INVAZIVNI DIJAGNOSTIČKI POSTUPCI U VIŠEPLODNOJ TRUDNOĆI

Over the past few years, the rising rate of multiple pregnancies, attributed to both increasing reliance on infertility treatment modalities and delayed childbearing, has expanded the need for prenatal invasive genetic testing. In multiples, first-trimester chorionic villus sampling and second-trimester amniocentesis are relatively safe and efficient alternative procedures, whereas fetal blood sampling is reserved for cases where an indefinite result of fetal karyotyping needs elucidation. The choice of invasive technique should be based on gestational age at referral date, procedure related risks and technical demands, but experience of the center performing the modality should be emphasized in decision making. Technological advances in modern high resolution ultrasound equipment along with increasing operator experience available today result in more accurate and efficacious invasive prenatal diagnosis in twin or higher-order pregnancies, minimizing potential post-procedural fetal loss rate.Monozigotni blizanci čine oko 30% blizanačkih trudnoća, njihova je učestalost stalna, a dvozigotni blizanci čine oko 70% blizanačkih trudnoća, njihova je učestalost u porastu, zbog učestale primjene tehnike pomognute oplodnje i zbog odgađanja prvih trudnoća te posljedične veće životne dobi trudnica. Rizik strukturalnih anomalija u blizanaca je veća nego u jednoplodnih trudnoća, rizik je do tri puta veći u monozigotnih, a u dizigotnih blizanaca je od prilike kao u jednoplodnih trudnoća. Zbog ukupno veće učestalosti višeplodnih trudnoća povećana je potreba za invazivnom prenatalnom dijagnostikom. U višeplodnim trudnoćama su biopsija korionskih resica u prvom i amniocenteza u drugom tromjesečju relativno sigurni i uspješni alternativni postupci, a uzimanje fetalne krvi kordocentezom je rezervirano za slučajeve kada je učinjena kariotipizacija fetusa nesigurna i nejasna. Izbor invazivne tehnike se temelji na dobi trudnoće kad se trudnica javlja, na postojeći rizik postupka i na tehničke zahtjeve, a od velikog je značaja iskustvo prenatalnog centra. Tehnološki napredak suvremene ultrazvučne aparature te rastuće iskustvo prenatalnog operatera doprinose točnoj i učinkovitijoj invazivnoj prenatalnoj dijagnostici u dvojaka i blizanaca višeg stupnja te na najmanju moguću mjeru smanjuju fetalni gubitak nakon invazivnog postupka

Reduced uptake of the proliferation-seeking radiotracer technetium-99m-labelled pentavalent dimercaptosuccinic acid in a 47-year-old woman with severe breast epithelial hyperplasia taking ibuprofen: a case report

<p>Abstract</p> <p>Introduction</p> <p>Recent studies have reported a risk reduction in the progression of benign breast disease to breast carcinoma through COX-2 pathways.</p> <p>Case presentation</p> <p>We present a case of severe epithelial hyperplasia in a 47-year-old woman with increased breast density submitted to scintimammography by the proliferation-imaging tracer Technetium-99m-labelled pentavalent dimercaptosuccinic acid, before and after an oral ibuprofen treatment for 4 weeks. The radiotracer uptake after ibuprofen intake was significantly reduced, both visually and by semi-quantitative analysis, based on a calculation of lesion-to-background ratios.</p> <p>Conclusion</p> <p>In proliferating breast lesions, scintigraphically displayed reduction in Technetium-99m-labelled pentavalent dimercaptosuccinic acid uptake may indicate inhibition by ibuprofen in the pathway of malignant epithelial cell transformation.</p

Perinatal health monitoring through a European lens: eight lessons from the Euro-Peristat report on 2015 births

International audienceNo abstract availabl

Oocyte and ovarian tissue cryopreservation in European countries : statutory background, practice, storage and use

