Publications by authors named "Richard Mayer"

76 Publications

Benefits of Writing an Explanation During Pauses in Multimedia Lessons.

Educ Psychol Rev 2021 Mar 23:1-27. Epub 2021 Mar 23.

Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA 93106 USA.

Generative learning theory posits that learners engage more deeply and produce better learning outcomes when they engage in selecting, organizing, and integrating processes during learning. The present experiments examine whether the generative learning activity of generating explanations can be extended to online multimedia lessons and whether prompts to engage in this generative learning activity work better than more passive instruction. Across three experiments, college students learned about greenhouse gasses from a 4-part online lesson involving captioned animations and subsequently took a posttest. After each part, learners were asked to generate an explanation (write-an-explanation), write an explanation using provided terms (write-a-focused-explanation), rewrite a provided explanation (rewrite-an-explanation), read a provided explanation (read-an-explanation), or simply move on to the next part (no-activity). Overall, students in the write-an-explanation group (Experiments 2 and 3), write-a-focused-explanation group (Experiment 2), and rewrite-an-explanation group (Experiment 3) performed significantly better on a delayed posttest than the no-activity group, but the groups did not differ significantly on an immediate posttest (Experiment 1). These results are consistent with generative learning theory and help identify generative learning strategies that improve online multimedia learning, thereby priming active learning with passive media.
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http://dx.doi.org/10.1007/s10648-021-09594-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985227PMC
March 2021

Retrospective evaluation of attempted vaginal deliveries in dichorionic twin pregnancies.

Arch Gynecol Obstet 2021 Jun 21;303(6):1461-1468. Epub 2020 Nov 21.

Department of Gynecology and Obstetrics, Konventhospital Barmherzige Brueder Linz, Linz, Austria.

Purpose: Numbers of planned cesarean deliveries are increasing in twin pregnancies, despite the lack of evidence for this approach, and the second twin is thought to be at risk for a poorer outcome. The aim of this study was to examine whether twins have a poorer outcome if an attempted vaginal delivery is changed to a cesarean section or combined delivery.

Methods: This retrospective data analysis included all women with dichorionic twin pregnancies attempting vaginal delivery over a 10-year period. Outcome parameters for the first and second twins relative to their mode of birth were compared. A correlation model between the interdelivery time interval and Apgar scores was calculated. Subgroup analyses assessing the birth mode of the first and second twins were conducted.

Results: A total of 248 women were enrolled in the study. The second twins had significantly lower values for outcome parameters, such as umbilical artery cord pH and Apgar scores in comparison with the first twins (P < 0.01). The subgroup analysis of birth modes in first and second twins showed a significantly poorer outcome in the cesarean section and combined delivery group (P < 0.05). The interdelivery time interval was significantly longer in the second twin cesarean section group (P < 0.01). There was no significant correlation between the interdelivery time intervals and Apgar scores (P > 0.05).

Conclusion: Although outcome parameters were significantly lower in second twins and twins born via secondary cesarean section, the clinical relevance of this appears to be negligible.
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http://dx.doi.org/10.1007/s00404-020-05882-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087563PMC
June 2021

Better together: Effects of four self-efficacy-building strategies on online statistical learning.

Contemp Educ Psychol 2020 Oct 3;63:101924. Epub 2020 Oct 3.

Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY 40506, United States.

The goal of this study is to test the individual and combined effects of supplementing an online statistics lesson with four motivational strategies corresponding to Bandura's (1997) four sources of self-efficacy (anxiety coping, modeling, mental practice, and effort feedback) on cognitive, motivational, and affective outcomes. Internet participants ( = 279) completed an online statistics module in one of six conditions with one or all four self-efficacy-building strategies (5 treatment conditions) or none of these strategies (control condition). The results indicated that the four strategies worked effectively in combination, significantly improving transfer test scores ( = 0.608), increasing self-efficacy ratings ( = 0.696), and reducing task anxiety ratings ( = -0.534), as compared with the control condition. By contrast, no motivational strategy alone was effective. The results suggest the importance of taking advantage of the power of all four sources of self-efficacy information in combination when designing motivational interventions for online mathematical lessons.
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http://dx.doi.org/10.1016/j.cedpsych.2020.101924DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532805PMC
October 2020

Retrospective evaluation of established cut-off values for the sFlt-1/PlGF ratio for predicting imminent delivery in preeclampsia patients.

Pregnancy Hypertens 2020 Jan 14;19:143-149. Epub 2020 Jan 14.

Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria.

Objective: The outcome of preeclampsia is difficult to predict. Laboratory markers such as soluble fms-like tyrosine kinase (sFlt-1) and placental growth factor (PlGF) are thought to be predictive factors. A 2012 study by Verlohren et al. evaluated cut-off values for assessing time to delivery in patients with elevated sFlt-1/PlGF ratios. The present study aimed to evaluate findings in patients with elevated sFlt-1/PlGF ratios who gave birth at Kepler University Hospital in Linz, Austria. The hypothesis was tested, that our patients show longer pregnancy duration despite elevated sFlt-1/PlGF ratios.

Study Design: This retrospective data analysis included all patients with sFlt-1/PlGF ratios above the established cut-off values between January 2014 and October 2017. Two groups were analyzed relative to gestational age and were matched with healthy controls: 24 + 0 to 33 + 6 gestational weeks, sFlt-1/PlGF ratio >655.2; and 34 + 0 to 36 + 6 gestational weeks, sFlt-1/PlGF ratio >201.

Main Outcome Measures: sFlt-1/PlGF ratio and time to delivery correlation.

Results: In the <34-week group, 43.2% of the patients delivered beyond 48 h, with a mean sFlt-1/PlGF ratio of 885.06, showing a significantly lower sFlt-1/PlGF ratio than patients who delivered within 2 days (P = 0.04). In the >34-week group, 66.7% were still pregnant after 48 h, with a mean sFlt-1/PlGF ratio of 273.7.

