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Measurements of Δ(14)C and CO(2) can cleanly separate biogenic and fossil contributions to CO(2) enhancements above background. Our measurements of these tracers in air around Los Angeles in 2015 reveal high values of fossil CO(2) and a significant and seasonally varying contribution of CO(2) from the urban biosphere. The biogenic CO(2) is composed of sources such as biofuel combustion and human metabolism and an urban biospheric component likely originating from urban vegetation, including turf and trees. The urban biospheric component is a source in winter and a sink in summer, with an estimated amplitude of 4.3 parts per million (ppm), equivalent to 33% of the observed annual mean fossil fuel contribution of 13 ppm. While the timing of the net carbon sink is out of phase with wintertime rainfall and the sink seasonality of Southern California Mediterranean ecosystems (which show maximum uptake in spring), it is in phase with the seasonal cycle of urban water usage, suggesting that irrigated urban vegetation drives the biospheric signal we observe. Although 2015 was very dry, the biospheric seasonality we observe is similar to the 2006–2015 mean derived from an independent Δ(14)C record in the Los Angeles area, indicating that 2015 biospheric exchange was not highly anomalous. The presence of a large and seasonally varying biospheric signal even in the relatively dry climate of Los Angeles implies that atmospheric estimates of fossil fuel–CO(2) emissions in other, potentially wetter, urban areas will be biased in the absence of reliable methods to separate fossil and biogenic CO(2).

Objective To establish an endometrioma treatment paradigm (decision tree) in the treatment of an ovarian endometrioma through the review of current literature. Data Sources A thorough literature search, including PubMed, Google Scholar, and the Cochrane Library, was performed from April 2020 to July 2020. The review was completed by using the following keywords: • Endometriosis and Pain (pre and post-surgery) • Endometriosis and Infertility (pre and post-surgery) • Endometriosis and ART (with and without surgery) • Endometriomas and IVF (with and without surgery) • Effect of endometriomas on implantation • Effect of endometriomas on antral follicle count (pre and post-surgery) • Evaluating the complex ovarian cyst (to rule out malignancy) • Resistive index in evaluation of the ovarian cyst • Endometriosis and BCL6 All relevant articles were assessed. The references of the assessed articles were then reviewed, and if pertinent, evaluated. Methods of Study Selection Articles published in English that addressed the endometrioma in regard to the following were included: (1) diagnosis, (2) treatment of pain on the basis of size and/or surgical intervention, (3) treatment of fertility on the basis of size and/or surgical intervention, (4) surgical technique, (5) in vitro fertilization success on the basis of size and/or surgical intervention, (6) risk of rupture at the time of egg retrieval, (7) impact on the antimullerian hormone and antral follicle count postsurgery, and (8) impact on implantation. Tabulation, Integration, and Results Fifty-six articles were included in this systematic review. While conducting this literature review, several themes were noted. In general, the literature on the ovarian endometrioma seems to be homogeneous in regard to imaging the endometrioma, excision rather than desiccation for an endometrioma ≥3-cm causing pain and/or infertility, minimal use of bipolar energy at the time of ovarian surgery, and risk of severe infection secondary to inadvertent rupture of cysts during egg retrieval. Conversely, studies on the ovarian endometrioma are much more heterogeneous in terms of surgery and assisted reproductive technology, that is, whether surgery should be performed. Certainly, an endometrioma ≥5-cm should be excised before assisted reproductive technology. Moreover, it seems that the antral follicle count and implantation may be enhanced with surgery. Conclusion By completing an extensive literature review, an easy-to-use algorithm for the diagnosis, evaluation, and treatment of endometriomas was developed to help clinicians in their treatment of patients with endometriosis in the short and long terms.

Study Objective To develop a new endometriosis classification system for scoring intraoperative surgical complexity and to examine its correlation with patient-reported pain and infertility. Design Multicenter study of patients treated at 3 recognized endometriosis centers. Setting Three specialized endometriosis surgical centers in Sao Paulo, Brazil and Barcelona, Spain. Patients Patients aged 15 to 45 years with histologically proven endometriosis and no history of pelvic malignancy underwent laparoscopic treatment of endometriosis. Interventions Demographic data and clinical history, including dysmenorrhea, noncyclic pelvic pain, dyspareunia, dysuria and dyschezia, were prospectively recorded. All patients were staged surgically according to the new 2021 American Association of Gynecologic Laparoscopists (AAGL) and revised American Society of Reproductive Medicine (ASRM) classification systems. The staging for each system was compared against a 4-level surgical complexity scale defined by the most complex procedure performed. Measurements and Main Results A total of 1224 patients undergoing surgery met inclusion criteria. The AAGL score discriminated between 4 stages of surgical complexity with high reproducibility (κ = 0.621), whereas the ASRM score discriminated between the complexity stages with poor reproducibility (κ = 0.317). The AAGL staging system correlated with dysmenorrhea, dyspareunia, dyschezia, total pain score, and infertility comparably with the ASRM staging system. Conclusion The AAGL 2021 Endometriosis Classification allows for identifying objective intraoperative findings that reliably discriminate surgical complexity levels better than the ASRM staging system. The AAGL severity stage correlates comparably with pain and infertility symptoms with the ASRM stage.

