently appeared when the dose was decreased to 10 milligrams per kilogram but was reversed upon resuming the administration of the higher dosage. Serum levels of bilirubin and hepatic enzymes, serum glutamic-oxalacetic transaminase, serum glutamic-pyruvic transaminase and alkaline phosphatase did not correlate with the development or resolution of histologic evidence of rejection in dogs receiving cyclosporine. Dogs receiving cyclosporine for 60 days had a prolonged survival when the drug was stopped, whereas the dogs receiving such therapy for less than 60 days did not have a prolonged survival period.     

Outcomes in the absence of the ductus venosus diagnosed in the first trimester

Purpose: To clarify the outcomes of the absence of the ductus venosus (DV) diagnosed in fetuses suspected to have a structural abnormality during a morphological assessment in the first trimester.

Methods: Infants in whom ultrasound fetal morphological assessments were attempted in the first trimester (11 to 13–6 weeks of gestation) and who were subsequently delivered between 2013 and 2015 at Showa University Hospital were enrolled. In cases in which the absence of the DV was diagnosed in the first trimester, the prognosis was assessed.

Results: First-trimester ultrasound screening was performed in a total of 2610 cases between 2013 and 2015. Fetal edema (n?=?38), hydrops (n?=?16), abnormal four-chamber view findings (n?=?2), and tricuspid regurgitation (n?=?1) were observed in a total of 52 cases (2.0%). In 4 of the 52 cases with abnormal ultrasound findings, the absence of the DV was detected.

Conclusion: If fetal edema or hydrops in early pregnancy is found without any other structural abnormalities, not only chromosomal abnormalities should be suspected but also an evaluation for the absence of the DV should be included. In addition, absence of the DV with fetal edema may be associated with the outcomes of cardiac dysfunction, chromosome abnormalities, and intrauterine sudden death. Severe fetal edema is associated with a poor prognosis, and the family must be carefully informed of the potential outcomes.     

Trends in the Utilization of Penile Prostheses in the Treatment of Erectile Dysfunction in the United States

BackgroundThe utilization of penile prosthesis (PP) insertion in the general population for medically refractory erectile dysfunction (ED) has not been well‐characterized. This study assessed the national temporal trends in the surgical management of ED utilizing PP.Materials and MethodsAn analysis of the 5% Medicare Public Use Files from 2001 to 2010 was performed to assess the use of PP. Regression analysis was performed to identify factors associated with PP placement, type of PP utilized, and factors associated with revisions.ResultsA total of 1,763,260 men were diagnosed with ED, 3% (53,180) of whom underwent PP insertion. The utilization of PP for ED decreased from 4.6% in 2002 to 2.3% in 2010 (P < 0.01). This temporal decline in utilization was significant across all demographic factors including age, ethnicity, and geographic location. Men aged 65–74, from the U.S. South and West, and those with Charlson comorbidity scores >1 were more likely to have a PP inserted for ED (P < 0.01). African American men were more likely to have a semirigid PP placed compared with a multicomponent inflatable PP, and were more likely to undergo a revision or removal of the PP compared with Caucasian men (P < 0.01).ConclusionsThe surgical management of ED with PP changed significantly between 2001 and 2010. The overall utilization of PP decreased, but its use in patients with significant medical comorbidities increased. Age >65, ethnicity, and geography influenced the likelihood of PP placement, prosthesis type, as well as the likelihood of prosthesis removal or revision. Lee DJ, Najari BB, Davison WL, Al Hussein Al Awamlh B, Zhao F, Paduch DA, Mulhall JP, Chughtai B, and Lee RK. Trends in the utilization of penile prostheses in the treatment of erectile dysfunction in the United States. J Sex Med 2015;12:1638–1645.     

Challenges in the Practice of Sexual Medicine in the Time of COVID-19 in the United Kingdom

