J.M. Sroga

Rats and mice exhibit distinct inflammatory reactions after spinal cord injury

Spinal contusion pathology in rats and mice is distinct. Cystic cavities form at the impact site in rats while a dense connective tissue matrix occupies the injury site in mice. Because inflammatory cells coordinate mechanisms of tissue injury and repair, we evaluated whether the unique anatomical presentation in spinally injured rats and mice is associated with a species‐specific inflammatory response. Immunohistochemistry was used to compare the leukocytic infiltrate between rats and mice. Microglia/macrophage reactions were similar between species; however, the onset and magnitude of lymphocyte and dendritic cell (DC) infiltration were markedly different. In rats, T‐cell numbers were highest between 3 and 7 days postinjury and declined by 50% over the next 3 weeks. In mice, significant T‐cell entry was not evident until 14 days postinjury, with T‐cell numbers doubling between 2 and 6 weeks. Dendritic cell influx paralleled T‐cell infiltration in rats but was absent in mouse spinal cord. De novo expression of major histocompatability class II molecules was increased in both species but to a greater extent in mice. Unique to mice were cells that resembled lymphocytes but did not express lymphocyte‐specific markers. These cells extended from blood vessels within the fibrotic tissue matrix and expressed fibronectin, collagen I, CD11b, CD34, CD13, and CD45. This phenotype is characteristic of fibrocytes, specialized blood‐borne cells involved in wound healing and immunity. Thus, species‐specific neuroinflammation may contribute to the formation of distinct tissue environments at the site of spinal cord injury in mice and rats. J. Comp. Neurol. 462:223–240, 2003.

Overexpression of Cyclin D3 Improves Decidualization Defects in Hoxa-10−/− Mice

Uterine decidualization, a crucial process for implantation, is a tightly regulated process encompassing proliferation, differentiation, and polyploidization of uterine stromal cells. Hoxa (Homeobox A)-10, a homeobox transcription factor, is highly expressed in decidualizing stromal cells. Targeted gene deletion experiments have demonstrated marked infertility resulting from severely compromised decidualization in Hoxa-10(-/-) mice. However, the underlying mechanism by which Hoxa-10 regulates stromal cell differentiation remains poorly understood. Cyclin D3, a G(1) phase cell-cycle regulatory protein involved in stromal cell proliferation and decidualization, is significantly reduced in Hoxa-10(-/-) mice. The expression of cyclin D3 in the pregnant mouse uterus parallels stromal cell decidualization. Here, we show that adenovirus-driven cyclin D3 replacement in Hoxa-10(-/-) mice improves stromal cell decidualization. To address our question of whether cyclin D3 replacement in Hoxa-10(-/-) mice can improve decidualization, both in vitro and in vivo studies were completed after the addition of cyclin D3 or empty (control) viral vectors. Immunostaining demonstrated increased proliferation and decidualization in both in vitro and in vivo studies, and in situ hybridization confirmed increased expression of decidualization markers in vivo. Placentation was demonstrated as well in vivo in the cyclin D3-replaced animals. However, fertility was not restored in Hoxa-10(-/-) mice after d 10 of pregnancy. Finally, we identified several downstream targets of cyclin D3 during decidualization in vitro via proteomics experiments, and these were confirmed using in situ hybridization in vivo. Collectively, these results demonstrate that cyclin D3 expression influences a host of genes involved in decidualization and can improve decidualization in Hoxa-10(-/-) mice.

Robotics in reproductive medicine.

In the past decade, robotic technology has been increasingly incorporated into various industries, including surgery and medicine. This chapter will review the history, development, current applications, and future of robotic technology in reproductive medicine. A literature search was performed for all publications regarding robotic technology in medicine, surgery, reproductive endocrinology, and its role in both surgical education and telepresence surgery. As robotic assisted surgery has emerged, this technology provides a feasible option for minimally invasive surgery, impacts surgical education, and plays a role in telepresence surgery.

Developmental regulation of decidual cell polyploidy at the site of implantation.

Polyploidy has been reported in several animal cells, as well as within humans; however the mechanism of developmental regulation of this process remains poorly understood. Polyploidy occurs in normal biologic processes as well as in pathologic states. Decidual polyploid cells are terminally differentiated cells with a critical role in continued uterine development during embryo implantation and growth. Here we review the mechanisms involved in polyploidy cell formation in normal developmental processes, with focus on known regulatory aspects in decidual cells.