The purpose of this review is to understand the minimally invasive approach to the excision and repair of an isthmocele.Previous small trials and case reports have shown that the minimally invasive approach by hysteroscopy and/or laparoscopy can cure symptoms of a uterine isthmocele, including abnormal bleeding, pelvic pain and secondary infertility. A recent larger prospective study has been published that evaluates outcomes of minimally invasive isthmocele repair. Smaller studies and individual case reports echo the positive results of this larger trial.The cesarean section scar defect, also known as an isthmocele, has become an important diagnosis for women who present with abnormal uterine bleeding, pelvic pain and secondary infertility. It is important for providers to be aware of the effective surgical treatment options for the symptomatic isthmocele. A minimally invasive approach, whether it be laparoscopic or hysteroscopic, has proven to be a safe and effective option in reducing symptoms and improving fertility. VIDEO ABSTRACT: http://links.lww.com/COOG/A37.

Context Elagolix is an oral gonadotropin-releasing hormone (GnRH) antagonist recently approved for the treatment of endometriosis-associated pain and being developed for heavy menstrual bleeding associated with uterine fibroids. Objective The objective was to evaluate the effects of elagolix on ovulation and ovarian sex hormones. Design and Setting This was a randomized, open-label, multicenter study. Participants Participants were healthy ovulatory women aged 18 to 40 years. Interventions Elagolix was administered orally for 3 continuous 28-day dosing intervals at 100 to 200 mg once daily (QD), 100 to 300 mg twice daily (BID), and 300 mg BID plus estradiol/norethindrone acetate (E2/NETA) 1/0.5 mg QD. Main Outcome Measures The main outcomes measures were ovulation rates measured by transvaginal ultrasound, progesterone concentrations, and hormone suppression. Results Elagolix suppressed ovulation in a dose-dependent manner. The percentage of women who ovulated was highest at 100 mg QD (78%), intermediate at 150 and 200 mg QD and 100 mg BID (47%–57%), and lowest at 200 and 300 mg BID (32% and 27%, respectively). Addition of E2/NETA to elagolix 300 mg BID further suppressed the ovulation rate to 10%. Elagolix also suppressed luteinizing hormone and follicle stimulating hormone in a dose-dependent manner, leading to dose-dependent suppression of estradiol and progesterone. Elagolix had no effect on serum biomarker of ovarian reserve, and reduced endometrial thickness compared to the screening cycle. Conclusion Women being treated with elagolix may ovulate and should use effective methods of contraception. The rate of ovulation was lowest with elagolix 300 mg BID plus E2/NETA 1/0.5 mg QD.

Study Objective To determine whether incorporation of operative hysteroscopy with biopsy of products of conception, in conjunction with a suction curettage for a first trimester missed abortion, affected the rate of maternal cell contamination when chromosomal analysis was performed on the products of conception, and to determine the rates of retained products of conception with incorporation of hysteroscopy after suction curettage. Design Retrospective chart study. Setting Private, minimally invasive surgery and infertility practice with academic-community hospital affiliation. Patients Infertility patients undergoing evacuation of products of conception for documented first trimester miscarriages between 2006 and 2017. Interventions Suction curettage or hysteroscopic biopsy and suction curettage, followed by chromosomal analysis of products of conception for determination of fetal genetics. Measurements and Results A total of 264 charts were analyzed. Patients were categorized into 2 groups based on surgical collection of products of conception: group 1 (N = 174), suction curettage only, and group 2 (N = 90), a single procedure consisting of operative hysteroscopy with biopsy of products of conception followed by suction curettage and then diagnostic hysteroscopy to look for retained products. Data for chromosome detection and retained products of conception were available for 246 and 239 patients, respectively. No significant differences were detected between the groups for age, body mass index, ethnicity, gravida, parity, primary infertility, secondary infertility, spontaneous conception, single or multiple gestation, and surgical complications. Fetal chromosome detection was significantly higher without maternal contamination in group 2 (88.5%) compared with group 1 (64.8%) (p Conclusion Obtaining fetal genetics can be useful when planning for a future successful pregnancy. The addition of operative hysteroscopy to biopsy the gestational sac, chorionic villi, and/or fetus significantly decreases the risk of maternal contamination and increases the ability to detect fetal chromosomes for genetic analysis without an increased risk of surgical complications. Despite the low risk of surgical complications, immediate second-look hysteroscopy after the completion of suction evacuation does not reduce the risk of postoperative retained products of conception.