Conclusion: The sFlt-1/PlGF ratio appears to be a powerful tool for diagnosing and predicting preeclampsia. However, the data do not confirm the cut-off values described earlier, with longer pregnancy durations in this group of patients.
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http://dx.doi.org/10.1016/j.preghy.2020.01.009DOI Listing
January 2020

Time-lapse imaging of cytoplasmic strings at the blastocyst stage suggests their association with spontaneous blastocoel collapse.

Reprod Biomed Online 2020 Feb 28;40(2):191-199. Epub 2019 Nov 28.

Kepler University, Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Krankenhausstrasse 26-30, Linz Upper Austria, Austria.

Research Question: To study the origin and temporal behaviour of cytoplasmic strings spanning the blastocoel (main objective) and their influence on treatment outcome (secondary objective).

Design: This retrospective analysis of prospectively collected data was set up in a university medical centre. Patients who either underwent fresh (n = 95) or vitrified-warmed (n = 55) single blastocyst transfer were included. Time-lapse sequences of in-vitro developed blastocysts were screened for the presence of cytoplasmic strings. Pregnancies in string-positive and string-negative transfers were followed up to live birth.

Results: A total of 387 blastocysts were obtained in the fresh cycles of 100 patients, corresponding to a blastocyst formation rate of 62.4%. Cytoplasmic strings were first detected around full stage (108.5 ± 6.4 h) in 170 blastocysts (43.9%). The number of strings varied (range: 1-7) and the duration of visibility was 5.2 ± 3.5 h. The occurrence of cytoplasmic strings was significantly associated with the presence of blastocoelic collapses (P < 0.001) but not with any of the annotated morphokinetic parameters. Live birth and neonatal outcome were the same for both string-positive and string-negative pregnancies. Moreover, collapses did not affect treatment outcome.

Conclusion: Time-lapse analysis of cytoplasmic strings at the blastocyst stage revealed that this morphological feature was not a negative predictor as previously reported. Although physiologically normal, at least some of the cytoplasmic strings are an artefact, possibly associated with blastocoelic collapses.
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http://dx.doi.org/10.1016/j.rbmo.2019.11.004DOI Listing
February 2020

Does the Porter formula hold its promise? A weight estimation formula for macrosomic fetuses put to the test.

Arch Gynecol Obstet 2020 01 27;301(1):129-135. Epub 2019 Dec 27.

Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz, Altenberger Strasse 69, Krankenhausstrasse 26-30, 4040, Linz, Austria.

Purpose: Estimating fetal weight using ultrasound measurements is an essential task in obstetrics departments. Most of the commonly used weight estimation formulas underestimate fetal weight when the actual birthweight exceeds 4000 g. Porter et al. published a specially designed formula in an attempt to improve detection rates for such macrosomic infants. In this study, we question the usefulness of the Porter formula in clinical practice and draw attention to some critical issues concerning the derivation of specialized formulas of this type.

Methods: A retrospective cohort study was carried out, including 4654 singleton pregnancies with a birthweight ≥ 3500 g, with ultrasound examinations performed within 14 days before delivery. Fetal weight estimations derived using the Porter and Hadlock formulas were compared.

Results: Of the macrosomic infants, 27.08% were identified by the Hadlock formula, with a false-positive rate of 4.60%. All macrosomic fetuses were detected using the Porter formula, with a false-positive rate of 100%; 99.96% of all weight estimations using the Porter formula fell within a range of 4300 g ± 10%. The Porter formula only provides macrosomic estimates.

Conclusions: The Porter formula does not succeed in distinguishing macrosomic from normal-weight fetuses. High-risk fetuses with a birthweight ≥ 4500 g in particular are not detected more precisely than with the Hadlock formula. For these reasons, we believe that the Porter formula should not be used in clinical practice. Newly derived weight estimation formulas for macrosomic fetuses must not be based solely on a macrosomic data set.
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http://dx.doi.org/10.1007/s00404-019-05410-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028832PMC
January 2020

Postpartum Galactostasis of the Vulva in a Case of Bilateral Lactating Ectopic Breast Tissue.

Obstet Gynecol 2019 07;134(1):138-140

Department of Gynecology, Obstetrics and Gynecologic Endocrinology, and the Institute of Radiology, Kepler University Hospital, Linz, Austria.

Background: In the general population, the incidence of accessory breast tissue, a congenital malformation, is 1-5%. The most common site is the lower axilla. Detecting such tissue may be problematic, and accessory breasts below the umbilicus are extremely rare.

Case: This report describes the case of a 5-day postpartum 29-year-old woman, G2P2, with painful vulvar swelling 6 cm in diameter. The patient was diagnosed with polymastia in the vulva, without polythelia, with galactostasis due to suturing of a birth laceration covering an excretory duct. The sutures were removed, and the pain decreased. Breastfeeding was continued.

Conclusion: Ectopic breast tissue is rare but should be taken into consideration in the differential diagnosis of a vulvar mass, especially postpartum in lactating women.
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http://dx.doi.org/10.1097/AOG.0000000000003313DOI Listing
July 2019

Equivalence of using a desktop virtual reality science simulation at home and in class.

PLoS One 2019 11;14(4):e0214944. Epub 2019 Apr 11.

School of Life Sciences, University of Glasgow, Glasgow, Scotland.

