Methods of resolution for haptic assistance during catheterization]

During catheterization navigation within the patient is mainly dependent on a live x-ray image on the screen. Although methods for 3D visualisation and remote navigation of the catheter are discussed and tested still precise positioning is merely the result of intense training and a high skill and level of training of the performing surgeon. This article refers to a system which can be considered as an add-on for existing procedures of catheterization. It compromises of a miniaturised force sensor located at the tip of guide-wires whose prototype is shown here. The measured forces will be presented to the surgeon amplified by an external actuator described in this article. As a result a haptic perception of the forces between the tip of the guide-wire and the vessels walls will be available and enable the surgeon to gain an impression which is comparable to palpation of living vessels from the inside     

Optical palpation for the visualization of tumor in human breast tissue

Accurate and effective removal of tumor in one operation is an important goal of breast‐conserving surgery. However, it is not always achieved. Surgeons often utilize manual palpation to assess the surgical margin and/or the breast cavity. Manual palpation, however, is subjective and has relatively low resolution. Here, we investigate a tactile imaging technique, optical palpation, for the visualization of tumor. Optical palpation generates maps of the stress at the surface of tissue under static preload compression. Stress is evaluated by measuring the deformation of a contacting thin compliant layer with known mechanical properties using optical coherence tomography. In this study, optical palpation is performed on 34 freshly excised human breast specimens. Wide field‐of‐view (up to ~46 × 46 mm) stress images, optical palpograms, are presented from four representative specimens, demonstrating the capability of optical palpation to visualize tumor. Median stress reported for adipose tissue, 4 kPa, and benign dense tissue, 8 kPa, is significantly lower than for invasive tumor, 60 kPa. In addition, we demonstrate that optical palpation provides contrast consistent with a related optical technique, quantitative micro‐elastography. This study demonstrates that optical palpation holds promise for visualization of tumor in breast‐conserving surgery.      

Quadrant通道下MIS-TLIF与传统术式治疗单节段腰椎退变性疾病的疗效比较

目的:对比分析Quadrant通道下微创椎间孔椎间融合术(MIS-TLIF)与传统开放经椎间孔椎间融合术(TLIF)治疗单节段腰椎退变性疾病的临床疗效和安全性。方法:选取2012年3月至2015年3月120例我院收治的120例单节段腰椎退变性疾病患者,并将其随机分为对照组和微创(MIS)组,每组各60例。对照组患者给予TLIF治疗,微创组给予MIS-TLIF治疗。观察和比较两组患者的手术情况,手术前后的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI),肌酸磷酸激酶(CPK)水平、椎间植骨融合率及并发症的发生情况。结果:微创组患者的切口长度、出血量、射线照射时间、下地活动时间以及住院时间均显著低于或短于对照组(P0.05);术后1周、6个月,微创组患者的VAS、ODI评分均显著低于对照组(P0.05);术后,两组患者的CPK水平出现剧烈上升,随后又逐渐下降,但同一时段微创组患者的CPK水平明显低于对照组(P0.05);微创组的椎骨性融合率为93.33%(56/60),显著低于对照组(85.00%,P0.05),且其神经损伤、硬膜囊破裂的发生率均显著低于对照组(P0.05),感染的发生率比较差异无统计学意义(P0.05)。结论:Quadrant通道下微创椎间孔椎间融合术治疗单节段腰椎退变性疾病的临床疗效明显优于传统开放经椎间孔椎间融合术,且创伤更小,患者康复更快,安全性更高。     

Force and torque modelling of drilling simulation for orthopaedic surgery

The advent of haptic simulation systems for orthopaedic surgery procedures has provided surgeons with an excellent tool for training and preoperative planning purposes. This is especially true for procedures involving the drilling of bone, which require a great amount of adroitness and experience due to difficulties arising from vibration and drill bit breakage. One of the potential difficulties with the drilling of bone is the lack of consistent material evacuation from the drill's flutes as the material tends to clog. This clogging leads to significant increases in force and torque experienced by the surgeon. Clogging was observed for feed rates greater than 0.5 mm/s and spindle speeds less than 2500 rpm. The drilling simulation systems that have been created to date do not address the issue of drill flute clogging. This paper presents force and torque prediction models that account for this phenomenon. The two coefficients of friction required by these models were determined via a set of calibration experiments. The accuracy of both models was evaluated by an additional set of validation experiments resulting in average R² regression correlation values of 0.9546 and 0.9209 for the force and torque prediction models, respectively. The resulting models can be adopted by haptic simulation systems to provide a more realistic tactile output.     

