The comparison of two different embryo culture methods in the course of in vitro fertilization program.

The objective of the study was to compare two different embryo culture methods in the course of in vitro fertilization program by means of fertilization rate, embryo development, total time and cost. 98 patients undergoing assisted reproduction procedures due to infertility were analyzed. The inclusion criteria for the study: first IVF-ET program, at least 10 MII oocytes, no indications for ICSI. Oocytes were divided into two study groups: group A- open culture (oocytes placed in four-well dishes together, then inseminated and cultured in successive wells) and group B - a closed culture (oocytes placed in microdroplets, each embryo cultured separately). The fertilization rate was assessed around 18 hours from insemination. The embryos were classified into four classes. The best embryos were chosen for transfer. In the group A the fertilization rate obtained was lower than in group B (68% vs. 78%, respectively). The microdroplet culture required more time on the insemination day and on the second day of culture, while the four-well dish method required more time on the first day of culture and on the day of transfer. On analyzing the total cost of the above procedures (MI medium and oil costs) it occurred that the microdroplet culture was more expensive than the four-well dish method (due to the intake of paraffin oil). However, the difference was of no practical importance. In the conclusion, microdroplet culture gives a higher fertilization rate than four-well dish culture, probably due to a homogenous sperm distribution. Despite the differences in time outside the incubator and laboratory expenses (which are after all insignificant) microdroplet culture allows a better control over the embryo development. The embryos of best developmental potential can therefore be chosen for ET

The postprandial hyperglycaemia and its role at the development of diabetic complications

Celem wyznaczonym przez aktualne zalecenia dotyczące leczenia chorych na cukrzycę jest osiągnięcie normoglikemii ocenianej za pomocą pomiaru glikemii na czczo (FPG, fasting plasma glucose) oraz odsetka hemoglobiny glikowanej (HbA1c). Jednak stężenie HbA1c przedstawia średnią glikemię w przedziale czasowym i nie odzwierciedla częstości krótkotrwałych wahań stężenia glukozy we krwi. Z tego powodu rutynowe oznaczenia FPG i HbA1c nie świadczą o rzeczywistym stężeniu glukozy poposiłkowej (PPG, postprandial plasma glucose). Na odsetek HbA1c składają się FPG (60-80%) oraz PPG (20-40%). Zwiększone PPG może się przyczyniać do niezadowalającego wyrównania glikemii. Hiperglikemia jest istotnym czynnikiem wpływającym na rozwój makro- i mikronaczyniowych powikłań cukrzycy oraz zwiększonego ryzyka zgonu. Aktualne wytyczne WHO i ADA zalecają kontrolowanie stężenia HbA1c oraz glikemii na czczo i przed posiłkiem. Jedyną grupą, w przypadku której należy badać PPG, stanowią kobiety ciężarne z cukrzycą. Brak jednak długofalowych badań oceniających wpływ PPG na rozwój późnych powikłań cukrzycy oraz porównujących grupy chorych leczonych preparatami kontrolującymi PPG z grupą poddaną terapii lekami wpływającymi na obniżenie stężenia HbA1c.Actually, the recommended goal of glycemic control in the treatment of diabetes mellitus is to approach normoglycaemia, usually assessed by fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c). The level of HbA1c is a statistical measure and expresses a mean blood glucose concentration in time. It does not provide information on short-term fluctuations of blood glucose. For that reason measurements of fasting blood glucose and HbA1c as a routine do not reflect the glucose level after a meal. HbA1c is related to fasting plasma glucose (60-80%) and postprandial plasma glucose (PPG) (20-40%). The elevated PPG contributes to overall glycemic control. Hyperglycaemia is independent risk factor for macro- and microvascular diabetic complications and increased risk of death. Actual WHO and ADA guidelinesrecommend fasting and preprandial glucose concentrations control as well as HbA1c. The only setting in which PPG monitoring has been shown to improve out-comes is gestational diabetes. There is lack of evidence in clinical trials on contribution of postprandial glucose to the long-term complications of diabetes and comparing PPG versus HbA1c lowering therapy

The postprandial hyperglycaemia and its role at the development of diabetic complications

Celem wyznaczonym przez aktualne zalecenia dotyczące leczenia chorych na cukrzycę jest osiągnięcie normoglikemii ocenianej za pomocą pomiaru glikemii na czczo (FPG, fasting plasma glucose) oraz odsetka hemoglobiny glikowanej (HbA1c). Jednak stężenie HbA1c przedstawia średnią glikemię w przedziale czasowym i nie odzwierciedla częstości krótkotrwałych wahań stężenia glukozy we krwi. Z tego powodu rutynowe oznaczenia FPG i HbA1c nie świadczą o rzeczywistym stężeniu glukozy poposiłkowej (PPG, postprandial plasma glucose). Na odsetek HbA1c składają się FPG (60–80%) oraz PPG (20–40%). Zwiększone PPG może się przyczyniać do niezadowalającego wyrównania glikemii. Hiperglikemia jest istotnym czynnikiem wpływającym na rozwój makro- i mikronaczyniowych powikłań cukrzycy oraz zwiększonego ryzyka zgonu. Aktualne wytyczne WHO i ADA zalecają kontrolowanie stężenia HbA1c oraz glikemii na czczo i przed posiłkiem. Jedyną grupę, w przypadku której należy badać PPG, stanowią kobiety ciężarne z cukrzycą. Brak jednak długofalowych badań oceniających wpływ PPG na rozwój późnych powikłań cukrzycy oraz porównujących grupy chorych leczonych preparatami kontrolującymi PPG z grupą poddaną terapii lekami wpływającymi na obniżenie stężenia HbA1c.Actually, the recommended goal of glycemic control in the treatment of diabetes mellitus is to approach normoglycaemia, usually assessed by fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c). The level of HbA1c) is a statistical measure and expresses a mean blood glucose concentration in time. It does not provide information on short-term fluctuations of blood glucose. For that reason measurements of fasting blood glucose and HbA1c as a routine do not reflect the glucose level after a meal. HbA1c is related to fasting plasma glucose (60–80%) and postprandial plasma glucose (PPG) (20–40%). The elevated PPG contributes to overall glycemic control. Hyperglycaemia is independent risk factor for macro- and microvascular diabetic complications and increased risk of death. Actual WHO and ADA guidelinesrecommend fasting and preprandial glucose concentrations control as well as HbA1c. The only setting in which PPG monitoring has been shown to improve out-comes is gestational diabetes. There is lack of evidence in clinical trials on contribution of postprandial glucose to the long-term complications of diabetes and comparing PPG versus HbA1c lowering therapy