The use of virtual laboratories is growing as companies and educational institutions try to expand their reach, cut costs, increase student understanding, and provide more accessible hands on training for future scientists. Many new higher education initiatives outsource lab activities so students now perform them online in a virtual environment rather than in a classroom setting, thereby saving time and money while increasing accessibility. In this paper we explored whether the learning and motivational outcomes of interacting with a desktop virtual reality (VR) science lab simulation on the internet at home are equivalent to interacting with the same simulation in class with teacher supervision. A sample of 112 (76 female) university biology students participated in a between-subjects experimental design, in which participants learned at home or in class from the same virtual laboratory simulation on the topic of microbiology. The home and classroom groups did not differ significantly on post-test learning outcome scores, or on self-report measures of intrinsic motivation or self-efficacy. Furthermore, these conclusions remained after accounting for prior knowledge or goal orientation. In conclusion, the results indicate that virtual simulations are learning activities that students can engage in just as effectively outside of the classroom environment.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214944PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459525PMC
December 2019

The participation rate of migrant women in gestational diabetes screening in Austria: a retrospective analysis of 3293 births.

Arch Gynecol Obstet 2019 02 21;299(2):345-351. Epub 2018 Nov 21.

Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.

Purpose: This study evaluated the extent to which migrant women participate in the mandatory oral glucose tolerance test (OGTT) for gestational diabetes mellitus (GDM) screening in Austria.

Methods: A retrospective data analysis was carried out of births at an obstetrics unit in a university hospital between January 2013 and December 2015. The inclusion criteria were singleton pregnancies, live births, birth weight ≥ 3500, and no preexisting diabetes mellitus. The patient's extramurally obtained OGTT values and history of GDM were checked. If the mother's country of birth was not Austria, the woman was classified as a migrant. Three groups were defined: group 1-women with normal OGTT; group 2-women with pathological OGTT; and group 3-women without OGTT or with an incomplete OGTT.

Main Outcome Measures: Numbers of complete and incomplete OGTTs and rate of women with pathological OGTTs not treated in accordance with the guidelines among mothers born in Austria or migrants. The groups were compared using the t-test, chi-squared test, or Fisher's exact test.

Results: A total of 3293 births met the inclusion criteria, and 43.52% of all mothers were migrants; 16.8% of all women had pathological OGTT findings. Only 60.1% of the latter received treatment in accordance with the guidelines. The proportion of mothers born in Austria who did not have OGTTs, or only incomplete ones, was 5.4%. In the group of migrant women, the corresponding figure was 10.5% (P < 0.01).

Conclusions: Migrant women have significantly lower rates of participation in GDM screening.
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http://dx.doi.org/10.1007/s00404-018-4964-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394424PMC
February 2019

The Role of Endometrial Volume and Endometrial and Subendometrial Vascularization Parameters in a Frozen Embryo Transfer Cycle.

Reprod Sci 2019 07 12;26(7):1013-1018. Epub 2018 Nov 12.

1 Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria.

The role of three-dimensional power Doppler ultrasonography of the endometrium in assisted reproduction is still far from clear. In this retrospective cohort study, transvaginal three-dimensional power Doppler examinations were performed 30 min before frozen-thawed embryo transfer. After pregnancy tests, two cohorts were established: P (pregnant, n = 31) and NP (nonpregnant, n = 31). The study only included nullipara with no uterine abnormalities who were undergoing infertility treatment at the Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Linz, Austria. The main outcome measures were the vascularization flow index (VFI), flow index (FI), and vascularization index (VI) in the endometrium/subendometrium, assessed using Virtual Organ Computer-aided AnaLysis (VOCAL™), and the endometrial volume. A total of 62 patients were enrolled in the study, forming two cohorts (pregnant, P; nonpregnant, NP). There were no significant differences between the two cohorts with regard to demographic data, numbers of embryos transferred, or embryo grading, but there was a significant difference in endometrial volume (cohort P, 3.17 ± 0.84 mL; cohort NP, 2.36 ± 0.9 mL; P = 0.001) and the pregnancy rate rises with larger volume. No differences were observed in the vascularization parameters FI, VFI, and VI in the endometrium and subendometrium. In the cohort of pregnant patients, there were 26 (41.9%) live births, with 21 term deliveries (80.8%). The endometrial volume was larger in the cohort of pregnant patients. Measurements were performed 30 min before embryo transfer, and no differences were observed in vascularization parameters in the subendometrium and endometrium.
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http://dx.doi.org/10.1177/1933719118804421DOI Listing
July 2019

Disadvantages of a weight estimation formula for macrosomic fetuses: the Hart formula from a clinical perspective.

Arch Gynecol Obstet 2018 12 4;298(6):1101-1106. Epub 2018 Oct 4.

Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University, Altenberger Straße 69, 4040, Linz, Austria.

Purpose: Sonographic fetal weight (FW) estimation to detect macrosomic fetuses is an essential part of everyday routine work in obstetrics departments. Most of the commonly used weight estimation formulas underestimate FW when the actual birth weight (BW) exceeds 4000 g. One of the best-established weight estimation formulas is the Hadlock formula. In an effort to improve the detection rates of macrosomic infants, Hart et al. published a specially designed formula including maternal weight at booking. The usefulness of the Hart formula was tested.

Methods: Retrospective study of 3304 singleton pregnancies, birth weight ≥ 3500 g. The accuracy of the Hadlock and Hart formula were tested. A subgroup analysis examined the influence of the maternal weight. The Chi-squared test and one-way analysis of variation were carried out. For all analyses, p < 0.05 was considered statistically significant.

Results: The overall percentages of births falling within ± 5% and ± 10% of the BW using the Hadlock formula were 27% and 53%, respectively. Using the Hart formula, 24% and 54% were identified within these levels. With the Hart formula, 94% of all weight estimations fall within 4200 g ± 5% and nearly 100% fall within 4200 g ± 10%.

Conclusions: Applying the Hart formula results in an overestimation of fetal weight in neonates with a birth weight < 4000 g and fails to identify high-risk fetuses. We, therefore, do not consider Hart's formula to be of clinical relevance.
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http://dx.doi.org/10.1007/s00404-018-4917-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6244680PMC
December 2018

Computer Games in Education.