Hysteroscopic Enucleation of Type II Submucosal Uterine Leiomyomas Using a TRUCLEAR Hysteroscopic Morcellator: Case Report and Review of the Literature

OBJECTIVE We describe a case of complete enucleation of a Type II leiomyoma using the TRUCLEAR™ (Smith & Nephew Endoscopy, Andover, MA) hysteroscopic morcellator (THM) and demonstrate appropriate preoperative assessment and intraoperative surgical principles during this case. Complete hysteroscopic enucleation of Type II leiomyomas is also systematically reviewed. MATERIALS AND METHODS In this case report and review, performed in a tertiary-care university setting, the THM was used for hysteroscopic resection of two submucosal leiomyomas. RESULTS A 41-year-old gravida 1 para 0010 presented with infertility and symptomatic leiomyomas. Preoperative assessment included a hysterosalpingogram, magnetic resonance imaging, and sonohysterography demonstrating several extrinsic impressions on the uterine cavity and two submucosal leiomyomas (Type I and Type II). Diagnostic hysteroscopy confirmed findings. As the THM blade started resecting the Type II leiomyoma, it began to separate from the underlying myometrium. Attempts to release the edge of the leiomyoma, including reverse rotation of the blade, completely enucleated the leiomyoma, which was subsequently removed from the cavity with the THM. Minimal bleeding was encountered; intraoperative ultrasound confirmed normal overlying myometrium. Postoperatively, sonohysterography showed complete closure of the dead space with only a slightly distorted endometrial cavity. CONCLUSIONS Hysteroscopic uterine leiomyoma enucleation should only be performed in experienced hands. Inadvertent enucleation of a Type II leiomyoma with a THM device is described, with review of key surgical principles that guided safe resection.

Hysterosalpingo‐Contrast Sonography With a Saline‐Air Device Is Equivalent to Hysterosalpingography Only in the Presence of Tubal Patency

To compare hysterosalpingo‐contrast sonography with a saline‐air device to hysterosalpingography for evaluating tubal patency.

Effect of delayed versus immediate embryo transfer catheter removal on pregnancy outcomes during fresh cycles

A retrospective study was performed to determine whether the timing of embryo transfer catheter removal effects pregnancy rates in fresh, day 3 IVF cycles. Two hundred eighteen patients were evaluated, and no difference was noted between delayed versus immediate catheter removal techniques.

Detection of the dietary xenoglycan N-glycolylneuraminic acid (Neu5Gc) and anti-Neu5Gc antibodies within reproductive tracts of male and female infertility subjects

Objective: To assess the frequency of dietary xenoglycanNeu5Gc and antibodies in males and females and its impact on fertility. Design: Prospective study of semen, uterine lavage, and follicular fluid from subjects undergoing infertility evaluation or in vitro fertilization (IVF) and fertile controls. Setting: University based infertility program. Participants: Males (n=23) and females (n=27) undergoing semen analysis and saline infusion sonography as part of their diagnostic evaluation and 37 women undergoing IVF were compared to fertile male (n=15) and female (n=14) controls. Intervention: Neu5Gc was measured by affinity purified antibody staining on Western blots, flow cytometry, and by high performance liquid chromatography. Anti- Neu5Gc antibodies were determined by ELISA. Main parameters measured: Frequency and levels of Neu5Gc antigen within sperm and endometrial cells and antibodies in semen, uterine lavage, and follicular fluid. Semen quality and IVF outcomes were assessed between antigen and antibody positive and negative subjects. Results: In infertile subjects,Neu5Gc was detected in 26% of sperm and 54% of endometrial cells compared to 0% in male and 0% female controls. Anti-Neu5Gc antibodies were identified in 54% of seminal fluid, 41% in uterine lavage and 43% of follicular fluid samples. There were no differences in semen parameters, oocyte quality, and embryo development in the presence or absence of Neu5Gc antigen or antibody. However, clinical pregnancy rate was significantly lower in the presence of anti-Neu5Gc antibodies intrauterine lavage (0% vs. 54.5.0%, p<0.05). Conclusions: Neu5Gc and directed antibodies are present in reproductive tracts of both male and female infertility subjects. Our results suggest their presence may interfere with fertility within the uterine environment.

Robotic applications in reproductive endocrinology and infertility

In reproductive medicine, minimally invasive techniques are commonly used to perform various surgeries (e.g., tubal reanastomosis and myomectomy) in the infertile patient. In recent years, robotic technology has been utilized to perform these surgeries. This article will review the laparoscopic and robotic applications for tubal reanastomosis and myomectomy within the field of reproductive medicine. In addition, current robotic techniques utilized at our institution will be reviewed. In reproductive medicine, robotic-assisted technology provides a feasible option for minimally invasive surgery.

The Road to Fatherhood Using Assisted Reproductive Technology: Decision Making Processes and Experiences Among Gay Male Intended Parents and Gestational Surrogates

Background: With the progression of the gay rights movement, including increased legalization of same sex marriage and parenting options through joint adoption and Assisted Reproductive Technology (ART), there is support of access to ART regardless of marital status or sexual ori- entation. As an increasing number of gay men are now seeking biological parenthood through gestational surrogacy, there is limited data on the decision making processes and experiences for gay male couples and their Gestational Surrogates (GS) using ART in order to identify po- tential needs for programmatic improvement.