The 2017–2027 National Academies' Decadal Survey, Thriving on Our Changing Planet, recommended Surface Biology and Geology (SBG) as a “Designated Targeted Observable” (DO). The SBG DO is based on the need for capabilities to acquire global, high spatial resolution, visible to shortwave infrared (VSWIR; 380–2500 nm; ~30 m pixel resolution) hyperspectral (imaging spectroscopy) and multispectral midwave and thermal infrared (MWIR: 3–5 μm; TIR: 8–12 μm; ~60 m pixel resolution) measurements with sub-monthly temporal revisits over terrestrial, freshwater, and coastal marine habitats. To address the various mission design needs, an SBG Algorithms Working Group of multidisciplinary researchers has been formed to review and evaluate the algorithms applicable to the SBG DO across a wide range of Earth science disciplines, including terrestrial and aquatic ecology, atmospheric science, geology, and hydrology. Here, we summarize current state-of-the-practice VSWIR and TIR algorithms that use airborne or orbital spectral imaging observations to address the SBG DO priorities identified by the Decadal Survey: (i) terrestrial vegetation physiology, functional traits, and health; (ii) inland and coastal aquatic ecosystems physiology, functional traits, and health; (iii) snow and ice accumulation, melting, and albedo; (iv) active surface composition (eruptions, landslides, evolving landscapes, hazard risks); (v) effects of changing land use on surface energy, water, momentum, and carbon fluxes; and (vi) managing agriculture, natural habitats, water use/quality, and urban development. We review existing algorithms in the following categories: snow/ice, aquatic environments, geology, and terrestrial vegetation, and summarize the community-state-of-practice in each category. This effort synthesizes the findings of more than 130 scientists.

Methane (CH4) fluxes from Alaska and other arctic regions may be sensitive to thawing permafrost and future climate change, but estimates of both current and future fluxes from the region are uncertain. This study estimates CH4 fluxes across Alaska for 2012-2014 using aircraft observations from the Carbon in Arctic Reservoirs Vulnerability Experiment (CARVE) and a geostatistical inverse model (GIM). We find that a simple flux model based on a daily soil temperature map and a static map of wetland extent reproduces the atmospheric CH4 observations at the state-wide, multi-year scale more effectively than global-scale, state-of-the-art process-based models. This result points to a simple and effective way of representing CH4 flux patterns across Alaska. It further suggests that contemporary process-based models can improve their representation of key processes that control fluxes at regional scales, and that more complex processes included in these models cannot be evaluated given the information content of available atmospheric CH4 observations. In addition, we find that CH4 emissions from the North Slope of Alaska account for 24% of the total statewide flux of 1.74 ± 0.44 Tg CH4 (for May-Oct.). Contemporary global-scale process models only attribute an average of 3% of the total flux to this region. This mismatch occurs for two reasons: process models likely underestimate wetland area in regions without visible surface water, and these models prematurely shut down CH4 fluxes at soil temperatures near 0°C. As a consequence, wetlands covered by vegetation and wetlands with persistently cold soils could be larger contributors to natural CH4 fluxes than in process estimates. Lastly, we find that the seasonality of CH4 fluxes varied during 2012-2014, but that total emissions did not differ significantly among years, despite substantial differences in soil temperature and precipitation; year-to-year variability in these environmental conditions did not affect obvious changes in total CH4 fluxes from the state.

Myomectomies can be performed open, hysteroscopically, laparoscopically, and with the assistance of the robot. Minimally invasive approaches, specifically laparoscopic and robotic, have demonstrated improved operative and perioperative outcomes compared to open myomectomies, with minimal complications.

Women that have a multiple fibroid uterus can present with a variety of symptoms such as menorrhagia, pelvic pressure or pain, dyspareunia, infertility, and recurrent pregnancy loss. Definitive therapy is a hysterectomy. However, in the premenopausal patient who desires fertility, myomectomy is the current standard of care for treatment. Hysteroscopic, laparoscopic, robotic, and open techniques are all tools in a surgeon’s armamentarium that can be used to treat a fibroid uterus. There are emerging modalities that utilize imaging combined with a form of energy to treat fibroids. Ultimately, medical therapy may be used as an alternative to surgery for symptom relief. The management of a patient with a fibroid uterus must be made on a case-by-case basis depending upon what resources are available, patient’s fertility desire, and surgeon’s expertise.

Video Objective To educate the minimally invasive gynecologist on the rare diagnosis of an undescended ovary and to demonstrate a laparoscopic technique for ovarian transposition to facilitate trans-vaginal oocyte monitoring and retrieval. Setting Community hospital in the suburbs of Chicago. Interventions Left ovarian transposition and ovarian drilling. Conclusion Laparoscopic ovarian transposition is a feasible, safe option to facilitate oocyte retrieval in cases of undescended ovaries.

