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Minerva Obstetrics and Gynecology Jun 2021Existing guidelines do not settle on a specific length to indicate surgical incision of subseptations because of differences in the four published diagnostic methods:... (Review)
Review
INTRODUCTION
Existing guidelines do not settle on a specific length to indicate surgical incision of subseptations because of differences in the four published diagnostic methods: AFS-10 mm classification, 1988/2003, ESHRE-ESGE classification, 2013, ASRM criteria, 2016- and 5.9-mm length cut-off, 2017. With this review and data analysis we sought to identify the classification method with the most accurate association with early pregnancy loss, as to identify a subseptation length cut-off to indicate surgical correction.
EVIDENCE ACQUISITION
We performed an exhaustive literature search of PubMed (MEDLINE), Embase, and Cochrane Library databases until April 20, 2020 (limited to articles published in English) of the terms "uterine septum," "arcuate uterus," "subseptation," "Müllerian anomalies," from 1980-2020. After identifying all the available classifications for uterine subseptations, we performed a secondary data analysis of our departmental database on uterine subseptations and compared the identified classification criteria. Measurement of the subseptation's length was obtained on 2-D and 3-D ultrasound in accordance with the different methods. The incidence of uterine subseptations according to each method's specifications was compared among the groups and the association with pregnancy loss was evaluated.
EVIDENCE SYNTHESIS
The database comprised 125 women with uterine subseptations and all four diagnostic systems identified septate uteri within it. The 5.9-mm cut-off diagnosed 89 septate, and 36 normal uteri and was the most inclusive while the ASRM cut-off was the most restrictive one, diagnosing 92/125 as arcuate uteri, only 8/125 as septate, and 25 in the gray zone. The AFS-10 mm criteria diagnosed 92/125 as arcuate, and 33 (26.4%) as septate uteri. Subseptations were inconsistently diagnosed by the ESHRE-ESGE classification, as some subseptations longer than 10 mm would be classified as normal uteri. Five/24 women had had one previous early loss and 19/24 had recurrent pregnancy loss. The 5.9-mm system was the most sensitive, while the ASRM was the least sensitive in predicting pregnancy loss (71.2% vs. 9.5% of septate uteri).
CONCLUSIONS
The proposed 5.9-mm cut-off was the most sensitive in diagnosing a septate uterus and in predicting an associated early pregnancy loss. Conversely, the AFS-10 mm and the ASRM were the most restrictive, potentially missing treatment for hazardous subseptations. This update highlights the major weaknesses in the current diagnosis of uterine subseptations and indication for surgical treatment. Standardization of clinical practice is essential for reproductive clinicians and efforts should be made to prevent even one further early pregnancy loss to uterine subseptations.
Topics: Abortion, Spontaneous; Female; Humans; Incidence; Pregnancy; Ultrasonography; Urogenital Abnormalities; Uterus
PubMed: 34008393
DOI: 10.23736/S2724-606X.21.04789-4 -
No Shinkei Geka. Neurological Surgery Jul 2023This study describes the anatomy of the pituitary gland during endoscopic endonasal surgery. Before surgery, the extent of pneumatization of the sphenoid sinus and bony...
This study describes the anatomy of the pituitary gland during endoscopic endonasal surgery. Before surgery, the extent of pneumatization of the sphenoid sinus and bony septations in the sphenoid sinus should be evaluated using computed tomography. After wide sphenoidotomy, several important surgical landmarks, including the medial and lateral opticocarotid recesses and carotid protuberances, can be observed in the sphenoid sinus. The pituitary gland is composed of two components: the adenohypophysis and neurohypophysis. Two small vessels, the superior and inferior hypophyseal arteries, supply the pituitary gland. Several vital structures exist inside the cavernous sinus, including the internal carotid artery and cranial nerves. Understanding the surgical anatomy is mandatory for treating lesions around the pituitary fossa via the endoscopic endonasal approach.
Topics: Humans; Pituitary Gland; Endoscopy; Sella Turcica; Nose; Sphenoid Sinus
PubMed: 37491053
DOI: 10.11477/mf.1436204789 -
ELife Sep 2022In the adult midgut, basal intestinal stem cells give rise to enteroblasts that integrate into the epithelium as they differentiate into enterocytes. Integrating...
