Objective: Thin or damaged endometrium remains to be an unsolved problem in the treatment of patients with infertility. The empirical preference for endometrial thickness (EMT) among clinicians is >7 mm, and the refractory thin endometrium, which doesn't respond to standard medical therapies, can be the etiology of recurrent implantation failure (RIF). Autologous platelet-rich plasma (PRP) is known to help tissue regeneration and is widely used in various fields. In the present study, we conducted PRP treatment and investigated its effect on the refractory thin endometrium. Design: Prospective interventional study ( https://cris.nih.go.kr/cris , clinical trial registration number: KCT0003375). Methods: Women who had a history of two or more failed IVF cycles and refractory thin endometrium were enrolled in this study. The main inclusion criteria were EMT of <7 mm after more than 2 cycles of previous medical therapy for increasing the EMT. Twenty-four women were enrolled in this study. The subjects were treated with intrauterine infusion of autologous PRP 2 or 3 times from menstrual cycle day 10 of their frozen-thawed embryo transfer (FET) cycle, and ET was performed 3 days after the final autologous PRP infusion. 22 patients underwent FET, and 2 patients were lost to follow up. Results: The ongoing pregnancy rate and LBR were both 20%. The implantation and clinical pregnancy rates were 12.7 and 30%, respectively, and the difference was statistically significant. The average increase in the EMT was 0.6 mm compared with the EMT of their previous cycle. However, this difference was not statistically significant. Further, EMT of 12 patients increased (mean difference: 1.3 mm), while that of seven patients decreased (mean difference: 0.7 mm); the EMT of one patient did not change. There were no adverse effects reported by the patients who were treated with autologous PRP. Conclusions: The use of autologous PRP improved the implantation, pregnancy, and live birth rates (LBR) of the patients with refractory thin endometrium. We assume that the ability of autologous PRP to restore the endometrial receptivity of damaged endometrium has some aspects other than increasing the EMT. The molecular basis of the treatment needs to be revealed in future studies.

ObjectiveTo update information on the clinical and microbiologic characteristics of pediatric vulvovaginitis in Korean prepubertal girls.MethodsA total of 120 girls (aged 0 to 9 years) with culture-confirmed pediatric vulvovaginitis, diagnosed between 2009 and 2014, were enrolled in the study. The epidemiologic and microbiologic characteristics, and clinical outcomes were assessed. Patients with sexual precocity, as well as those who were referred for suspected sexual abuse, were excluded.ResultsGirls aged 4 to 6 years were at the highest risk of pediatric vulvovaginitis. Seasonal distribution indicated obvious peaks in summer and winter. Of the 120 subjects, specific pathogens were identified in the genital specimens in only 20 cases (16.7%). Streptococcus pyogenes (n=12, 60%) was the leading cause of specific vulvovaginitis. Haemophilus influenzae was isolated in one patient. No cases presented with enteric pathogens, such as Shigella or Yersinia. A history of recent upper respiratory tract infection, swimming, and bubble bath use was reported in 37.5%, 15.8%, and 10.0% of patients, respectively. Recent upper respiratory tract infection was not significantly correlated with the detection of respiratory pathogens in genital specimens (P>0.05). Of 104 patients who underwent perineal hygienic care, 80 (76.9%) showed improvement of symptoms without antibiotic treatment. Furthermore, the efficacy of hygienic care was not significantly different between patients with or without specific pathogens (P>0.05).ConclusionSpecific pathogens were only found in 16.7% of pediatric vulvovaginitis cases. Our results indicate an excellent outcome with hygienic care, irrespective of the presence of specific pathogens.

Aim: The present study investigates the procedure-related fetal loss rate and obstetrical outcomes of selective feticide in dichorionic twins. Methods: We retrospectively analyzed the data of 44 cases of dichorionic twins. Two different indications for selective feticide were set: (i) the presence of genetic or congenital anomaly; and (ii) an obstetrical indication specified as a past maternal history of preterm delivery that caused fetal death or cerebral palsy of the child. Primarily, data on procedure-related fetal loss and obstetrical outcomes were retrieved. Additionally, data on obstetrical outcomes by reduction time and by indication of SF were obtained. Results: Selective feticide was performed in 44 casesspecifically, in 23 cases with genetic or congenital anomaly and in 21 cases with obstetrical indications. The median gestational age at delivery was 38 + 4 weeks. One pregnancy loss (2.3%, 1/44) occurred within 4 weeks after the procedure. The overall pregnancy loss rate throughout the pregnancy term was 2.3% (1/44). When selective feticide was performed at 15 weeks and beyond, the birth weight was significantly decreased compared with when selective feticide was performed earlier than 15 weeks. Conclusion: Transabdominal ultrasound-guided selective feticide in dichorionic twins is an effective and safe procedure. If a patient desires to maximize her chances of having a healthy child and decrease the risk of prematurity, the option of selective feticide should be considered in certain cases of twin pregnancies. Selective feticide may be a reasonable alternative to expectant management or termination of the whole twin pregnancy.