The real-time electrochemical detection of catecholamine secretion from murine adrenal slices using fast-scan cyclic voltammetry (FSCV) and amperometry at carbon fiber microelectrodes is described. Bright-field and immunofluorescent microscopy supported that chromaffin cells in the adrenal medulla are organized into clusters and positively stain for tyrosine hydroxylase confirming that they are catecholaminergic. Spontaneous exocytotic catecholamine events were observed inside chromaffin cell clusters with both FSCV and amperometry and were modulated by the nicotinic acetylcholine receptor antagonist hexamethonium and low extracellular calcium. Reintroduction of extracellular calcium and pressure ejection of acetylcholine caused the frequency of spikes to increase back to predrug levels. Electrical stimulation caused the synchronous secretion from multiple cells within the gland, which were modulated by nicotinic acetylcholine receptors but not muscarinic receptors or gap junctions. Furthermore, electrically stimulated release was abolished with perfusion of low extracellular calcium or tetrodotoxin, indicating that the release requires electrical excitability. An extended waveform was used to study the spontaneous and stimulated release events to determine their chemical content by FSCV. Consistent with total content analysis and immunohistochemical studies, about two thirds of the cells studied spontaneously secreted epinephrine, whereas one third secreted norepinephrine. Whereas adrenergic sites contained mostly epinephrine during electrical stimulation, noradrenergic sites contained a mixture of the catecholamines showing the heterogeneity of the adrenal medulla.

Objective To assess the efficacy and safety of a vaginal progesterone (P4) insert (Endometrin) for luteal support for assisted reproductive technology (ART). Design Multicenter, randomized, open-label (assessor-blinded) phase III clinical trial. Setting Twenty-five U.S. ART centers. Patient(s) A total of 1,211 ART patients randomized to three groups: Endometrin 100 mg twice daily (n = 404), Endometrin 100 mg three times daily (n = 404), and P4 90 mg 8% gel daily (n = 403). Intervention(s) In vitro fertilization and ET were performed according to site-specific protocols. The day after oocyte retrieval, Endometrin or vaginal P4 gel was begun for luteal support and continued for up to 10 weeks of pregnancy. Main Outcome Measure(s) Biochemical, clinical, and ongoing pregnancy and live birth rates. Result(s) Pregnancy rates were high and similar in all treatment groups, with biochemical rates exceeding 50%, clinical and ongoing rates ≥40%, and live birth rates at 35%–38%. The adverse event profiles were similar across groups. Conclusion(s) Pregnancy rates and live birth rates for Endometrin (twice daily and three times daily) were high and similar to those for P4 gel. The adverse event profiles for both were similar to that for P4 gel and primarily due to IVF stimulation and oocyte retrieval. Endometrin was safe and well tolerated.

Previously we obtained self-broadened halfwidth and self-induced shift coefficients at room temperature for 15 near infrared CO 2 bands between 4750 and 7000 cm −1 [R.A. Toth, L.R. Brown, C.E. Miller, V.M. Devi, D.C. Benner, J. Mol. Spectrosc., 239 (2006) 243–271]. The present study expands our work on the near infrared line parameters of CO 2 to include air broadening coefficients. Here we report nearly 400 air-broadened half width and air-induced pressure shift coefficients spanning 11 different CO 2 vibrational bands in the 4750–7000 cm −1 region. Retrievals have been performed using Voigt line profiles over three distinct spectral intervals: (a) 4750–5200 cm −1 , covering the 20011 ← 00001, 20012 ← 00001, and 20013 ← 00001 Fermi Triad and three associated hot bands 21111 ← 01101, 21112 ← 01101, 21113 ← 01101; (b) 6100–7000 cm −1 , covering the 30011 ← 00001, 30012 ← 00001, 30013 ← 00001 and 30014 ← 00001 Fermi Tetrad; (c) near 6950 cm −1 for the 00031 ← 00001 overtone band. The air-broadened halfwidth and air-induced pressure shift coefficients have been modeled with empirical expressions and compared to other measurements available in the literature.