Authors:
Richard E Mayer

Annu Rev Psychol 2019 01 19;70:531-549. Epub 2018 Sep 19.

Department of Psychological and Brain Sciences, University of California, Santa Barbara, California 93106, USA; email:

Visionaries offer strong claims for the educational benefits of computer games, but there is a need to test those claims with rigorous scientific research and ground them in evidence-based theories of how people learn. Three genres of game research are ( a) value-added research, which compares the learning outcomes of groups that learn academic material from playing a base version of a game to the outcomes of those playing the same game with one feature added; ( b) cognitive consequences research, which compares improvements in cognitive skills of groups that play an off-the-shelf game to the skill improvements of those who engage in a control activity; and ( c) media comparison research, which compares the learning outcomes of groups that learn academic material in a game to the outcomes of those who learn with conventional media. Value-added research suggests five promising features to include in educational computer games: modality, personalization, pretraining, coaching, and self-explanation. Cognitive consequences research suggests two promising approaches to cognitive training with computer games: using first-person shooter games to train perceptual attention skills and using spatial puzzle games to train two-dimensional mental rotation skills. Media comparison research suggests three promising areas where games may be more effective than conventional media: science, mathematics, and second-language learning. Future research is needed to pinpoint the cognitive, motivational, affective, and social processes that underlie learning with educational computer games.
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http://dx.doi.org/10.1146/annurev-psych-010418-102744DOI Listing
January 2019

Designing multimedia instruction in anatomy: An evidence-based approach.

Authors:
Richard E Mayer

Clin Anat 2020 Jan 21;33(1):2-11. Epub 2018 Nov 21.

Department of Psychological and Brain Sciences, University of California, Santa Barbara, California.

This paper summarizes 10 research-based principles for how to design effective multimedia instruction in medical education involving anatomy. Clin. Anat. 32:2-11, 2019. © 2018 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.23265DOI Listing
January 2020

Good-quality blastocysts derived from vacuolized morulas show reduced viability.

Fertil Steril 2018 06;109(6):1025-1029

Department of Gynecology, Obstetrics, and Gynecologic Endocrinology, Kepler University, Linz, Austria. Electronic address:

Objective: To study whether late spontaneous vacuolization on day 4 is an artefact or an alternate means of blastocele formation and to analyze its impact on pregnancy outcome and live birth.

Design: Prospective observational study.

Setting: University teaching hospital.

Patient(s): A total of 424 patients who fulfilled inclusion criteria were subgrouped according to the spontaneous vacuolization on day 4: Group 1 had all morulas affected, group 2 showed no signs of vacuoles, and group 3 was mixed (some day 4 embryos had vacuoles and others did not).

Intervention(s): Screening for the presence of vacuoles on day 4 and fresh single-blastocyst transfer.

Main Outcome Measure(s): Morula and blastocyst scoring, utilization rate, pregnancy and live birth rates.

Result(s): Patients of group 1 had a reduced blastocyst formation rate on day 5 (P<.01) and significantly fewer good-quality blastocysts for usage (P<.05). In addition, pregnancy (P<.001) and live birth (P<.01) rate were significantly worse in group 1 compared with groups 2 and 3.

Conclusion(s): Late onset of vacuolization around compaction stage is a negative predictor of blastocyst formation and outcome.
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http://dx.doi.org/10.1016/j.fertnstert.2018.02.131DOI Listing
June 2018

Reference Ranges for Transvaginal Examined Fossa Posterior Structures in Fetuses from 45 to 84 mm Crown-Rump Length.

Gynecol Obstet Invest 2018 5;83(4):375-380. Epub 2018 Jun 5.

Ambulatorium für Fetalmedizin, Feldkirch, Austria.

Objective: The study aimed to describe reference values for structures of the posterior fossa in fetuses with a crown-rump length (CRL) between 45 and 84 mm.

Materials And Methods: This was a prospective, cross-sectional study including 216 normal appearing fetuses. In transvaginal acquired 3-dimensional volume blocks, the longest diameter of the vermis (VE), posterior membranous area (PMA), medulla-oblongata-pons angle (MOPA), diameters of the medulla oblongata (MO) and pons (PO), and the area of Blake's pouch (BP) were measured. Polynomial or linear regression analysis were performed to calculate the mean, 5th and 95th centile according to CRL. In 20 fetuses, intra- and interobserver repeatability were calculated.

Results: There is a curvilinear correlation between CRL and PO (PO [mean] = 1.3893 + 0.004356 × CRL + 0.000002610 × CRL3; SD = 1.6818 - 0.03765 × CRL + 0.000003831 × CRL3; R2 = 0.489); CRL and MO (MO [mean] = 1.5959-0.001905 × CRL + 0.000003362*CRL3; SD = -0.1417 + 0.005404 × CRL + 0.0000004988 × CRL3; R2 = 0.525); CRL and VE (VE [mean] = -0.3640 + 0.04302 × CRL+ 0.000001486 × CRL3; SD = 0.5854 - 0.004812 × CRL + 0.0000005896 × CRL3; R2 = 0.643); CRL and PMA (PMA [mean] = 0.6901 + 0.04307 × CRL - 0.0000008459 × CRL3; SD = -0.4232 + 0.02026 × CRL - 0.000001320 × CRL3; R2 = 0.272); CRL and BP (mm2; BP [mean] -12.2067 + 0.3334 × CRL - 0.00001262 × CRL3; SD = -1.6431 + 0.06380 × CRL+ 0.0000003257 × CRL3; R2 = 0.289). The relation between CRL and MOPA (°) is best described by a linear regression (MOPA [mean] = 79.6332 + 0.6122 × CRL; SD = 4.8453 + 0.07333 × CRL; R2 = 0.318).