高血压脑出血的微创治疗

目的：探讨微创清除颅内血肿技术的手术效果。方法：将42例高血压脑出血的患者,都采用YL-1型一次性使用颅内血肿粉碎穿刺针,进行钻颅手术。结果：16例术后次日即拔针,10例第二日拔针,其余全部患者均在一周内拔针。术后一个月意识恢复良好者27例,重残者10例,死亡5例。结论：谊术式操作时间短,血块及时有效地清除,减轻了副损伤,大大提高了救治成功率。适合广大基层医院使用。     

Referral Patterns for Endocrine Surgical Disease

ObjectiveReferrals between physician specialties are common practice, and clear patterns develop. The increasing availability of high-volume endocrine surgery subspecialists with better outcomes may change these patterns. This study aimed to determine what factors influence endocrinologists’ referral patterns for the surgical treatment of endocrine disease.MethodsA national, cross-sectional, voluntary survey of members of the American Association of Clinical Endocrinologists examined physician demographics, physician’s opinions on referral to endocrine surgery, preferred surgeon specialty, knowledge about surgeon characteristics, and how these factors influenced which surgeons they referred patients, as well as what changes in these factors would alter their referral patterns.ResultsThe survey response rate was 15% (73/500), and 97% were endocrinologists. On average, 0 to 5 patients/ week were referred for surgery. Most respondents (91.8%) felt that endocrinologists should decide which surgeon to refer. General surgery was the preferred surgeon specialty (43.7%), and endocrine surgery was the preferred subspecialty (70.8%). The factors most often cited as very important in referral to a surgeon included surgeon outcome/ complications (71%), familiarity with surgeon (65%), surgeon’s communication with referring physician (61%), and surgeon volume (59%). The factors most often cited as likely to change physician referral patterns included patient satisfaction (62%), complication rates (57%), surgeon outcomes (54%), and surgeon volume (50%). The factors most often cited as unlikely to change referral patterns included new surgeon availability (70%) and hospital/surgeon advertising (58%).ConclusionReferring physicians want experienced endocrine surgeons with high operative volumes and good outcomes whom they are familiar with. The promotion of referral to high-volume surgeons requires communication, good outcomes, and satisfied patients. (Endocr Pract. 2014;20:571-575)     

Determinación rápida intraoperatoria de la paratirina intacta en la cirugía del hiperparatiroidismo primario. La experiencia en nuestro centro

IntroductionPrimary hyperparathyroidism (PHPT) is due to a single adenoma in 85%-95% of cases, and is often cured after adenoma removal. Intraoperative rapid determination of intact parathyroid hormone (PTHio) may be a tool for monitoring the effectiveness of PHPT surgery. The main objective of our study was to evaluate PTHio determination and to establish whether its successful implementation contributed to achieve minimally invasive surgery (MIS) and major ambulatory surgery (MAS) in the treatment of PHPT.Material and methodsRetrospective study of a consecutive series of patients diagnosed and operated on for PHPT at the University General Hospital of Ciudad Real between January 2005 and January 2012.ResultsIn the study period, 91 patients underwent surgery. 39 (42.9%) under general anesthesia, while 52 (57.1%) were candidates for regional anesthesia by cervical block. Seventy-six of all patients (83.5%) were amenable to MIS using a unilateral approach. Classical cervicotomy was performed in all other patients. PTHio determination was done in 75 patients, showing cure in the same surgery in 68 of them. MAS was performed in 70.3% (64) of patients.ConclusionsDetermination of PTHio may allow for changing the surgical approach to PHPT at our department, allowing for performance of MIS on an outpatient basis in a significant proportion of patients with some cosmetic improvement, probably less pain, shorter hospital stay, and less potential complications than bilateral cervical exploration.     