Cerebral amyloid angiopathy-related inflammation – A case report presenting diagnostic difficulties

We describe an 86-year-old woman with a history of hypertension who presented sudden disturbances of consciousness and left hemiparesis. Brain magnetic resonance imaging (MRI) revealed diffused hyperintensive changes on T2-weighted images localized subcortically in the white matter of both cerebral hemispheres, corresponding to acute vasogenic edema, causing moderate mass effect. Posterior reversible encephalopathy syndrome was initially diagnosed. After implementation of anti-edema intravenous steroid treatment and hypotensive therapy the symptoms began to retire, till the total regression. The successive hospitalizations took place two and eight months later due to the occurrence of seizures, motor deficits and the development of mild cognitive impairment. Brain MRI revealed progression of the white matter changes and diffused subcortical microhemorrhages. Each time pulse steroid therapy was implemented and the symptoms improved significantly after several days. Chronic oral steroid treatment resulted in the stabilization of neurological status. The long-term observation of clinical symptoms, remission after immunosuppressive therapy and white matter changes with subcortical microhemorrhages in brain MRI leaded to the diagnosis of cerebral amyloid angiopathy-related inflammation

The association between serum metalloproteinase concentration, obesity, and hormone levels in reproductive-aged women

Introduction: Increased levels and activity of some matrix metalloproteinases (MMPs) are described in obesity-related vascular diseases. Factors that influence MMP blood concentration are still being investigated. This research aims to evaluate the concentration of most types of MMPs: collagenases (MMP-1, -3, -8, -13), matrilysin (MMP-7), gelatinase (MMP-9), and metalloelastase (MMP-12) in serum of women in reproductive age in relation with their body mass index (BMI), age, oestradiol, and progesterone concentrations. Material and methods: Blood samples were taken from 54 healthy reproductive-aged women with normal menstrual cycles. The weight and height of all women were measured, and body mass index (BMI) was calculated. Concentration of MMP-1, -3, -7, -8, -9, -12, and MMP-13 was evaluated using a Procarta Immunoassay Kit. Serum concentrations of oestradiol and progesterone were evaluated by immunochemiluminescence (32 in the proliferative and 20 in the secretory phase of menstrual cycle). The results of the study were statistically calculated using Pearson, Spearman, and Kruskal-Wallis tests. Results: Positive correlation between MMP-7, -8, -9, -12, and -13 levels and BMI was demonstrated. Significantly higher concentrations of MMPs were found especially in obese women compared to women with normal BMI. In healthy, regularly menstruating premenopausal women, MMP levels did not correlate with oestradiol and progesterone concentrations. Conclusions: The results suggest that body mass can influence MMP serum concentration in women with regular menstrual cycles

1,5-Anhydroglucitol as a marker of maternal glycaemic control and predictor of neonatal birthweight in pregnancies complicated by type 1 diabetes mellitus

AIMS/HYPOTHESIS: Most pregnant women with type 1 diabetes mellitus achieve HbA(1c) targets; however, macrosomia remains prevalent and better pregnancy glycaemic markers are therefore needed. 1,5-Anhydroglucitol (1,5-AG) is a short-term marker of glycaemia, reflecting a period of 1 to 2 weeks. Its excretion rate depends on the renal glucose threshold and thus it is unclear whether it may be used in pregnant type 1 diabetes women. We evaluated 1,5-AG as a glycaemic marker and birthweight predictor in pregnant women with type 1 diabetes, and compared its performance with HbA(1c). METHODS: 1,5-AG and HbA(1c) were measured in 82 pregnant women with type 1 diabetes. In addition, 58 continuous glucose monitoring system (CGMS) records were available. Macrosomia was defined as birthweight >90th centile. The data were analysed with Pearson’s correlations, and linear and logistic regression models. Receiver operating characteristic (ROC) analysis was used to evaluate third trimester 1,5-AG as a predictor of macrosomia. RESULTS: Unlike HbA(1c), 1,5-AG strongly correlated with CGMS indices: the AUC above 7.8 mmol/l (r = −0.66; p < 0.001), average maximum glucose (r = −0.58; p < 0.001) and mean glucose (r = −0.54; p < 0.001). In the third trimester, 1,5-AG was the strongest predictor of macrosomia, with ROC AUC 0.81 (95% CI 0.70, 0.89). In contrast, HbA(1c) in the third trimester had a ROC AUC of 0.69 (95% CI 0.58, 0.81). The best discrimination was achieved when both markers were used jointly, yielding a ROC AUC of 0.84 (95% CI 0.76, 0.93). CONCLUSIONS/INTERPRETATION: In pregnant women with type 1 diabetes, 1,5-AG is a better glycaemic marker than HbA(1c), as assessed by CGMS. A decreased third trimester 1,5-AG level, either singly or with HbA(1c), is a strong predictor of macrosomia