Conclusion: We provide reference values for anatomical structures of the posterior fossa of fetuses between 45 and 84 mm CRL. The established reference values might ease the diagnosis of fetal malformations in early pregnancy.
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http://dx.doi.org/10.1159/000486334DOI Listing
October 2018

CORM-401 Reduces Ischemia Reperfusion Injury in an Ex Vivo Renal Porcine Model of the Donation After Circulatory Death.

Transplantation 2018 07;102(7):1066-1074

Matthew Mailing Centre for Translational Transplantation Studies, Western University, London, Canada.

Background: Carbon monoxide (CO) inhalation protects organ by reducing inflammation and cell death during transplantation processes in animal model. However, using CO in clinical transplantation is difficult due to its delivery in a controlled manner. A manganese-containing CO releasing molecules (CORM)-401 has recently been synthesized which can efficiently deliver 3 molar equivalents of CO. We report the ability of this anti-inflammatory CORM-401 to reduce ischemia reperfusion injury associated with prolonged cold storage of renal allografts obtained from donation after circulatory death in a porcine model of transplantation.

Methods: To stimulate donation after circulatory death condition, kidneys from large male Landrace pig were retrieved after 1 hour warm ischemia in situ by cross-clamping the renal pedicle. Procured kidneys, after a brief flushing with histidine-tryptophan-ketoglutarate solution were subjected to pulsatile perfusion at 4°C with University of Wisconsin solution for 4 hours and both kidneys were treated with either 200 μM CORM-401 or inactive CORM-401, respectively. Kidneys were then reperfused with normothermic isogeneic porcine blood through oxygenated pulsatile perfusion for 10 hours. Urine was collected, vascular flow was assessed during reperfusion and histopathology was assessed after 10 hours of reperfusion.

Results: We have found that CORM-401 administration reduced urinary protein excretion, attenuated kidney damage markers (kidney damage marker-1 and neutrophil gelatinase-associated lipocalin), and reduced ATN and dUTP nick end labeling staining in histopathologic sections. CORM-401 also prevented intrarenal hemorrhage and vascular clotting during reperfusion. Mechanistically, CORM-401 appeared to exert anti-inflammatory actions by suppressing Toll-like receptors 2, 4, and 6.

Conclusions: Carbon monoxide releasing molecules-401 provides renal protection after cold storage of kidneys and provides a novel clinically relevant ex vivo organ preservation strategy.
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http://dx.doi.org/10.1097/TP.0000000000002201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228623PMC
July 2018

Meta-analysis of action video game impact on perceptual, attentional, and cognitive skills.

Psychol Bull 2018 01 27;144(1):77-110. Epub 2017 Nov 27.

Faculté de Psychologie et Sciences de l'Education (FPSE), section de Psychologie, Université de Genève.

The ubiquity of video games in today's society has led to significant interest in their impact on the brain and behavior and in the possibility of harnessing games for good. The present meta-analyses focus on one specific game genre that has been of particular interest to the scientific community-action video games, and cover the period 2000-2015. To assess the long-lasting impact of action video game play on various domains of cognition, we first consider cross-sectional studies that inform us about the cognitive profile of habitual action video game players, and document a positive average effect of about half a standard deviation (g = 0.55). We then turn to long-term intervention studies that inform us about the possibility of causally inducing changes in cognition via playing action video games, and show a smaller average effect of a third of a standard deviation (g = 0.34). Because only intervention studies using other commercially available video game genres as controls were included, this latter result highlights the fact that not all games equally impact cognition. Moderator analyses indicated that action video game play robustly enhances the domains of top-down attention and spatial cognition, with encouraging signs for perception. Publication bias remains, however, a threat with average effects in the published literature estimated to be 30% larger than in the full literature. As a result, we encourage the field to conduct larger cohort studies and more intervention studies, especially those with more than 30 hours of training. (PsycINFO Database Record
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http://dx.doi.org/10.1037/bul0000130DOI Listing
January 2018

Time-lapse imaging provides further evidence that planar arrangement of blastomeres is highly abnormal.

Arch Gynecol Obstet 2017 Dec 20;296(6):1199-1205. Epub 2017 Sep 20.

Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Clinic, Campus IV, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.

Purpose: Recently, guidelines on the annotation of dynamic human embryo monitoring recommended screening for the presence of planar blastomere arrangement at the 4-cell stage. This observational study was set up in order to analyze whether developmental kinetics of planar human embryos are different from tetrahedral ones.

Methods: Therefore, embryos of 115 consecutive ICSI patients (showing 32 planar and 554 tetrahedral embryos) were cultured in a new time-lapse system (Miri TL) and their embryos were annotated for morphokinetic development and screened for irregular cleavages and morphological dysmorphisms.

Results: Significantly less planar embryos reached blastocyst stage and showed worse quality as compared to regular tetrahedral embryos. The rate of bi- and/or multinucleation was also significantly higher in the affected group. Irregular cleavages, particularly embryo rolling, were more often seen in planar embryos. Morphokinetics between planar and tetrahedral were distinguishable up to 4-cell stage (t2-t4), thereafter the observed delay in planar embryos (t8) was more likely the result of a higher rate of arrested embryos in the planar group.

Conclusions: Planar embryos are associated with both a significant increase in irregular cleavage as well as a delay in preimplantation development. This indicates that planar embryos are rather abnormal and should only be considered for transfer if no other embryos are available.
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http://dx.doi.org/10.1007/s00404-017-4531-5DOI Listing
December 2017

Playing Some Video Games but Not Others Is Related to Cognitive Abilities: A Critique of Unsworth et al. (2015).

Psychol Sci 2017 05 27;28(5):679-682. Epub 2017 Mar 27.

3 Faculté de Psychologie et Sciences de l'Education, Université de Genève.

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http://dx.doi.org/10.1177/0956797616644837DOI Listing
May 2017

Delivery after Operation for Deeply Infiltrating Endometriosis.