Enhanced Neuroprotection of Minimally Invasive Surgery Joint Local Cooling Lavage against ICH-induced Inflammation Injury and Apoptosis in Rats

Hypothermia treatment is one of the neuroprotective strategies that improve neurological outcomes effectively after brain damage. Minimally invasive surgery (MIS) has been an important treatment of intracerebral hemorrhage (ICH). Herein, we evaluated the neuroprotective effect and mechanism of MIS joint local cooling lavage (LCL) treatment on ICH via detecting the inflammatory responses, oxidative injury, and neuronal apoptosis around the hematoma cavity in rats. ICH model was established by type IV collagenase caudatum infusion. The rats were treated with MIS 6 h after injection, and then were lavaged by normothermic (37 °C) and hypothermic (33 °C) normal saline in brain separately. The results indicated that MIS joint LCL treatment showed enhanced therapeutic effects against ICH-induced inflammation injury and apoptosis in rats, as convinced by the decline of TUNEL-positive cells, followed by the decrease of IL-1β and LDH and increase of IL-10 and SOD. This study demonstrated that the strategy of using MIS joint LCL may achieve enhanced neuroprotection against ICH-induced inflammation injury and apoptosis in rats with potential clinic application.     

The variation of upper ocean structure and paleoproductivity in the Kuroshio source region during the last 200 kyr

A core from the source region of the Kuroshio warm current (east of the Luzon Island) was analyzed using several proxies in order to study the variability of the Western Pacific Warm Pool (WPWP) during the last two glacial–interglacial cycles. Primary productivity (PP) variations were deduced from variations in the coccolith flora. Primary productivity was higher during glacial periods (the end of Marine Isotope Stage [MIS] 3, some periods in MIS 2 and 6), and decreased during interglacial periods (MIS 7, MIS 5e and probably MIS 5c–5d), with the lowest PP in MIS 5e. Variations in the δ¹³C difference in benthic and bulk carbonate, thus in the vertical gradient of δ¹³C in dissolved inorganic carbon (Δδ¹³C_{C. wuellerstorfi–N. dutertrei} and Δδ¹³C_{C. wuellerstorfi–coccolith}) coincided with the PP changes, showing that export productivity was low during interglacial periods (MIS 7, MIS 5e and Holocene) and high during glacial periods (MIS 6, probably MIS 5c–5d, late MIS 4 and late MIS 3). Comparison of foraminiferal carbonate dissolution indicators and PP changes reveals that nannofossil assemblage in core Ph05-5 is not sensitive to carbonate dissolution intensity. The depth of the thermocline (DOT) was estimated from planktonic forminiferal assemblages, and was relatively greater during interglacial periods (MIS 7, MIS 5e, probably MIS 5c and Holocene) than during glacials (middle MIS 6, probably MIS 5b and 5d, some periods in MIS 4, MIS 3 and MIS 2). Good coherence between the paleoproductivity records and the DOT suggests that the DOT changes could be the primary control factor in changes of paleoproductivity, and the glacial high productivity in the Kuroshio source region could be associated with a global increase of nutrient concentration in the intermediate waters that upwelled into the photic zone. The low CO₂ values derived for intervals of high productivity and a relatively shallow DOT suggest that the changes in biological productivity and DOT in the equatorial Pacific could have modified atmospheric CO₂ concentrations. High Sea Surface Temperatures (SSTs) during the warm MIS 5e in combination with intensified monsoonal rain fall could have resulted in a more intense stratification of the upper waters, resulting in low nutrient supply to the surface waters and a resulting decrease in productivity.     

Time course and extent of functional recovery during the first postoperative year after minimally invasive total hip arthroplasty with two different surgical approaches--a randomized controlled trial

While others have reported short-term comparisons between various minimally invasive surgical (MIS) approaches to total hip arthroplasty (THA) and their conventional analogues, longer-term data is lacking, as is information indicating whether MIS approaches to THA provide a biomechanically complete recovery. Furthermore, different MIS approaches have not been compared. Our approaches of interest were a one-incision modified Watson-Jones, and a two-incision approach. Hypotheses: (1) There are significant differences in gait recovery patterns between the two surgical groups and (2) THA subjects have significant differences in function one year after surgery compared to control subjects. To test these hypotheses, THA candidates (n=26) were randomized to receive one of these MIS approaches and evaluated preoperatively, and postoperatively at 3 weeks, and at 3, 6 and 12 months. Evaluations included three-dimensional gait analysis and 24-hour step-counts. The same data were obtained from 25 control subjects. Recovery time-course was assessed using repeated measures ANOVA. T-tests were used to compare controls with the pooled group of THA subjects. We found no differences between the two THA surgical groups regarding the time-course of recovery (p≥0.591). Although recovery was statistically complete by 3 months postoperatively for all variables, there were significant differences from controls at 12 months. Most notably, the external hip adduction moment, which reflects hip abductor function, was more than one standard deviation below normal (p<0.001). THA subject inactivity could not explain the gait differences, since one year after surgery daily step counts were not significantly different from controls (p=0.346). More work is necessary to determine ways to improve biomechanical outcomes for today's patients with high expectations for function and implant longevity.     

