Adhesion between the oocyte-cumulus complex and infundibulum plays an important, but poorly understood, role in oocyte pick-up. The purposes of this study were to determine which components of the oocyte-cumulus complex and oviductal epithelium function in adhesion, to measure adhesion under physiological conditions, and to examine the effect of modulation of adhesion on oocyte-cumulus complex pick-up rate. Oocyte-cumulus complexes containing an expanded matrix were readily transported into the oviduct, while unexpanded complexes lacking an extracellular matrix were not picked up, indicating that the matrix is necessary for pick-up. Transmission electron microscopy revealed that during pick-up, adhesion occurred specifically between the ciliary crowns of the oviduct and the granules and filaments of the cumulus matrix. An assay was developed using vacuum from a low-flow peristaltic precision pump, modified for bi-directional flow, to measure the strength of adhesion between the oocyte-cumulus complex and the oviductal epithelium, and adhesion was measured during physiological conditions. The lectin wheat germ agglutinin and the polycation poly-L-lysine were then used to modulate adhesion, and the effects of increasing or decreasing adhesion on oocyte pick-up rate and ciliary beat frequency were examined. The data show that 1) the matrix of the oocyte-cumulus complex and the ciliary crowns of the oviduct function in adhesion during pick-up and that adhesion is necessary for pick-up, 2) adhesion can be assayed quantitatively and is very uniform among control infundibula, and 3) decreasing or increasing adhesion decreases oocyte pick-up rate and in some cases prevents pick-up without affecting ciliary beat frequency.

Expert pediatric dentists demonstrated greater knowledge of dental trauma compared to novice clinicians. The mobile app clinical decision support tool was a more effective means of improving the diagnosis and management of traumatic dental injuries by both dental students and pediatric dentists than the print CDST.

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Anti-protein Z (aPZ) and protein S (aPS) antibodies have been reported to be associated with adverse pregnancy outcome and thrombosis. We have studied the prevalence of aPZ and aPS antibodies in 63 patients who were referred to our laboratory for antiphospholipid antibody (APA) and lupus inhibitor (LI) evaluation, and 46 normal controls. We considered patients who have increased levels of anticardiolipin (ACL), anti-ß2 glycoprotein I (aB2GPI), or antiphosphatidyl-serine antibodies (aPSer) as APA positive. We define LI positive as patients with prolonged LI sensitive PTT (PTT-LA), and positive for any one of the confirmatory tests (Hexagonal phase assay, platelet neutralization procedure, and diluted Russel Viper Venom Time Ratio). 27 of the 63 patients have APA, 24 of the 63 patients have LI, and 12 of the 63 patients have both APA and LI. Table 1 shows the means and standard deviation (SD) of aPS and aPZ levels of the 63 patients compared to the 46 normal controls. The means aPZ IgM for the total 63 patients group and the 27 patients with APA alone are statistically significantly greater than the control group (p<0.05). We considered aPZ and aPS levels greater than the normal control mean plus 2 SD as positive (aPZ IgG>2.32, IgM>2.95, aPS IgG>3.18, IgM>5.8). Of the 63 patients, 7 (11%) are positive for aPZ IgG, 22 (35%) positive for aPZ IgM, 4 (6%) positive for aPS IgG, and 4 (6%) positive for aPS IgM. In the aPZ, IgG and IgM, positive patients (N=28), 9 (32%) are LI only, 16(57%) are APA only, and 3 (11%) have both LI and APA. Of the 16 APA only, 13 have ACL, 11 have aPSer, and 8 have aB2GPI. For the aPS positive group, 4 positive IgG patients have APA only, and 4 positive IgM patients have LI only. We also have three additional patients other than the 63 patient, who have increased anti-prothrombin antibodies present. These three patients have high aPS IgM antibody (mean 4.50 +/− 3.16). In conclusion, we have found that aPZ IgM antibody are higher in the patients with serological markers for APA and LI compared to our normal controls. We also found that a substantial minority of our patients have increase aPZ (46%) and aPS (13%) antibodies. Since these antibodies have been reported to be associated with thrombosis and adverse pregnancy outcome they may have prognostic implications in those patients with serological markers for APA and LI. We also noticed that high percentage of our aPZ and aPS positive patients have LI. Our data would suggest the inclusion of these antibodies in the evaluation for immune related prothrombotic states and adverse pregnancy outcome. However, larger population study with detailed clinical information and patient outcomes are needed to make appropriated recommendations as to the efficacy for this type of laboratory testing. Mean aPS and aPZ levels of the 63 patients and 46 controls CTR (N=46) All patients (N=66) APA only (N=30) LI only (N=24) APA + LI (N=12) * vs CTR P<0.05 aPZ IgG 0.50 +/− 0.91 1.01 +/− 2.28 0.92 +/− 1.08 1.20 +/− 3.52 0.84 +/− 0.58 aPZ IgM 0.99 +/− 0.98 2.83 +/− 2.96* 3.07 +/− 2.0* 2.21 +/− 3.66 3.52 +/− 3.24* aPS IgG 0.64 +/− 1.27 0.84 +/− 1.08 1.22 +/− 1.47 0.35 +/− 0.29 0.98 +/− 0.6 aPS IgM 2.02 +/− 1.89 2.51 +/− 3.52 2.22 +/− 1.30 2.93 +/− 5.45 2.30 +/− 1.77

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