Biomed Res Int 2016 19;2016:8271452. Epub 2016 Jul 19.

Department of Obstetrics and Gynecology, Kepler University Clinic, Campus IV, Krankenhausstrasse 26-30, 4020 Linz, Austria.

Background. It has been suggested that, during pregnancy, endometriosis can cause a variety of disease-related complications. Objectives. The purpose of the study was to find out if women with histologically confirmed endometriosis do have a higher risk of adverse pregnancy outcome and if they suffer from a higher rate of complications during labor. Study Design. 51 women who underwent surgery because of deeply infiltrating endometriosis in the General Hospital Linz and the Women's General Hospital Linz and who gave birth in the Women's General Hospital Linz after the surgery were included in our survey. Results. 31 women (60.8%) had a spontaneous delivery and in 20 women (39.2%) a caesarean section was performed. There were no cases of third- and fourth-degree perineal lacerations. Collectively there were 4 cases (7.8%) of preterm delivery and one case (2.0%) of premature rupture of membranes. In two women (6.5%) a retained placenta was diagnosed. Conclusions. Our study is the first description on delivery modes after surgery for deeply infiltrating endometriosis. We did not find an elevated risk for perineal or vaginal laceration in women with a history of surgery for deeply infiltrating endometriosis, even when a resection of the rectum or of the posterior vaginal wall had been performed.
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http://dx.doi.org/10.1155/2016/8271452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969519PMC
March 2017

Oocyte competence in in vitro fertilization and intracytoplasmic sperm injection patients suffering from endometriosis and its possible association with subsequent treatment outcome: a matched case-control study.

Acta Obstet Gynecol Scand 2017 Jun 22;96(6):736-744. Epub 2016 Jul 22.

Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Johannes Kepler University, Linz, Austria.

Introduction: Endometriosis affects up to 15% of women of reproductive age. There is an obvious lack of studies dealing with morphological parameters of oocyte morphology in endometriosis patients in assisted reproduction. One aim of the study is to describe oocyte morphology in patients undergoing intracytoplasmic sperm injection suffering from endometriosis. In addition, the impact of endometriosis on in vitro fertilization results is analyzed. Both in vitro fertilization and intracytoplasmic sperm injection patients are then matched with an endometriosis-free control group for highlighting the possible association of endometriosis with pregnancy outcome.

Material And Methods: Oocyte morphology of endometriosis patients was assessed in two groups. Both study group and control group consisted of 129 in vitro fertilization/intracytoplasmic sperm injection cycles each. Patients were matched according to anti-Müllerian hormone, female age, previous treatment cycles, and method of fertilization. Endometriosis was graded according to the revised American Society for Reproductive Medicine guidelines of 1997.

Results: Patients with endometriosis had a significantly lower rate of mature oocytes (p < 0.03) and morphologically normal oocytes (p < 0.001). In particular, brownish oocytes (p < 0.009; stage I-IV) and the presence of refractile bodies (p < 0.001; stage IV) were found to be increased. Endometriosis stage IV was associated with significantly worse-quality oocytes than stages I-III (p < 0.01). Fertilization was significantly reduced in conventional in vitro fertilization but not in intracytoplasmic sperm injection (p < 0.03). This was due to lower fertilization rates in stage III-IV endometriosis compared with stage I-II (p < 0.04). No difference was observed with respect to rates of implantation, clinical pregnancy, miscarriage, live birth, and malformation.

Conclusions: Endometriosis patients, in particular those with severe endometriosis, present lower-quality oocytes. Once fertilized, no impairment of further preimplantation embryo development and pregnancy outcome right up to healthy live birth rate has to be expected.
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http://dx.doi.org/10.1111/aogs.12941DOI Listing
June 2017

Sonoembryology of the fetal posterior fossa at 11 + 3 to 13 + 6 gestational weeks on three-dimensional transvaginal ultrasound.

Prenat Diagn 2016 Aug 19;36(8):731-7. Epub 2016 Jun 19.

Ambulatorium für Fetalmedizin, Feldkirch, Austria.

Objective: To describe the sonographic appearance and temporal changes of the structures of the posterior cranial fossa in fetuses at a crown-rump length (CRL) between 45 and 84 mm in transvaginal acquired three-dimensional volume blocks.

Methods: This was a prospective, cross-sectional, observational study including 80 fetuses, whose mothers attended Kepler University Hospital Linz or the Ambulatorium für Fetalmedizin Feldkirch for first-trimester sonography. Three-dimensional volume blocks were acquired in a standardized way and after processing the sonographic characteristics of the brainstem, cerebellar vermis, choroid plexus, anterior membranous area (AMA) and Blake's metapore were described. Measurements of the length of the cerebellar vermis, the length of the AMA and the medulla-oblongata-pons angle (MOPA) were performed. In 20 fetuses the intra- and interobserver repeatability was calculated.

Results: The sonomorphologic characteristics of posterior fossa structures as cerebellar vermis, AMA, Blake's metapore, choroid plexus, pons and medulla oblongata were described. There is a significant correlation between CRL and vermis length, CRL and MOPA and CRL and AMA.

Conclusions: Transvaginal three-dimensional sonography allows a detailed depiction of the structures of the posterior fossa and their temporal course in early pregnancy. © 2016 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/pd.4852DOI Listing
August 2016

Initial clinical experience with a misoprostol vaginal insert in comparison with a dinoprostone insert for inducing labor.

Eur J Obstet Gynecol Reprod Biol 2016 May 12;200:89-93. Epub 2016 Mar 12.

Department of Gynecology and Obstetrics, Kepler University Hospital, Linz, Austria.

Objective: Only one phase III trial has been published to date on the efficacy and safety of misoprostol vaginal inserts for inducing labor. The aim of this study was to compare misoprostol inserts with dinoprostone inserts.