Study Objective To examine whether the addition of narrow band imaging (NBI) to traditional white light imaging during laparoscopic surgery impacts pain and quality of life (QOL) at 3 and 6 months after surgery among women with suspected endometriosis and/or infertility. Design A randomized controlled trial (Canadian Task Force classification level I). Setting The trial was conducted in 2 medical centers. Patients From October 2011 to November 2013, 167 patients undergoing laparoscopic examination for suspected endometriosis and/or infertility were recruited. The analytic study sample includes 148 patients with pain and QOL outcome data. Interventions Patients were randomized in a 3:1 ratio to receive white light imaging followed by NBI (WL/NBI) or white light imaging only (WL/WL). Measurements and Main Results Questionnaires were administered at baseline and at 3- and 6-month follow-up time points. Average and most severe pain at each time point were assessed using a 10-cm visual analog scale. QOL was measured using the Endometriosis Health Profile-30. Baseline characteristics were similar for the study groups. The WL/NBI and WL/WL groups had similar reductions in pain at 3 and 6 months. In addition, QOL improved similarly for both the WL/NBI and WL/WL groups at 3 and 6 months. Conclusion Laparoscopic surgery for suspected endometriosis is associated with a reduction in pain and an improvement in QOL. The differences in pain reduction and QOL improvement, which are noted at 3 months and remain stable at 6 months after surgery, are similar for those undergoing surgery with WL/NBI compared with those undergoing surgery under traditional white light conditions.

Study Objective To evaluate the ability of narrow band imaging (NBI) in conjunction with standard white light imaging to improve the detection and diagnosis of endometriosis during laparoscopic evaluation compared with white light imaging alone. Sensitivity of NBI in detecting endometriosis was assessed and compared with white light imaging. Design Randomized controlled trial. Classification of Study Design: Level I Evidence obtained from a properly designed, randomized, controlled trial. Setting The trial was conducted in 2 medical centers. Patients One hundred sixty-seven women undergoing laparoscopic evaluation for suspected endometriosis and/or infertility were recruited. Of these, 150 were assessable to determine sensitivity of NBI compared with white light imaging for the detection of endometriotic lesions. Interventions Patients were randomized in a 3:1 ratio to receive white light imaging followed by NBI or white light imaging only. The pelvis was systematically visualized with each assigned imaging modality; lesions were recorded under each visualization and then resected. All patients had white light imaging on the first visualization followed by either a second white light examination (control arm) or NBI examination (intervention arm). Measurements Pathology of resected lesions was the criterion standard for evaluating sensitivity and was conducted at each institution. The method of detection of the lesion (white light or NBI) was masked. Central pathology review was conducted for a randomly selected 10% sample of specimens and for those lesions visualized under only 1 imaging modality among patients assigned to the intervention arm. The sensitivity was assessed for each modality (white light and NBI) and compared using a McNemar's test. Main Results Among the group randomized to receive both white light and NBI, 4 patients had lesions detected with NBI but no lesions detected with white light. Among the 255 lesions confirmed as endometriosis by pathologic review, all were detected by NBI for a sensitivity of 100%; 79% were detected by white light imaging (p Conclusion The addition of NBI to white light imaging increased the number of endometriotic lesions identified during laparoscopy and the diagnosis of endometriosis compared with the use of white light imaging alone.

In the previous paper, we report line strength measurements for 58 bands of 12CO2 between 4550 and 7000 cm−1 [R.A. Toth, L.R. Brown, C.E. Miller, V. Malathy Devi, D. Chris Benner, J. Mol. Spectrosc., this issue, doi:10.1016/j.jms.2006.008.001 .]. In the present study, self-broadenedwidth and self-induced pressure shift coefficients are determined in two intervals: (a) between 4750 and 5400 cm−1for bands of the Fermi triad (20011 ← 00001, 20012 ← 00001, 20013 ← 00001), three corresponding hot bands (21111 ← 01101, 21112 ← 01101, 21113 ← 01101) and the 01121← 00001 combination band; (b) between 6100 and 7000 cm−1 for the Fermi tetrad (30014 ← 00001, 30013 ← 00001, 30012 ← 00001, 30011 ← 00001), two associated hot bands (31113 ← 01101, 31112 ← 01101), as well as 00031 ← 00001 and its hot band 01131 ← 01101. Least-squares fits of the experimental width and pressure shift coefficients are modeled using empirical expressions: b 0 = exp ∑ i a ( i ) x ( i ) for widths where x ( 1 ) = 1 , x ( 2 ) = m , x ( 3 ) = m 2 , x ( 4 ) = m 3 , x ( 5 ) = m 4 , x ( 6 ) = 1 m , and d 0 = ∑ i a ( i ) x ( i ) for pressure shifts where x ( 1 ) = 1 , x ( 2 ) = 1 m , x ( 3 ) = m , x ( 4 ) = m 2 , x ( 5 ) = 1 m 2 , x ( 6 ) = 1 m 3 , x ( 7 ) = m 3 , x ( 8 ) = m m The modeled width coefficients generally agree with the experimental values with standard deviations of less than 1%, while the standard deviations of the modeled values for the pressure-induced shift coefficients range between 2.3% and 6.7%. The largest percentage error is associated with the system of the three hot bands: 21111 ← 01101, 21112 ← 01101, and 21113 ← 01101. It is observed that transitions with the same rotational quantum numbers have slightly different widths in some of the bands. As expected, pressure-induced-shift coefficients vary as a function of the band center, but there are also subtle differences from band to band for transitions with the same rotational quanta.

