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Background and Objective: TRIV is a new and promising technique based on the fact that Vulva can be divided into three circular zones based on anatomy, embryology, and histology- Outer, Middle, and Inner ring. The Vulvoscopy Index and N-S-P scheme are objective tools to improve the systematization of vulvoscopy findings and to simplify information management using TRIV. Methods: Hundred women with vulvar complaints (Cases) and 100 asymptomatic women (Controls) underwent TRIV and findings were documented as per N-S-P Scheme and Vulvoscopy Index. Biopsy was taken from specific lesions. Vulvar disorders were categorized into 5 categories based on histology and clinical findings—Vulvodynia, Impaired vulvar skin, Vulvar dermatosis, pre-malignant lesions of the vulva, and others. Results: According to N-S-P scheme most common formulas were- N–N-N for Normal vulva, P-P-P for vulvar dermatoses, and N-S–N for Impaired Vulvar skin. The mean Vulvoscopy index was 4.33 ± 0.52 for Impaired vulvar skin, 6.11 ± 2.87 for vulvodynia, 24 ± 6.04 for pre-malignant lesions of vulva, and 25.17 ± 4.31 for vulvar dermatosis. The sensitivity, specificity, and diagnostic accuracy of the Vulvoscopy Index for detecting vulvar disorders were 100%, 96.51%, and 98.50%, respectively. The positive and negative predictive values were 0.97 and 1.00, respectively. Conclusion: The Vulvoscopy Index is a significant predictor for vulvar disorders. N-S-P scheme helps in the objective and systematic documentation of TRIV findings, which allows monitoring of the vulvar changes. TRIV can be used for preventing early stages of vulvar dermatosis which is a risk factor for vulvar malignancy.

Neural tube defects NTDs represent some of the most common congenital malformations in humans. The causes of NTDs are complex with both genetic and environmental contributing factors. Periconception nutrition is an important environmental factor influencing the penetrance of NTDs. NTDs arise from failure to close the neural tube completely during development, an event that occurs before establishment of the chorioallantoic placenta. During neurulation, nutrients are absorbed by histotrophic mechanisms and absorbed by endocytosis in the endodermderived cell layer of the visceral yolk sac VYS. Here we review the histotrophic mechanisms by which nutrients are delivered to the human embryo during this critical time period. Because more detailed studies on the molecular mechanisms regulating uptake of nutrients have been performed using rodent models, most importantly mouse and rat models, we will also review nutrient uptake in these model organisms to set the stage for presentation of experimental data that have provided valuable information about how nutrients are delivered to the neurulating embryo. Birth Defects Research Part A, 2010. © 2010 WileyLiss, Inc.

The development of the aortic arch is a complex process that involves remodeling of the bilaterally symmetrical pharyngeal arch arteries (PAAs) into the mature asymmetric aortic arch. Retinoic acid signaling is a key regulator of this process by directing patterning of the second heart field (SHF), formation of the caudal PAAs and subsequent remodeling of the PAAs to form the aortic arch. Here, we identify the HECTD1 ubiquitin ligase as a novel modulator of retinoic acid signaling during this process. Hectd1opm/opm homozygous mutant embryos show a spectrum of aortic arch abnormalities that occur following loss of 4th PAAs and increased SHF marker expression. This sequence of defects is similar to phenotypes observed in mutant mouse models with reduced retinoic acid signaling. Importantly, HECTD1 binds to and influences ubiquitination of the retinoic acid receptor, alpha (RARA). Furthermore, reduced activation of a retinoic acid response element (RARE) reporter is detected in Hectd1 mutant cells and embryos. Interestingly, Hectd1opm/+ heterozygous embryos exhibit reduced retinoic acid signaling, along with intermediate increased expression of SHF markers; however, heterozygotes show normal development of the aortic arch. Decreasing retinoic acid synthesis by reducing Raldh2 (also known as Aldh1a2) gene dosage in Hectd1opm/+ heterozygous embryos reveals a genetic interaction. Double heterozygous embryos show hypoplasia of the 4th PAA and increased incidence of a benign aortic arch variant, in which the transverse arch between the brachiocephalic and left common carotid arteries is shortened. Together, our data establish that HECTD1 is a novel regulator of retinoic acid signaling required for proper aortic arch development.