Study Design: This retrospective cohort study evaluated the reduction in time to vaginal delivery and delivery within 24h, in routine clinical work, in 119 labor inductions using a 200-μg misoprostol vaginal insert (Misodel(®); June-October 2014) in comparison with 124 inductions using a 10-mg dinoprostone insert (Propess(®); December 2013-April 2014).

Results: Vaginal delivery within 24h occurred in 77.3% (n=92) of the misoprostol cohort and 74.2% (n=92) of the dinoprostone cohort (P=0.654). Time from insert application to vaginal delivery (min) was 761.76 (±409.44, cohort M) versus 805.17 (±473.00, cohort D) (P=0.817). Cesarean delivery was performed in 10.1% (n=12) versus 10.5% (n=13) in the misoprostol and dinoprostone cohorts, respectively (P≥0.999). The modified Bishop scores were 2.0 versus 3.0 (P=0.001), mean body mass index (BMI) was 24.72 versus 23.95 (P=0.033), and fetal scalp blood testing was required in 12.6% (n=15) versus 3.2% (n=4; P=0.008). No differences were observed with regard to the rates of transfer to the neonatal unit or any type of fetal acidosis.

Conclusions: The groups thus had similar results for rates of vaginal delivery within 24h, cesarean delivery and fetal outcomes. The misoprostol group had lower modified Bishop scores, higher BMIs, and a higher rate of fetal scalp blood testing.
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http://dx.doi.org/10.1016/j.ejogrb.2016.03.008DOI Listing
May 2016

Chromosomal Aneuploidies and Early Embryonic Developmental Arrest.

Int J Fertil Steril 2015 Oct-Dec;9(3):346-53. Epub 2015 Oct 31.

Landes-Frauen-und Kinderklinik Linz, Department of Human Genetics, Krankenhausstraße, Linz, Austria ; Johannes Kepler University, Faculty of Medicine, Linz, Austria.

Background: Selecting the best embryo for transfer, with the highest chance of achieving a vital pregnancy, is a major goal in current in vitro fertilization (IVF) technology. The high rate of embryonic developmental arrest during IVF treatment is one of the limitations in achieving this goal. Chromosomal abnormalities are possibly linked with chromosomal arrest and selection against abnormal fertilization products. The objective of this study was to evaluate the frequency and type of chromosomal abnormalities in preimplantation embryos with developmental arrest.

Materials And Methods: This cohort study included blastomeres of embryos with early developmental arrest that were biopsied and analyzed by fluorescence in-situ hybridization (FISH) with probes for chromosomes 13, 16, 18, 21 and 22. Forty-five couples undergoing IVF treatment were included, and 119 arrested embryos were biopsied. All probes were obtained from the Kinderwunsch Zentrum, Linz, Austria, between August 2009 and August 2011.

Results: Of these embryos, 31.6% were normal for all chromosomes tested, and 68.4% were abnormal. Eleven embryos were uniformly aneuploid, 20 were polyploid, 3 were haploid, 11 displayed mosaicism and 22 embryos exhibited chaotic chromosomal complement.

Conclusion: Nearly 70% of arrested embryos exhibit chromosomal errors, making chromosomal abnormalities a major cause of embryonic arrest and may be a further explanation for the high developmental failure rates during culture of the embryos in the IVF setting.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4671381PMC
http://dx.doi.org/10.22074/ijfs.2015.4550DOI Listing
December 2015

Quantitative and qualitative trophectoderm grading allows for prediction of live birth and gender.

J Assist Reprod Genet 2016 Jan 14;33(1):49-57. Epub 2015 Nov 14.

Department of Gynecological Endocrinology and Kinderwunsch Zentrum, Landes- Frauen- und Kinderklinik, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.

Purpose: Prolonged in vitro culture is thought to affect pre- and postnatal development of the embryo. This prospective study was set up to determine whether quality/size of inner cell mass (ICM) (from which the fetus ultimately develops) and trophectoderm (TE) (from which the placenta ultimately develops) is reflected in birth and placental weight, healthy live-birth rate, and gender after fresh and frozen single blastocyst transfer.

Methods: In 225 patients, qualitative scoring of blastocysts was done according to the criteria expansion, ICM, and TE appearance. In parallel, all three parameters were quantified semi-automatically.

Results: TE quality and cell number were the only parameters that predicted treatment outcome. In detail, pregnancies that continued on to a live birth could be distinguished from those pregnancies that aborted on the basis of TE grade and cell number. Male blastocysts had a 2.53 higher chance of showing TE of quality A compared to female ones. There was no correlation between the appearance of both cell lineages and birth or placental weight, respectively.

Conclusions: The presented correlation of TE with outcome indicates that TE scoring could replace ICM scoring in terms of priority. This would automatically require a rethinking process in terms of blastocyst selection and cryopreservation strategy.
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http://dx.doi.org/10.1007/s10815-015-0609-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4717145PMC
January 2016

Viability of cumulus cells is associated with basal AMH levels in assisted reproduction.

Eur J Obstet Gynecol Reprod Biol 2014 Dec 20;183:59-63. Epub 2014 Oct 20.

Landes- Frauen- und Kinderklinik, Departement of Gynecological Endocrinology and Kinderwunsch Zentrum Linz, Krankenhausstr. 26-30, Linz, Upper Austria, Austria; Johannes Kepler University, Faculty of Medicine, Altenberger Straße 69, Linz, Upper Austria, Austria.

Objective(s): An interesting non-invasive approach to select embryos for transfer is analyzing the health state of somatic granulosa cells surrounding the oocyte addressing their mutual dependence. This prospective study was set up to analyse whether the DNA integrity of cumulus cells correlates with preimplantation development and basal AMH levels.