Recently, alterations in dopamine signaling have been implicated in Huntington's disease. In this work, dopamine release and uptake was measured in striatal slices from the R6/2 transgenic mouse model of Huntington's disease using fast-scan cyclic voltammetry at carbon-fiber microelectrodes. Dopamine release in brain slices from 6-week-old R6/2 mice is substantially reduced (53% of wild type), while dopamine uptake is unaffected. In agreement with this, R6/2 mice injected with the dopamine uptake inhibitor cocaine exhibited a blunted motor activity response (54% of wild type). At 10 weeks of age, an even more dramatic motor activity decrease in response to cocaine injection (21% of wild type) was observed. Moreover, the pre-drug activity of 10-week-old R6/2 mice was significantly reduced (by 37%) compared with 6-week-old R6/2 mice. Striatal dopamine release decreased with age, indicating that progressive alterations in dopaminergic pathways may affect motor activity. The inhibition constants of cocaine and methamphetamine (METH) determined in brain slices differed little between genotype or age group, suggesting that the decreased responses to cocaine and METH arise from compromised dopamine release rather than differences in uptake or drug action. Collectively, these data demonstrate (i) a reduction in the ability of dopamine terminals to release dopamine and (ii) the importance of this attenuation of release on the motor symptoms of Huntington's disease.

This article analyzes differences between a myomectomy by way of laparotomy and a laparoscopic approach to myomectomy. Surgical techniques are presented. Comparisons are made based on technical difficulty, complications, postoperative adhesion formation, and subsequent pregnancy and delivery rates.

Objective To determine the effect on pregnancy rate (PR) of low-dose glucocorticoid treatment in cycles without micromanipulation. Design Randomized, prospective, double-blinded, placebo-controlled trial. Setting One university-based tertiary infertility center and two private infertility centers. Patients All patients receiving standard stimulation IVF-ET or transfer of cryopreserved embryos at the participating facilities from January to September 1993 were asked to participate in this study. Patients having micromanipulation were excluded from this study. Interventions Participating patients were randomized to either 16mg oral 6- α -methylprednisolone for four evenings starting the evening of retrieval or the evening before thawing cryopreserved embryos or to placebo administered in an identical fashion. Both groups were treated with 250mg oral tetracycline four times per day starting with initiation of the study medication and continuing for 4 days. Cryopreservation and stimulation cycles were managed according to pre-established protocols for all patients. A clinical pregnancy was confirmed by an appropriately rising hCG titer and a gestational sac on ultrasound. Results A total of 206 stimulation patients and 61 cryopreservation patients were randomized and had an ET. Patient characteristics were similar between groups. The clinical pregnancy and implantation rates between placebo and glucocorticoid groups were 35.9% versus 40.8% and 12.8% versus 11.7% for stimulation cycles and 30.3% versus 25% and 9.9% versus 7.4% for cryopreservation cycles, respectively. None of these differences were statistically significant. Conclusions Glucocorticoid plus antibiotic treatment at these doses for transfers of nonmicro-manipulated embryos does not appear to have a significant effect on pregnancy or implantation rates.

We investigated possible explanations for the common occurrence of perivenular lesions in liver allografts of patients on FK506 within a few weeks to several months after OLT. Hematoxylin and eosin-stained sections of pre- and postperfusion biopsy specimens and day 7 post-transplant protocol biopsy specimens from 31 patients, randomly assigned to either FK506 or CsA as primary immunosuppressive agent, were reviewed, and immu-nohistochemical stains for HLA-DR antigen and S-100 protein were performed by the avidin-biotin peroxidase complex method. The histologic features of cellular rejection in the portal tracts of day 7 posttransplant allograft biopsy specimens from patients on FK506 were milder than those from patients on CsA. Immunohisto-chemical stains for HLA-DR showed intense positivity in a variety of cell types in day 7 posttransplant specimens from both groups, including sinusoidal-lining cells, bile duct epithelial cells, vascular endothelial cells, inflammatory cells, and occasional injured hepatocytes. Although diffuse tabular staining was seen in the majority of cases in both groups, either with or without rejection, liver biopsy specimens from patients on FK506 showed concentration of positively stained cells in perivenular regions more often, and at a lower overall histologic grade of rejection, than specimens from patients on CsA. There were no differences in the number and distribution of S-100 protein-positive dendritic APC between biopsy specimens from FK506 versus CsA-treated patients, or between specimens with and without cellular rejection in either group. It is suggested that the development of perivenular injury, which is seen frequently in allograft biopsy specimens from patients on FK506 obtained at various intervals after transplantation, may be related to drug toxicity rather than to the process of allograft rejection.