BackgroundOn 23rd March 2020, the UK government released self-isolation/social distancing guidance to reduce the risk of transmission of SARS-CoV-2. The influence such guidance has on sexual activity is not known.AimTo investigate levels and correlates of sexual activity during COVID-19 self-isolation/social distancing in a sample of the UK public.MethodsThis paper presents preplanned interim analyses of data from a cross-sectional epidemiological study, administered through an online survey.OutcomesSexual activity was measured using the following question: “On average after self-isolating how many times have you engaged in sexual activity weekly?” Demographic and clinical data were collected, including sex, age, marital status, employment, annual household income, region, current smoking status, current alcohol consumption, number of chronic physical conditions, number of chronic psychiatric conditions, any physical symptom experienced during self-isolation, and number of days of self-isolation/social distancing. The association between several factors (independent variables) and sexual activity (dependent variable) was studied using a multivariable logistic regression model.Results868 individuals were included in this study. There were 63.1% of women, and 21.8% of adults who were aged between 25 and 34 years. During self-isolation/social distancing, 39.9% of the population reported engaging in sexual activity at least once per week. Variables significantly associated with sexual activity (dependent variable) were being male, a younger age, being married or in a domestic partnership, consuming alcohol, and a higher number of days of self-isolation/social distancing.Clinical ImplicationsIn this sample of 868 UK adults self-isolating owing to the COVID-19 pandemic, the prevalence of sexual activity was lower than 40%. Those reporting particularly low levels of sexual activity included females, older adults, those not married, and those who abstain from alcohol consumption.Strength and LimitationsThis is the first study to investigate sexual activity during the UK COVID-19 self-isolation/social distancing. Participants were asked to self-report their sexual activity potentially introducing self-reporting bias into the findings. Second, analyses were cross-sectional and thus it is not possible to determine trajectories of sexual activity during the current pandemic.ConclusionInterventions to promote health and well-being during the COVID-19 pandemic should consider positive sexual health messages in mitigating the detrimental health consequences in relation to self-isolation/social distancing and should target those with the lowest levels of sexual activity.Jacob L, Smith L, Butler L, et al. Challenges in the Practice of Sexual Medicine in the Time of COVID-19 in the United Kingdom. J Sex Med 2020;17:1229–1236.     

Changes in the sensitivity of adrenergic receptors in the oviduct during early gestation in the rabbit.

There is evidence to indicate that the transport of an egg through the rabbit oviduct is controlled through an interaction of the sympathetic nervous system and ovarian hormones. The effect of norepinephrine (NE) on the contractility of the oviduct during the first 8 days of gestation was studied using the rabbit perfused oviduct. The sensitivity of the alpha-adrenergic receptors of the oviduct to NE decreased progressively during early gestation. This was reflected in a potency change and a decrease in the maximal response obtained. These data support the concept that an isthmic sphinctering effect mediated by the autonomic nervous system may play a role in the regulation of egg transport through the oviduct. Blood pressure responses to NE did not change during early pregnancy except that the responses to NE were significantly enhanced immediately after mating. This suggests that the sensitivity changes to autonomic agents during early gestation may be selective for reproductive tissues.     

Veralipride in the treatment of hot flushes in the menopause

Thirty-six menopausal women and 18 women with surgically-induced menopause were treated with a daily oral dose of 100 mg of veralipride for a period of 20 days followed by 10 days without therapy. Following 2 or 3 treatment periods, the drug was effective in 27 women from the first group and in 13 women from the second group. Six women had to discontinue therapy because of adverse effects. There was no significant variation in FSH or LH serum levels.     

Aberrations in the structure of the X chromosome in women

The authors review structural aberrations of the X chromosome in women. The correlation of their occurrence with clinical experience has led to a better understanding of the syndromes they provoke as well as of the gene content and mode of action of the X chromosome.     

Changes in the isoforms of the sodium pump in the placenta and myometrium of women in labor

OBJECTIVE: We determined whether changes in sodium pump isoform abundance accompanied active human labor. STUDY DESIGN: Specimens of placenta, amniochorion, and myometrium were collected from women in active spontaneous labor and from those not in labor. The abundance of the three sodium pump alpha-isoforms was determined by Western blot analysis. RESULTS: Levels of the alpha1 and alpha2 isoforms were comparable in the three tissues for women in labor and not in labor. However, alpha3 isoform abundance in placenta and myometrium (but not amniochorion) was significantly decreased in women in active labor compared with women not in labor (sodium pump alpha3 in placenta: no labor 91.2 +/- 27.6 vs labor 46.9 +/- 3.6 density units, P =.002. Sodium pump alpha3 in myometrium: no labor 52.3 +/- 7.7 vs labor 19.8 +/- 1.6 density units, P =.0002). CONCLUSION: Because reductions in sodium pump number can result in hormone release from secretory tissues and in contraction of muscle, this suggests that the sodium pump may play a significant role in the initiation or maintenance of human labor.     

Carcinoma in situ of the cervix in the postmenopausal female

Eleven cases of postmenopausal carcinoma in situ of the cervix (CIS) are reviewed. They comprised 7% of the 178 cases of CIS evaluated and treated at The Johns Hopkins Hospital between January 1, 1977 and June 30, 1980. The extensive involvement of the endocervical canal in the postmenopausal patient requires conization in addition to colposcopy and endocervical curettage in order to fully evaluate the cervical disease.