Study Design: Therefore, 56 patients who gave written consent were enrolled. Sequential denudation of the cumulus-oocyte-complexes was performed in order to separate corona radiata from outer cumulus cells. DNA integrity of both cell types was analysed using a modified chromatin dispersion test.

Results: The percentage of viable corona radiata cells per patient showed a linear correlation to blastulation (P<0.05). These innermost cells showed significantly lower rates of strand breaks (P<0.01) as compared to outer cumulus cells. Age-corrected AMH was significantly associated with the DNA integrity of outer cumulus cells (P<0.05).

Conclusion(s): For the first time it could be shown that in fact clinical embryologists deal with two different entities of cumulus cells, inner and outer ones. It seems that any protective mechanism of the female gamete follows an outward gradient, so that negative effects, e.g. apoptosis, may impair outer cumulus cells first. Age-corrected AMH reflects quality of these outer cumulus cells.

Keywords: AMH; Corona radiata cells; DNA fragmentation; Outer cumulus cells; SCD test.
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http://dx.doi.org/10.1016/j.ejogrb.2014.10.015DOI Listing
December 2014

Some reflections on intracytoplasmic morphologically selected sperm injection.

Int J Fertil Steril 2014 Jul 8;8(2):105-12. Epub 2014 Jul 8.

Department of Gynecological Endocrinology and Kinderwunsch Zentrum, Landes-Frauen-and Kinderklinik and Faculty of Medicine, Johannes Kepler University, Linz, Upper Austria, Austria.

Although intracytoplasmic sperm injection (ICSI) allows proper fertilization in most cases of male sub fertility, it is one of the most unphysiological techniques in assisted reproductive technologies (ART). Thus, over the last decade, researchers have tried to improve sperm observation with higher-resolution microscopy techniques such as the intracytoplasmic morphologically selected sperm injection (IMSI) technique. In order to identify literatures for this review, the PubMed database was searched from 2000 onwards using the terms IMSI, motile sperm organelle morphology examination (MSOME) and sperm vacuole. Approximately 10 years after the introduction of the MSOME and IMSI procedures, several questions related to the prevalence, origin, location, and clinical consequences of sperm vacuoles have not yet been clarified. It seems that IMSI as a routine application is not state of the art and the only confirmed indications for IMSI are recurrent implantation failure following ICSI and severe male factor.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107682PMC
July 2014

Healthy live birth using theophylline in a case of retrograde ejaculation and absolute asthenozoospermia.

Fertil Steril 2014 Feb 1;101(2):340-3. Epub 2013 Nov 1.

Abteilung für Gynäkologische Endokrinologie und Kinderwunsch Zentrum, Landes, Frauen, und Kinderklinik, Austria.

Objective: To analyze whether the use of ready-to-use theophylline is a feasible option in a case of retrograde ejaculation and absolute asthenozoospermia.

Design: Case report.

Setting: In vitro fertilization unit of a public hospital.

Patient(s): Thirty-one-year-old nulliparous woman, and 39-year-old male with retrograde ejaculation and absolute asthenozoospermia.

Intervention(s): Retrieval of postejaculatory urine, restoration of motility using a methylxanthine, intracytoplasmic sperm injection, single-embryo transfer.

Main Outcome Measure(s): Sperm motility, fertilization, embryo quality, live birth.

Result(s): Successful fertilization and a single-embryo transfer resulted in a healthy live birth.

Conclusion(s): Theophylline turned out to be a safe, efficient agent for stimulating immotile spermatozoa in patients with retrograde ejaculation.
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http://dx.doi.org/10.1016/j.fertnstert.2013.10.006DOI Listing
February 2014

Allen-Masters syndrome: do the classic risk factors also apply in patients with endometriosis?

J Obstet Gynaecol Res 2013 Nov 15;39(11):1513-7. Epub 2013 Jul 15.

Department of Obstetrics and Gynecology, Linz General Hospital, Linz, Austria; Department of Gynecology, Erlangen University Hospital, Erlangen, Germany.

Aim: To evaluate whether the classic risk factors for Allen-Masters syndrome, such as body mass index (BMI) and spontaneous births, are in fact responsible for the condition in patients with endometriosis.

Methods: A total of 26 women who underwent a laparoscopic procedure due to chronic pelvic pain, Allen-Masters syndrome and endometriosis from 2009-2011 were enrolled in this study from an endometriosis competence center specializing in minimally invasive surgery. This was a retrospective cohort study (Canadian Task Force classification II-2).

Results: Only eight of the 26 patients (30.77%; 95% confidence interval [CI], 14.33-51.79%) had the classic risk factors (BMI >25 kg/m(2) and/or at least one spontaneous birth). The mean age in the study group was 32.08 years (SD ± 5.45). The patients had a mean BMI (kg/m(2) ) of 19.61 (SD ± 3.07). The means for the patients' clinical data were 0.88 (SD ± 1.53) pregnancies, 0.81 (SD ± 1.23) for parity, 0.27 (SD ± 0.60) for cesareans and 0.54 (SD ± 0.99) for spontaneous births. The revised American Society for Reproductive Medicine (rASRM) stage showed a median of grade III. The left side of the posterior compartment was more often affected (73.1% of cases) than the right side in all patients.

Conclusion: In all, 69.23% of the cases (95% CI, 48.21-85.67%) were not explained by the classic risk factors. In view of the absence of other diseases and otherwise unremarkable parameters, we consider mechanical damage of the lesser pelvis not to be solely responsible for AMS. Further observations in patients with AMS, with and without endometriosis, may be able to contribute to research into the actual etiology of the condition.
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http://dx.doi.org/10.1111/jog.12093DOI Listing
November 2013

Cost-effective bead-based method for high-throughput homogenization of individual small arthropods.

J Vector Borne Dis 2013 Mar;50(1):62-4

Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

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March 2013