Automated knot tying for fixation in minimally invasive, robot-assisted cardiac surgery

Cardiovascular disease (CVD) is perhaps the most significant worldwide health issue. While open-heart surgery remains the predominant treatment, significant advancements have been made in minimally invasive surgery (MIS) and minimally invasive robot-assisted (MIRA) surgery. MIRA techniques offer many advantages over open-heart procedures and have extended the capabilities of MIS. However, these benefits come at the cost of increased operating times due to time spent tying knots. The additional bypass time limits patient access and is the most significant barrier to the adoption of MIRA techniques. This research seeks to overcome this barrier by designing a device for MIRA cardiac procedures that automates the knotting of sutures. If this task can be automated while ensuring the delivery of high-quality knots, great progress can be made in transforming the field. MIRA cardiac procedures can move from novel procedures performed by a select group of surgeons on a limited pool of patients to a viable alternative available to the majority of patients with CVD. In this research we propose a design for a self-contained device that delivers a locking knot. Results suggest that consistent knots can be delivered at a time savings of 12.5% and 26.4% over manual knots for trained and untrained users of a surgical robot, respectively.     

Haptic guidance improves the visuo-manual tracking of trajectories

BACKGROUND: Learning to perform new movements is usually achieved by following visual demonstrations. Haptic guidance by a force feedback device is a recent and original technology which provides additional proprioceptive cues during visuo-motor learning tasks. The effects of two types of haptic guidances-control in position (HGP) or in force (HGF)-on visuo-manual tracking ("following") of trajectories are still under debate. METHODOLOGY/PRINCIPALS FINDINGS: Three training techniques of haptic guidance (HGP, HGF or control condition, NHG, without haptic guidance) were evaluated in two experiments. Movements produced by adults were assessed in terms of shapes (dynamic time warping) and kinematics criteria (number of velocity peaks and mean velocity) before and after the training sessions. Trajectories consisted of two Arabic and two Japanese-inspired letters in Experiment 1 and ellipses in Experiment 2. We observed that the use of HGF globally improves the fluency of the visuo-manual tracking of trajectories while no significant improvement was found for HGP or NHG. CONCLUSION/SIGNIFICANCE: These results show that the addition of haptic information, probably encoded in force coordinates, play a crucial role on the visuo-manual tracking of new trajectories.     

Minimally Invasive Surgery Combined with Regenerative Biomaterials in Treating Intra-Bony Defects: A Meta-Analysis

Background

With the popularity of minimally invasive surgery (MIS) in periodontics, numerous publications have evaluated the benefits of MIS with or without various regenerative biomaterials in the treatment of periodontal intra-bony defects. However, it is unclear if it is necessary to use biomaterials in MIS. Thus, we conducted a meta-analysis of randomized clinical trials in patients with intra-bony defects to compare the clinical outcomes of MIS with regenerative biomaterials for MIS alone.

Methods

The authors retrieved English publications on relevant studies from Cochrane CENTRAL, PubMed, Medline, Embase, Clinical Evidence, and ClinicalTrails.gov (up to June 30, 2015). The main clinical outcomes were the reduction of probing pocket depths (PPDs), gain of clinical attachment level (CAL), recession of gingival margin (REC) and radiographic bone fill. Review Manager 5.2 (Cochrane Collaboration, Oxford, England) was used to calculate the heterogeneity and mean differences of the main clinical outcomes.

Results

In total, 464 studies in the literature were identified but only four were ultimately feasible. The results showed no significant difference regarding CAL gain (P = 0.32) and PPD reduction (P = 0.40) as well as REC increase (P = 0.81) and radiographic bone fill (P = 0.64) between the MIS plus biomaterials group and the MIS alone group.

Conclusions

The meta-analysis suggested no significant difference in treatment of intra-bony defects between the MIS plus biomaterials group and the MIS alone group, indicating that it is important to take costs and benefits into consideration when a decision is made about a therapeutic approach. There needs to be an in-depth exploration of the induction of intrinsic tissue healing of MIS without biomaterials to achieve optimal outcomes.     

