Successful treatment with hysteroscopy for infertility due to isthmocele and hydrometra secondary to cesarean section: A case report

BACKGROUND An isthmocele is a scar defect in the uterine wall due to a cesarean section. Its prevalence is unknown,but it has been associated with secondary infertility.Here,we present a case where the patient suffered from an isthmocele that was associated with persistent hydrometra,which developed during in vitro fertilization.CASE SUMMARY The patient underwent hysteroscopic surgery,which successfully resolved the isthmocele as well as the hydrometra. Afterward,two high-quality,euploid embryos,determined by morphological assessment and pre-implantation genetic diagnostic testing,were transferred. This resulted in uterine pregnancy,as determined byserum β-human chorionic gonadotropin levels on day 14(180 m U/mL) and ultrasound-confirmed presence of a gestational sac with a positive embryocardia at week 6. The pregnancy reached 36 wk without any complications,and the product was born in good health. We report a successful isthmocele treatment in a patient with secondary infertility,in which the isthmocele was the cause of persistent hydrometra.CONCLUSION Hydrometra caused by secondary cesarean is an infertility factor,which can be corrected by hysteroscopy plus ablation of the isthmocele.

Surgical and nutritional interventions for endometrial receptivity:A case report and review of literature

BACKGROUND Polycystic ovary syndrome(PCOS)is an endocrine disease that combines metabolic,reproductive,and psychological dysfunctions.Ovulation disorders and impaired endometrial receptivity in PCOS can cause infertility.Insulin resistance(IR)is a pathological state of inadequate response to insulin that affects reproduction in PCOS,as damage caused by IR at the endometrial level becomes an obstacle for embryo implantation.Reversing IR resulted in spontaneous pregnancies in PCOS patients,indicating that metabolic corrections improve endometrial dysfunctions.Mesenchymal stem-cell treatment has also corrected endometrial quality and lead to pregnancies in patients with Asherman’s syndrome.We propose a combination of nutritional intervention with the surgical placement of stem cells to improve endometrial quality to achieve pregnancy in a PCOS patient undergoing in vitro fertilization(IVF)treatment.CASE SUMMARY After two failed IVF cycles,a metabolic intervention,consisting of a ketogenic diet with daily consumption of 50 g of carbohydrates(CH),was indicated until pregnancy.Metabolic Syndrome was assessed using the Harmonizing Definition(3 of 5 pathologies:Central obesity,hypertension,hyperglycemia,hypertriglyceridemia,and dyslipidemia),and the Homeostatic Model Assessment of IR(HOMA-IR)was used to measure the level of IR.Once IR improved,endometrial quality improved.However,two day 5-thawed embryos(euploid,donated oocyte–partner's sperm)failed to implant,suggesting endometrial quality improvement was insufficient.Therefore,transmyometrial implantation of mesenchymal stem cells from the stromal vascular fraction of adipose tissue was performed to enrich the endometrial stem cell niche.Minimal endometrial mean thickness for embryo transfer(6.9 mm)was achieved three months after stem cell treatment and continuous dietary control of IR.Two euploid-day 5-thawed embryos(donated oocyte–partner's sperm)were transferred,and embryo implantation was confirmed on day 14 byβ-hCG serum levels.Currently,a 37 wk baby girl is born.CONCLUSION In PCOS,endometrial quality can be improved by combining nutrient-based metabolic correction with endometrial stem cell niche enrichment.

Genetic Diversity of Great Dane Breed Using Ten Microsatellites: Impact of Breeding Control over the Breeding Line

The American Kennel Club and the Fédération Cynologique Internationale recognize two phenotypic variants of Great Dane breed denominated American and European varieties. Historically, these varieties have been segregated according to morphological characteristics. In an attempt to obtain a better characterization, breeders have been interested in the genetic parameters that could evaluate the within-breed diversity. In this document, we studied the genetic structure of Great Dane breed with 10 STR markers in 88 dogs using capillary electrophoresis. Cluster analysis, population differentiation and phylogenetic analyses revealed that American and European varieties are genetically independent. Nevertheless, within the American variety a genetic stratification was found. Additionally, a high misclassification (28%) was detected, which could be due to wrong registration or false paternity. Our results support the importance to deem genetic markers as useful tools in breeding control. Similarly, these studies serve as an accurate reference to establish standards by dog breeding associations and for choosing among dogs for inter-breeding. Nevertheless, genetic tools are only a complement of morphological methods, since both are reshuffling the control over the breeding line. Notwithstanding, this database provides an overall and scape concerning the impact of genetic diversity within-breed. Unmistakably, more databases are needed to increase the quality of the breeding line as well as the number of STR in order to study, with more detail, the genetic structure in the Great Dane race.

Aryl hydrocarbon receptor as a new therapeutic target for cancer and immune disorders

The aryl hydrocarbon receptor （AhR） was discovered more than three decades ago, and initially was char-acterized as a transcription factor with a role in xe-nobiotic metabolism. However, based on subsequent observations that AhR remains active under physiologi-cal conditions, exhibits constitutive expression during development, and has a high degree of conservation among species, it was hypothesized that AhR is re-sponsible for functions in addition to its role in detoxif-cation. Correspondingly, recent studies have elucidated novel physiological roles for this ligand-dependent transcription factor that link it to several pathways associated with disease development. In this review, studies are presented that support a role for AhR in cell proliferation, apoptosis, and immune homeostasis, thereby highlighting the therapeutic potential of this receptor for cancer and immune disorders.

Genetic Structure of Cartagena de Indias Population Using Hypervariable Markers of Y Chromosome

Ethnicity has been associated with the incidence of diseases and consequently it is a cornerstone in medical genetic studies. It is mainly important in admixture populations, where the population stratification can produce spurious results that lead to erroneous conclusions. Consequently, population stratification has become one of the most important confounding factors in population-based genetic association studies, especially in Latino populations. Cartagena de Indias is a cosmopolitan city with dissimilar ancestry proportions due to recent miscegenation. This population mainly exhibits African and Amerindian matrilineal ancestries. Nevertheless, important asymmetries in the paternal genetic history related to the complex patterns of migration in the colonial period increase the male genetic diversity in this population. As a result of this recent admixture, population stratification has arisen, where each subpopulation is not equally represented. Consequently, the allele differences between cases and controls could be related with different frequencies among different population strata rather than the association of the genes with the disease. In order to define the patrilineal substructure of the Cartagena’s population, a total of 130 unrelated men were ancestrally studied using 15 Y-STR loci routinely employed in anthropological, forensic and population genetics. Our results show that Cartagena is an admixture population consisting of European (80%), Amerindian (10%) and African ancestries (10%), which are represented by haplogroups R1b and I2a (xI2a1), Q-M242/Q-M3, and E1b1a/E1b1b, respectively. Complex genetic patterns found in Cartagena’s population emphasize the importance to know the genetic variation in order to diminish the inconsistence for future genetic association studies. In addition, our findings illustrate the complex genetic background of Cartagena population and reinforce the need to encompass more geographic regions to generate more robust data for anthropological and forensic applications.