There are a variety of enzymes which are specifically capable of hydrolyzing organophosphorus esters with different phosphoryl bonds from the typical phosphotriester bonds of common insecticidal neurotoxins (e.g. paraoxon or coumaphos) to the phosphonate-fluoride bonds of chemical warfare agents (e.g. soman or sarin). These enzymes comprise a diverse set of enzymes whose basic architecture and substrate specificities vary dramatically, yet they appear to be ubiquitous throughout nature. The most thoroughly studied of these enzymes is the organophosphate hydrolase (opd gene product) of Pseudomonas diminuta and Flavobacterium sp. ATCC 27551, and the heterologous expression, post-translational modification, and genetic engineering studies undertaken with this enzyme are described.

On 27 May 2010, NASA announced the first Earth Venture (EV-1) selections in response to a recommendation made by the National Research Council for low-cost investigations fostering innovation in Earth Science. The five EV-1 investigations span the Earth science focus areas of atmosphere, weather, climate, water and energy and, carbon and represent Earth science researchers from NASA as well as other government agencies, academia and industry from around the world. The five EV-1 missions are (1) Airborne Microwave Observatory of Subcanopy and Subsurface (AirMOSS); (2) Airborne Tropical TRopopause Experiment (ATTREX); (3) Carbon in Arctic Reservoirs Vulnerability Experiment (CARVE); (4) Deriving Information on Surface Conditions from Column and VERtically Resolved Observations Relevant to Air Quality (DISCOVER-AQ), and (5) Hurricane and Severe Storm Sentinel (HS3). The Earth Venture missions are managed out of the Earth System Science Pathfinder (ESSP) Program Office [3]

Uterine myomas may develop in many women, but only become clinically significant in about one third of the affected population. Although uterine myomas are most often benign, they are associated with debilitating symptoms and commonly result in hysterectomy. Current treatments for uterine myomas include pharmacologic therapies, delivery of focused energy, alteration of uterine vascular supply, or surgical procedures. Factors such as the woman's desire for future pregnancy, the importance of uterine preservation, symptom severity, and tumor characteristics direct the choice of therapeutic approach. The ideal treatment will have the following characteristics: easy to perform, minimally invasive, cost effective, preserves fertility, preserves the uterus, efficacious, acceptable tolerability and durability, and low incidence of myoma recurrence.

Does a Reduced HCG Trigger Dose Compromise Outcomes in a Large Prospective Trial of Vaginal Progesterone for Luteal Phase Support? B. Kolb, MD, J. L. Frederick, MD, C. Miller, MD, K. Doody, MD, P. W. Heiser, PhD. Huntington Reproductive Center Pasadena, CA, USA; Huntington Reproductive Center, Laguna Hills and Newport Beach, CA, USA; Charles Miller & Associates, Arlington Heights, IL, USA; Center for Assisted Reproduction, Bedford, TX, USA; Ferring Pharmaceuticals, Inc., Parsippany, NJ, USA.

Study Objective To show a technique of power morcellation within a rip-stop nylon specimen bag. Design Step-by-step explanation of the technique. Background The Food and Drug Administration recently warned against the use of electromechanical power morcellation for hysterectomy and myomectomy because of potential tissue dissemination within the abdomen and pelvis. If the tumor is malignant, this technique increases the staging of the patient and may further warrant re-operation and chemotherapy. If the tumor is benign, the patient is at risk for parasitic myomas that may lead to, but are not limited to, pain and/or bowel obstruction. Intervention To reduce the preceding risks, we reviewed the techniques of power morcellation within a specimen bag used by other surgeons across the United States. This technique was modified to incorporate a more durable bag made out of rip-stop nylon. Laparoscopic supracervical hysterectomy during power morcellation was performed, along with an introduction to incorporating power morcellation of multiple myomas during a laparoscopic myomectomy. Conclusion This technique of power morcellation within a rip-stop nylon bag minimizes the risk of inadvertent tissue spread. This allows the patient an opportunity to undergo minimally invasive surgery for hysterectomy and myomectomy.

Analysis of experimental ozone absorption spectra reveals that ultraviolet photolysis within the structured Huggins band yields extraordinary wavelength-dependent isotopic fractionation, oscillating between complete enrichment and complete depletion for changes of less than 2 nm in the excitation wavelength. Visible photolysis yields wavelength-dependent fractionation that varies from −300‰ to +300‰. Photochemical modeling demonstrates photolysis contributes fractionation up to +45‰ to the heavy ozone anomaly in the middle stratosphere with measurable ^(17)O and ^(18)O isotopologue-dependent variations as a function of altitude despite the fact that the extraordinary photolysis-induced isotopic fractionation effect is dampened in the atmosphere due to the integration over all excitation wavelengths.

