The role of specific cortical regions in sleep-regulating circuits is unclear. The anterior insula (AI) has strong reciprocal connectivity with wake and sleep-promoting hypothalamic and brainstem regions, and we hypothesized that the AI regulates patterns of sleep and wakefulness. To test this hypothesis, we lesioned the AI in rats ( n = 8) and compared sleep, wake, and activity regulation in these animals with nonlesioned controls ( n = 8) with 24-h sleep recordings and chronic infrared activity monitoring. Compared to controls, animals with AI lesions had decreased wakefulness and increased rapid eye movement (REM) sleep and non-REM (NREM) sleep. AI-lesioned animals had shorter wake bouts, especially during the active dark phase. AI-lesioned animals also had more transitions from NREM to REM sleep, especially during the inactive light phase. Chronic infrared monitoring revealed that AI-lesioned animals also had a disturbed temporal organization of locomotor activity at multiple time scales with more random activity fluctuations from 4 to 12 h despite intact circadian rhythms. These results suggest that the AI regulates sleep and activity and contributes to the regulation of sleep and motor behavior rhythmicity across multiple time scales. Dysfunction of the AI may underlie changes in sleep-wake patterns in neurological diseases.

Introduction: The ultimate treatment approach for cervical ectopic pregnancy remains controversial. Gestational age, serum β-hCG levels, fetal cardiac activity presence and the patient’s claim for fertility preservation are the major challenges for method of choice in each individual case. Medical treatment may be a favorable option for the treatment of late diagnosed cases, as well as the early ones. Presentation of case: In this case report, we aim to present a case of 10 4/7 weeks of cervical ectopic pregnancy successfully treated with transvaginal ultrasound-guided local and systemic methotrexate injection. Discussion: The case presented here is exceptional because even though the advanced gestational age, presence of fetal cardiac activity and high serum β-hCG values, the abortion has occurred successfully. Conservative treatment without any need of further surgical intervention was sufficient for full recovery with the preservation of reproductive capacity. Conclusion: In conclusion, transvaginal ultrasound guided local and systemic methotrexate injection may be performed successfully for the cases of advanced gestational age with fetal cardiac activity and high serum β-hCG levels. Highlights:

Fibromyalgia syndrome (FMS) is a chronic pain syndrome, characterised by diffuse pain in musculoskeletal system and accompanied by stiffness, fatigue, tender points, sleep disturbances and cognitive and gastrointestinal symptoms. It affects middle-aged women (between 40 and 65) predominantly. Climacteric syndrome, which is characterised by vasomotor, somatic (headache, sleep disorders, myalgia and arthralgia) and psychical (mood changes) symptoms, results from the change in brain neurotransmitter concentrations due to gradual decline of ovarian hormone levels. Currently, studies focus on the similarities of FMS and climacteric syndrome in terms of age of occurrence, epidemiology, etiopathogenesis, symptomatology and treatment. Hormonal fluctuation during menopausal transition is likely the triggering factor for both syndromes. Therefore, hormone replacement therapy is a favourable approach in the treatment of FMS due to the antiallodynic, anti-inflammatory and neuroprotective effect of oestrogen. In this review, we emphasise the similarity of FMS and climacteric syndrome and suggested that FMS could be considered as a characteristic symptom of climacterium.

The ovary is the source of oocytes and supplier of sex steroid hormones. Being responsible for female fertility and endocrine homeostasis, the progressive decline in the quantity and quality of str...

Objective: This study aimed to evaluate the effect of the coronavirus disease-19 (COVID-19) pandemic on obstetrics and gynecology residency in Turkey. Materials and Methods: A 40-item questionnaire was prepared by the European Network of Trainees in Obstetrics and Gynecology. The survey included four parts, namely, workload, training aspects, trainees' health and safety, and women's and maternal health, conducted between April 2020 and September 2020. The submission of the questionnaire was voluntary. Results: A total of 103 trainees from 28 cities responded to the survey. The mean duration of training was 2.5 years, and first-to fifth-year residents were included. In this study, 66 trainees (65.3%) were deployed in COVID-19 units, and the number of working hours was 84 hours per week. Moreover, 67% of the trainees reported insufficient outpatient clinic experience to meet education targets. Almost all trainees (101 of 103) trainees reported that the number of surgeries and/or elective surgeries decreased or were canceled. In addition, 63% and 68% of the trainees reported that their surgical skills were hindered by the reduced number of surgeries and dissatisfaction by not achieving a sufficient number of surgeries, respectively. Overall, 71% (n=73) were worried about their training. Only 45 trainees (43.6%) have raised their concerns to their program coordinators. Trainees in Turkey experienced a decrease in the workload during the first COVID-19 wave by 62% (n=64). In average, trainees worked nearly 30 h less than their usual workweek. Only 5% of the trainees (n=5) worked from home. Trainees claimed to have used sufficient personal protective equipment, and 66% (n=68) could keep their social distance in the hospital. The availability of health care was different between departments, and the family planning and reproductive medicine departments were the most affected. Conclusion: The obstetrics and gynecology training in Turkey has significantly been affected by the COVID-19 pandemic.