In the adult midgut, basal intestinal stem cells give rise to enteroblasts that integrate into the epithelium as they differentiate into enterocytes. Integrating enteroblasts must generate a new apical domain and break through the septate junctions between neighbouring enterocytes, while maintaining barrier function. We observe that enteroblasts form an apical membrane initiation site (AMIS) when they reach the septate junction between the enterocytes. Cadherin clears from the apical surface and an apical space appears between above the enteroblast. New septate junctions then form laterally with the enterocytes and the AMIS develops into an apical domain below the enterocyte septate junction. The enteroblast therefore forms a pre-assembled apical compartment before it has a free apical surface in contact with the gut lumen. Finally, the enterocyte septate junction disassembles and the enteroblast/pre-enterocyte reaches the gut lumen with a fully formed brush border. The process of enteroblast integration resembles lumen formation in mammalian epithelial cysts, highlighting the similarities between the fly midgut and mammalian epithelia.
Topics: Animals; Cadherins; Digestive System; Drosophila; Drosophila Proteins; Drosophila melanogaster; Epithelium; Mammals
PubMed: 36169289
DOI: 10.7554/eLife.76366 -
Current Biology : CB Jul 2023Bacteria inside fungal hyphae allow the fungus Rhizopus microsporus to form spores and operate via effectors in 'stealth' mode. When the functionality of one effector is...
Bacteria inside fungal hyphae allow the fungus Rhizopus microsporus to form spores and operate via effectors in 'stealth' mode. When the functionality of one effector is taken away, bacteria are captured in septated cells and die.
Topics: Symbiosis; Hyphae; Bacteria; Fungi
PubMed: 37490862
DOI: 10.1016/j.cub.2023.06.028 -
Reproductive Sciences (Thousand Oaks,... Dec 2018To compare the surgical results and reproductive performances of patients with ESHRE/ESGE (European Society for Human Reproduction and Embryology/European Society for...
AIM
To compare the surgical results and reproductive performances of patients with ESHRE/ESGE (European Society for Human Reproduction and Embryology/European Society for Gynaecologic Endoscopy) class U1a and U2b uterine anomalies after hysteroscopic correction.
METHODS
A retrospective cohort study was conducted at a university hospital infertility clinic. Ninety-six patients with class U2b (complete septate uterus) and 78 patients with class U1a (T-shaped uterus) uterine anomalies who underwent hysteroscopic correction between January 2009 and December 2015 were recruited.
RESULTS
The operation time was significantly longer in class U2b anomalies (26.5 ± 5.3 minutes) than class U1a anomalies (22.8 ± 5.8 minutes; mean difference [95% confidence interval [CI]: 3.6 ± 0.9 [1.8-5.3]; P < .001). Six out of all complete septate patients and 3 of T-shaped patients were reoperated due to postoperative synechia or to further enlarge the cavity. There were no differences between the groups regarding intraoperative (blood loss and uterine rupture) and postoperative (bleeding and infection) complications. After surgical correction, the term delivery rates increased from 3% to 71% ( P < .001) in class U2b and from 4% to 62.1% ( P < .001) in class U1a. The chance of live birth significantly increased after hysteroscopic correction both in class U2b (odds ratio [OR] 106.1; 95% CI, 29.1-387.1; P < .001) and class U1a (OR 35.7; 95% CI, 11.6-109.9; P < .001). The postoperative reproductive performances of both anomalies were similar.
CONCLUSION
Both types of anomalies seem to have similar severity and prognosis. Patients with both types of anomalies have excellent reproductive outcome after hysteroscopic correction.
Topics: Adult; Female; Humans; Hysteroscopy; Infertility, Female; Live Birth; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Retrospective Studies; Treatment Outcome; Urogenital Abnormalities; Uterus
PubMed: 29402197
DOI: 10.1177/1933719118756774 -
Frontiers in Neuroscience 2014The efficacy of neuronal function requires a well-balanced extracellular ion homeostasis and a steady supply with nutrients and metabolites. Therefore, all organisms... (Review)
Review
The efficacy of neuronal function requires a well-balanced extracellular ion homeostasis and a steady supply with nutrients and metabolites. Therefore, all organisms equipped with a complex nervous system developed a so-called blood-brain barrier, protecting it from an uncontrolled entry of solutes, metabolites or pathogens. In higher vertebrates, this diffusion barrier is established by polarized endothelial cells that form extensive tight junctions, whereas in lower vertebrates and invertebrates the blood-brain barrier is exclusively formed by glial cells. Here, we review the development and function of the glial blood-brain barrier of Drosophila melanogaster. In the Drosophila nervous system, at least seven morphologically distinct glial cell classes can be distinguished. Two of these glial classes form the blood-brain barrier. Perineurial glial cells participate in nutrient uptake and establish a first diffusion barrier. The subperineurial glial (SPG) cells form septate junctions, which block paracellular diffusion and thus seal the nervous system from the hemolymph. We summarize the molecular basis of septate junction formation and address the different transport systems expressed by the blood-brain barrier forming glial cells.