In research on contrast effects in performance appraisals, control conditions or measures of accuracy have rarely been used. In the present study, the authors included appropriate controls and used expert ratings to develop "true scores" for assessing accuracy. The study is an examination of the influence of 3 variables on performance ratings: (a) the sequence of viewing and rating performance, (b) the delay between viewing and rating performance, and (c) whether the target of the performance rating was the same person as the anchor. Experimental conditions did not have the expected differential effects on target ratings, but target ratings in all the experimental conditions showed contrast effects when compared with ratings in relevant control conditions. The target ratings in experimental conditions were accurate, however, as assessed by comparisons with true scores, thus raising questions about the relationship between contrast effects and accuracy.

Developmental changes in the expression of endothelial nitric oxide synthase (eNOS) within the mesenteric artery of swine were studied in fetal (110 days postconception/117 days total gestation) and on postnatal days 1, 3, 10, and 30. Subjects in the 1-day-old group were subdivided into fed and nonfed. Transcription of eNOS was determined by real-time PCR, protein expression was evaluated by Western blotting, and hemodynamic and oxygenation parameters were measured within in situ gut loops before and after the administration of NG-monomethyl-l-arginine (l-NMMA). The abundance of eNOS mRNA remained steady throughout all ages. In contrast, expression of eNOS protein was twofold greater in the 1-day-old fed subjects compared with fetal or 1-day-old nonfed subjects. eNOS protein expression remained elevated on day 3, increased on day 10, and then declined to a level similar to the day 1 nonfed group by postnatal day 30. Intestinal vascular resistance was 31% lower in the day 1 fed group when compared to the day 1 nonfed group; resistance continued to decline through day 10 but then significantly increased on day 30. We conclude that the expression of eNOS changes within the mesenteric artery during early postnatal development at a posttranscriptional level.

Introduction Physical and Chemical Properties Manufacture and Processing Thermal Activation Processes Chemical Activation Processes Forms of Activated Carbon Products Shipping and Storage Specifications Economic Aspects Analytical Test Procedures and Standards Health and Safety Liquid-Phase Applications Potable Water Treatment Groundwater Remediation Industrial and Municipal Wastewater Treatment Sweetener Decolorization Chemical Processing Food, Beverage, and Cooking Oil Pharmaceuticals Mining Miscellaneous Uses Gas-Phase Applications Solvent Recovery Gasoline Emission Control Adsorption of Radionuclides Control by Chemical Reaction Protection against Atmospheric Contaminants Process Stream Separations Gas Storage Catalysis Bibliography Additional Reading Keywords: activated carbon; adsorption isotherms; adsorption of radionuclides; BET surface area; emissions, motor vehicles; food, beverage, and cooking oil; pharmaceuticals; pore volume; powdered carbon regeneration; solvent recovery

Recently, data have been published on the possible damage to the healthy ovarian tissue determined by surgery for the excision of endometriomas. We believe that, besides endometriosis in itself, the overall quality of surgery may have a major role in determining damage to the ovary. In recent years, surgeons dedicated to the treatment of endometriosis have refined the technique of laparoscopic surgery for the excision of endometriomas, with particular attention in developing the correct plane of cleavage and in the judicious use of electrosurgery. Quality of the surgery, and not surgery per se, may be important. Surgery is the gold standard treatment for ovarian endometriomas, but it should be performed with proper techniques by specifically trained surgeons. It's the singer, not the song.

We aimed to characterize endothelin (ET) receptors in the swine intestinal vasculature and to determine ischemia-reperfusion (I/R) effects on these receptors. Saturation and competitive binding assays were performed on mesenteric artery protein membranes from 1- and 40-day-old animals, both control and those subjected to 1 h of partial ischemia followed by 6 h of reperfusion in vivo. Scatchard analysis of saturation binding with125I-labeled ET-1 in membranes from endothelium-denuded (E−) vessels revealed that the maximum number of binding sites was greater in younger animals. Competitive125I-ET-1 binding was significant for a one-site model with ET-1, ET-3, and sarafotoxin S6c (S6c) in membranes from endothelium-intact (E+) and E−vessels in both age groups. The maximum number of ET-1 binding sites was significantly greater in younger animals. In the presence of the ETAreceptor antagonist BQ-123, competitive125I-ET-1 binding was significant for a one-site model with ET-1 and S6c in membranes from E+vessels in both age groups. The maximum number of ET-1 binding sites was significantly greater in younger animals. After I/R, the maximum number of ET-1 binding sites was unchanged. In the presence of BQ-123, specific binding by ET-1 and S6c was eliminated in both age groups after I/R. These results suggest that both ET receptor populations are expressed to a greater degree in younger animals and I/R significantly affects the ETBreceptor.