Effects of suture material on incision healing, growth and survival of juvenile largemouth bass implanted with miniature radio transmitters: case study of a novice and experienced fish surgeon

Juvenile largemouth bass Micropterus salmoides , intraperitoneally implanted with microradio transmitters exhibited short-term (5 days) inflammation around the incision and suture insertion points for both non-absorbable braided silk and non-absorbable polypropylene monofilament, but in the longer term (20 days) almost all sutures were shed and the incisions were completely healed. Cumulative mortality was higher for fish with braided silk sutures, however, post-mortem analysis revealed that violations to the gastro-intestinal tract from the surgical procedure were the usual cause of the mortality. Mortality was generally low in control fish. The two surgeons who performed the implantations differed substantially in experience. Despite receiving basic training, the novice surgeon took longer to complete the surgeries, had reduced suture precision and experienced more fish mortality relative to the experienced surgeon. For both surgeons, it took longer to complete suturing with polypropylene than with braided silk. During the surgery day, the experienced surgeon exhibited consistently rapid surgery times, whereas the novice surgeon exhibited significantly improved speed as the number of surgeries completed increased. This study suggests that microtransmitters can be successfully implanted in juvenile largemouth bass but some mortality can be expected. This mortality seems to be independent of suture material, but dependent upon the experience of the surgeon.     

Spontaneous endometriosis in a cynomolgus monkey (Macaca fascicularis)

An adult female Macaca fascicularis developed anorexia and minimal fecal production. Abdominal palpation was unrewarding. Rectal palpation revealed a rectal stricture and a large soft tissue mass in the area of the uterus. Clinical pathology tests were within normal limits. Exploratory surgery and histopathology confirmed a diagnosis of endometriosis.     

Willingness to Pay for Cataract Surgery Provided by a Senior Surgeon in Urban Southern China

Purpose

To study willingness to pay for cataract surgery and surgical service provided by a senior cataract surgeon in urban Southern China.

Methods

This study was a cross-sectional willingness-to-pay (WTP) interview using bidding formats. Two-hundred eleven persons with presenting visual impairment in either eye due to cataract were enrolled at a tertiary eye hospital. Participants underwent a comprehensive eye examination and a WTP interview for both surgery and service provided by a senior surgeon. Demographic information, socioeconomic status and clinical data were recorded.

Results

Among 211 (98% response rate) persons completing the interview, 53.6% were women and 80.6% were retired. About 72.2% had a monthly income lower than 1000 renminbi (US $161). A total of 189 (89.6%) were willing to pay for cataract and the median amount of WTP was 6000 renminbi (US$968). And 102 (50.7%) were willing to pay additional fees for surgery performed by a senior surgeon, and the median amount of WTP was 500 renminbi (US$81). In regression models adjusting for age and gender, persons with preexisting eye diseases other than cataract, were more likely to pay for cataract surgery and service provided by a senior surgeon (P = 0.04 for both).

Conclusions

In urban China, cataract patients, especially those with preexisting eye conditions, are willing to pay additional fees for a senior surgeon. Moving to a system where the price of cataract surgery is proportional to the consultant’ skill and expertise is possible and may have a potential impact on waiting list and quality of eye care. Further studies are needed to examine the impact of such pricing system on attitudes and choices of cataract patients.     

The economics of plastic surgery practices: trends in income, procedure mix, and volume

Anecdotally, plastic surgeons have complained of working harder for the same or less income in recent years. They also complain of falling fees for reconstructive surgery and increasing competition for cosmetic surgery. This study examined these notions using the best available data. To gain a better understanding of the current plastic surgery market, plastic surgeon incomes, fees, volume, and relative mix of cosmetic and reconstructive surgery were analyzed between the years 1992 and 2002. To gain a broader perspective, plastic surgeon income trends were then compared with those of other medical specialties and of nonmedical professions. The data show that in real dollars, plastic surgeon incomes have remained essentially steady in recent years, despite plastic surgeons increasing their surgery load by an average of 41 percent over the past 10 years. The overall income trend is similar to that of members of other medical specialties and other nonmedical professionals. The average practice percentage of cosmetic surgery was calculated and found to have increased from 27 percent in 1992 to 58 percent in 2002. This most likely can be explained by the findings that real dollar fees collected for cosmetic surgery have decreased very slightly, whereas those for reconstructive procedures have experienced sharp declines. This study demonstrates that plastic surgeons have adjusted their practice profiles in recent years. They have increased their case loads and shifted their practices toward cosmetic surgery, most likely with the goal of maintaining their incomes. The strategy appears to have been successful in the short term. However, with increasing competition and falling prices for cosmetic surgery, it may represent a temporary bulwark for plastic surgeon incomes unless other steps are taken.     