PubMed: 25452710
DOI: 10.3389/fnins.2014.00365 -
Clinical Case Reports Apr 2022The septate gallbladder is a rare congenital malformation. It is considered a risk factor of complications after laparoscopic cholecystectomy. We are reporting an image...
The septate gallbladder is a rare congenital malformation. It is considered a risk factor of complications after laparoscopic cholecystectomy. We are reporting an image in surgery of a septate gallbladder. It was discovered at an adult age. We are showing the difficulty of the diagnosis preoperatively on the radiological find.
PubMed: 35414909
DOI: 10.1002/ccr3.5666 -
International Journal of Pediatrics &... Mar 2022Lipoblastoma is a rare benign soft tissue tumor found in infants and young children. It presents as an enlarging mass commonly observed in extremities, trunk, head and...
Lipoblastoma is a rare benign soft tissue tumor found in infants and young children. It presents as an enlarging mass commonly observed in extremities, trunk, head and neck regions. Imaging features include a hyper-echoic mass on ultrasound, heterogonous fat density lesion on CT scan with enhancing septations and no calcification, and high T1 signal mass that drops the signal intensity on fat suppression MRI images. Total excision of such lesion is the treatment of choice, and follow-up is recommended to rule out recurrence.
PubMed: 35573075
DOI: 10.1016/j.ijpam.2021.05.004 -
Diagnostics (Basel, Switzerland) Feb 2023The septate uterus is the most common congenital uterine anomaly, and hysteroscopy is the gold standard for diagnosing it. The goal of this meta-analysis is to perform a... (Review)
Review
Diagnostic Performance of Two-Dimensional Ultrasound, Two-Dimensional Sonohysterography and Three-Dimensional Ultrasound in the Diagnosis of Septate Uterus-A Systematic Review and Meta-Analysis.
BACKGROUND
The septate uterus is the most common congenital uterine anomaly, and hysteroscopy is the gold standard for diagnosing it. The goal of this meta-analysis is to perform a pooled analysis of the diagnostic performance of two-dimensional transvaginal ultrasonography, two-dimensional transvaginal sonohysterography, three-dimensional transvaginal ultrasound, and three-dimensional transvaginal sonohysterography for the diagnosis of the septate uterus.
METHODS
Studies published between 1990 and 2022 were searched in PubMed, Scopus, and Web of Science. From 897 citations, we selected eighteen studies to include in this meta-analysis.
RESULTS
The mean prevalence of uterine septum in this meta-analysis was 27.8%. Pooled sensitivity and specificity were 83% and 99% for two-dimensional transvaginal ultrasonography (ten studies), 94% and 100% for two-dimensional transvaginal sonohysterography (eight studies), and 98% and 100% for three-dimensional transvaginal ultrasound (seven articles), respectively. The diagnostic accuracy of three-dimensional transvaginal sonohysterography was only described in two studies, and we did not calculate the pooled sensitivity and specificity for this method.
CONCLUSION
Three-dimensional transvaginal ultrasound has the best performance capacity for the diagnosis of the septate uterus.
PubMed: 36832295
DOI: 10.3390/diagnostics13040807 -
Frontiers in Plant Science 2020Changing climates can cause shifts in temperature and precipitation, resulting in warming and drought in some regions. Although each of these factors has been shown to...
Changing climates can cause shifts in temperature and precipitation, resulting in warming and drought in some regions. Although each of these factors has been shown to detrimentally affect forest ecosystems worldwide, information on the impacts of the combined effects of warming and drought is lacking. Forest trees rely on mutualistic root-associated fungi that contribute significantly to plant health and protection against climate stresses. We used a six-year, ecosystem-scale temperature and precipitation manipulation experiment targeted to simulate the climate in 2100 in the Southwestern United States to quantify the effects of drought, warming and combined drought and warming on the root colonization (abundance), species composition and diversity of ectomycorrhizal fungi (EMF), and dark septate fungal endophytes in a widespread woodland tree, pinyon pine ( E.). Our results show that pinyon shoot growth after 6 years of these treatments was reduced more by drought than warming. The combined drought and warming treatment reduced the abundance and diversity of EMF more than either treatment alone. Individual ectomycorrhizal fungal taxa, including the drought tolerant , were present in all treatments but the combined drought and warming treatment. The combined drought and warming treatment also reduced the abundance of dark septate endophytes (DSE), but did not affect their diversity or species composition. The current year shoot growth of the trees correlated positively with ectomycorrhizal fungal diversity, highlighting the importance of diversity in mutualistic relationships to plant growth. Our results suggest that EMF may be more important than DSE to aboveground growth in , but also more susceptible to the negative effects of combined climate stressors.
PubMed: 33193530
DOI: 10.3389/fpls.2020.582574