STUDY QUESTION: What is known in Europe about the practice of oocyte cryopreservation (OoC), in terms of current statutory background, funding conditions, indications (medical and ‘non-medical’) and specific number of cycles? SUMMARY ANSWER: Laws and conditions for OoC vary in Europe, with just over half the responding countries providing this for medical reasons with state funding, and none providing funding for ‘non-medical’ OoC. WHAT IS ALREADY KNOWN: The practice of OoC is a well-established and increasing practice in some European countries, but data gathering on storage is not homogeneous, and still sparse for use. Ovarian tissue cryopreservation (OtC) is only practiced and registered in a few countries. STUDY DESIGN, SIZE, AND DURATION: A transversal collaborative survey on OoC and OtC, was designed, based on a country questionnaire containing information on statutory or professional background and practice, as well as available data on ovarian cell and tissue collection, storage and use. It was performed between January and September 2015. PARTICIPANTS/MATERIALS, SETTING AND METHODS: All ESHRE European IVF Monitoring (EIM) consortium national coordinators were contacted, as well as members of the ESHRE committee of national representatives, and sent a questionnaire. The form included national policy and practice details, whether through current existing law or code of practice, criteria for freezing (age, health status), availability of funding and the presence of a specific register. The questionnaire also included data on both the number of OoC cycles and cryopreserved oocytes per year between 2010 and 2014, specifically for egg donation, fertility preservation for medical disease, ‘other medical’ reasons as part of an ART cycle, as well as for ‘non-medical reasons’ or age-related fertility decline. Another question concerning data on freezing and use of ovarian tissue over 5 years was added and sent after receiving the initial questionnaire. MAIN RESULTS AND THE ROLE OF CHANCE: Out of 34 EIM members, we received answers regarding OoC regulations and funding conditions from 27, whilst 17 countries had recorded data for OoC, and 12 for OtC. The specific statutory framework for OoC and OtC varies from absent to a strict frame. A total of 34 705 OoC cycles were reported during the 5-year-period, with a continuous increase. However, the accurate description of numbers was concentrated on the year 2013 because it was the most complete. In 2013, a total of 9126 aspirations involving OoC were reported from 16 countries. Among the 8885 oocyte aspirations with fully available data, the majority or 5323 cycles (59.9%) was performed for egg donation, resulting in the highest yield per cycle, with an average of 10.4 oocytes frozen per cycle. OoC indication was ‘serious disease’ such as cancer in 10.9% of cycles, other medical indications as ‘part of an ART cycle’ in 16.1%, and a non-medical reason in 13.1%. With regard to the use of OoC, the number of specifically recorded frozen oocyte replacement (FOR) cycles performed in 2013 for all medical reasons was 14 times higher than the FOR for non-medical reasons, using, respectively, 8.0 and 8.4 oocytes per cycle. Finally, 12 countries recorded storage following OtC and only 7 recorded the number of grafted frozen/thawed tissues. LIMITATIONS, REASONS FOR CAUTION: Not all countries have data regarding OoC collection, and some data came from voluntary collaborating centres, rather than a national authority or register. Furthermore, the data related to use of OoC were not included for two major players in the field, Italy and Spain, where numbers were conflated for medical and non-medical reasons. Finally, the number of cycles started with no retrieval is not available. Data are even sparser for OtC. WIDER IMPLICATIONS OF THE FINDINGS: There is a need for ART authorities and professional bodies to record precise data for practice and use of OoC (and OtC), according to indications and usage, in order to reliably inform all stakeholders including women about the efficiency of both methods. Furthermore, professional societies should establish professional standards for access to and use of OoC and OtC, and give appropriate guidance to all involved. STUDY FUNDING/COMPETING INTEREST(S): The study was supported by ESHRE. There are no conflicts of interest.peer-reviewe

CRD-BP/IMP1 expression characterizes cord blood CD34+ stem cells and affects c-myc and IGF-II expression in MCF-7 cancer cells.

The coding region determinant-binding protein/insulin-like growth factor II mRNA-binding protein (CRD-BP/IMP1) is an RNA-binding protein specifically recognizing c-myc, leader 3' IGF-II and tau mRNAs, and the H19 RNA. CRD-BP/IMP1 is predominantly expressed in embryonal tissues but is de novo activated and/or overexpressed in various human neoplasias. To address the question of whether CRD-BP/IMP1 expression characterizes certain cell types displaying distinct proliferation and/or differentiation properties (i.e. stem cells), we isolated cell subpopulations from human bone marrow, mobilized peripheral blood, and cord blood, all sources known to contain stem cells, and monitored for its expression. CRD-BP/IMP1 was detected only in cord blood-derived CD34(+) stem cells and not in any other cell type of either adult or cord blood origin. Adult BM CD34(+) cells cultured in the presence of 5'-azacytidine expressed de novo CRD-BP/IMP1, suggesting that epigenetic modifications may be responsible for its silencing in adult non-expressing cells. Furthermore, by applying the short interfering RNA methodology in MCF-7 cells, we observed, subsequent to knocking down CRD-BP/IMP1, decreased c-myc expression, increased IGF-II mRNA levels, and reduced cell proliferation rates. These data 1) suggest a normal role for CRD-BP/IMP1 in pluripotent stem cells with high renewal capacity, like the CB CD34(+) cells, 2) indicate that altered methylation may directly or indirectly affect its expression in adult cells, 3) imply that its de novo activation in cancer cells may affect the expression of c-Myc and insulin-like growth factor II, and 4) indicate that the inhibition of CRD-BP/IMP1 expression might affect cancer cell proliferation.In VitroJournal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Management of the twin-to-twin transfusion syndrome (TTTS)

Twin-to-twin transfusion syndrome (TTTS) is a severe complication of multiple pregnancy occurring in 10-12% of monochorionic twins. This complication is mainly due to the presence of unbalanced arterio-venous anastomoses between placental branches of the umbilical circulations. The natural history of TTTS is variable. It is often difficult to predict whether a patient will show stable rather than rapidly progressive disease. A formal staging system has been suggested based on the sonographic time sequence of cases with progressive deterioration and poorer outcome. The mortality of untreated TTTS has been quoted to be more than 80% with advances in neonatal care the mortality rate may have decreased. The three most commonly used therapies for mid-trimester TTTS are amnioreduction, fetoscopic laser coagulation of the vascular anastomoses and septostomy. Outcome for fetuses with TTTS treated with amnioreduction depends on several antenatal variables which may help in counseling patients. Fetoscopic laser coagulation of vascular anastomoses represents an important evolution in the surgical treatment of TTTS. The management of the TTTS according to stage should be corroborated with an appropriate clinical trial. © 2005 Taylor &amp; Francis Group Ltd