Forskolin and the meiosis inducing substance synergistically initiate meiosis in fetal male germ cells

We have shown that Meiosis Inducing Substance (MIS) and forskolin synergistically and dose dependently induce meiosis in germ cells of cultured fetal mouse testes. We used a bioassay which consists of fetal mouse testes and ovaries cultured for 6 days. In this study MIS media are spent culture media from 24 hour cultures of minced adult mouse testes. In the bioassay one gonad of each fetus is cultured either in MIS medium, in control medium with forskolin, or in MIS medium with forskolin. The other gonad serves as the control and is cultured in control medium. After culture the gonads are fixed, squashed, and DNA-stained. In these preparations germ cells and somatic cells can be distinguished, and the number of germ cells in the different stages of meiosis is counted as is the number of somatic cells in mitosis. MIS activity is defined to be present in a medium when meiosis is induced in male germ cells during culture. We found that MIS media as well as forskolin induced meiosis in fetal male germ cells in a dose-dependent manner. In addition, MIS media and forskolin acted synergistically by inducing meiosis. Female germ cells seem to be unaffected by the various culture media. These findings indicate that receptors for stimuli of meiotic initiation may exist in germ cells or neighbouring somatic cells. In addition to induction of meiosis, MIS media and forskolin also dose dependently increase the number of male germ cells compared to controls. This increase is correlated with induction of advanced stages of meiosis: Male germ cells seem to survive better if they are triggered to enter meiosis. Neither MIS media nor forskolin affected the growth of somatic cells. We therefore propose that MIS media has a growth factor activity with a specific effect on meiotic initiation. © 1993 Wiley-Liss, Inc.     

Upregulation of the maturation-inducing steroid membrane receptor in spotted seatrout ovaries by gonadotropin during oocyte maturation and its physiological significance

Changes in ovarian maturation-inducing steroid (MIS; 17,20 beta, 21-trihydroxy-4-pregnen-3-one [20 beta-S]) membrane receptor concentrations during the reproductive cycle were investigated in spotted seatrout (Cynoscion nebulosus) captured at their spawning grounds. Ovarian receptor concentrations increased gradually during ovarian recrudescence and subsequently increased rapidly during oocyte maturation, reaching 3.5-fold the prematuration values by the beginning of ovulation. The significant elevation of receptor concentrations by the germinal vesicle migration stage of oocyte maturation was accompanied by increases in circulating levels of gonadotropin (LH, GTH II) and MIS (20 beta-S). The regulation and physiological significance of the increase in ovarian MIS membrane receptor concentrations were investigated in a double in vitro incubation system. Incubation of fully grown, follicle-enclosed oocytes with hCG (10 IU/ml) for 6 h caused a two- to fourfold increase in oocyte and ovarian MIS receptor concentrations and the development of oocyte maturational competence (OMC; ability to complete oocyte maturation in vitro in response to exogenous 20 beta-S in a second incubation). Both upregulation of the MIS receptor and development of OMC in response to gonadotropin were blocked by coincubation with actinomycin D or cycloheximide, which are inhibitors of mRNA and protein synthesis, respectively, but not by cyanoketone, which is an inhibitor of 3 beta-hydroxysteroid dehydrogenase-dependent steroid synthesis. Incubation with a variety of steroids, including 20 beta-S, failed to increase receptor concentrations or to induce OMC, further supporting a steroid-independent mechanism of gonadotropin action. In contrast, insulin-like growth factor I (IGF-I) mimicked the actions of gonadotropin, which suggests IGF-I may be a component of the hormone signaling pathway. A close correlation was found between the relative increase in MIS receptor concentrations and the percentage of oocytes that became maturationally competent after treatment with different concentrations of gonadotropins and drugs that elevate cAMP levels. The finding that upregulation of the MIS receptor in response to gonadotropin and other treatments is invariably associated with the development of OMC indicates that these two processes are intimately related, and it suggests that the increase in MIS receptor concentrations is a critical regulatory step in the hormonal control of oocyte maturation.