Platelet-Rich Plasma (PRP) Promotes Fetal Mesenchymal Stem/Stromal Cell Migration and Wound Healing Process

Numerous studies have shown the presence of high levels of growth factors during the process of healing. Growth factors act by binding to the cell surface receptors and contribute to the subsequent activation of signal transduction mechanisms. Wound healing requires a complex of biological and molecular events that includes attraction and proliferation of different type of cells to the wound site, differentiation and angiogenesis. More specifically, migration of various cell types, such as endothelial cells and their precursors, mesenchymal stem/stromal cells (MSCs) or skin fibroblasts (DFs) plays an important role in the healing process. In recent years, the application of platelet rich plasma (PRP) to surgical wounds and skin ulcerations is becoming more frequent, as it is believed to accelerate the healing process. The local enrichment of growth factors at the wound after PRP application causes a stimulation of tissue regeneration. Herein, we studied: (i) the effect of autologous PRP in skin ulcers of patients of different aetiology, (ii) the proteomic profile of PRP, (iii) the migration potential of amniotic fluid MSCs and DFs in the presence of PRP extract in vitro, (iv) the use of the PRP extract as a substitute for serum in cultivating AF-MSCs. Considering its easy access, PRP may provide a valuable tool in multiple therapeutic approaches. © 2014 Springer Science+Business Media New York

P-255 Double vitrification and warming does not impact clinical pregnancy rate in single blastocyst transfer cycles

Abstract Study question Does double vitrification and thawing impact clinical pregnancy rate after a single blastocyst transfer? Summary answer The clinical pregnancy rate obtained after double vitrification was comparable to that obtained after single vitrification. What is known already Double vitrification-warming (DVW) is commonly practiced to accommodate surplus viable embryos suitable for transfer, allow retesting of inconclusive-diagnosed blastocysts for PGT and circumvent limitations associated with national policies on embryo culture in certain countries. Despite its popularity, the evidence concerning the impact of DVW on IVF/ICSI outcomes is limited and lacking credibility. Biopsied blastocysts have comparable chance of clinical pregnancy following double and single round of vitrification. However, our study is the first to report clinical pregnancy outcomes following DVW in the absence of biopsy and in the case where the first round of vitrification occurred at the zygote stage. Study design, size, duration This is a retrospective observational analysis of n = 452 single blastocyst transfers that were either vitrified-warmed once (SVW, n = 349) or twice (DVW, n = 103) between January 2017 and December 2021. Participants/materials, setting, methods In the SVW group, blastocysts were vitrified on day 5/6 and warmed on the day of embryo transfer (ET). In the DVW group, zygotes (2PN) were first vitrified-warmed and then vitrified again on day 5/6 and warmed on the day of ET. Exclusion criteria were ETs from PGT and vitrified-warmed oocyte cycles. All ETs were performed at the University Hospital of Zurich in Switzerland following a spontaneous or artificial endometrial preparation. Main results and the role of chance Mean maternal age at oocyte pick-up (OPU) and at ET did not differ between the two groups: at OPU: 35.1±4.4 and 35.9±4.1 years for DVW and SVW groups respectively (p = 0.106), at ET: 36.6±4.4 and 36.5±4.4 years for DVW and SVW respectively (p = 0.73). The causes of infertility did not differ between the groups (p = 0.87): male factor infertility was most common: 46.6% and 50.1% of cases for DVW and SVW respectively while other causes included idiopathic infertility, anovulation, endometriosis and polycystic ovarian syndrome. The rate of fertilisation method utilised was similar between the groups (p = 0.98): DVW had 71.8% ICSI and 29% IVF while SVW had 71.9% ICSI and 28% IVF. The quality of blastocysts at ET was equal in the two groups (p = 0.09): DVW had 33.9% top, 30.9% medium and 35.9% low quality blastocyst while SVW had 34.3% top, 31.2% medium and 34.3% low quality blastocysts. The blastocyst expansion grade at ET was similar between the groups (p = 0.087): DVW had 64.9% 3-4 expanded, 32% hatching and 2.9% hatched blastocysts while SVW had 75.8% 3-4 expanded, 21.7% hatching and 2.2% hatched blastocysts. The clinical pregnancy rate was comparable between the groups (p = 0.54): for DVW it was 46.6% and for SVW it was 43.2%. Limitations, reasons for caution The study is limited by its retrospective nature and rather small cohort. Caution should be taken concerning interpretation of these findings in the case that double vitrification-warming occurs at different stages of embryo development. Wider implications of the findings The result of the present study on double vitrification-warming procedure provides a framework for counselling couples on their chance of clinical pregnancy per warming cycle. It additionally provides confidence and reassurance to laboratory professionals in certain countries where national policies limit embryo culture strategies making DVW inevitable. Trial registration number N/A </jats:sec

The complex nature of constitutional de novo apparently balanced translocations in patients presenting with abnormal phenotypes

OBJECTIVE: To describe the systematic analysis of constitutional de novo apparently balanced translocations in patients presenting with abnormal phenotypes, characterise the structural chromosome rearrangements, map the translocation breakpoints, and report detectable genomic imbalances.METHODS: DNA microarrays were used with a resolution of 1 Mb for the detailed genome-wide analysis of the patients. Array CGH was used to screen for genomic imbalance and array painting to map chromosome breakpoints rapidly. These two methods facilitate rapid analysis of translocation breakpoints and screening for cryptic chromosome imbalance. Breakpoints of rearrangements were further refined (to the level of spanning clones) using fluorescence in situ hybridisation where appropriate.RESULTS: Unexpected additional complexity or genome imbalance was found in six of 10 patients studied. The patients could be grouped according to the general nature of the karyotype rearrangement as follows: (A) three cases with complex multiple rearrangements including deletions, inversions, and insertions at or near one or both breakpoints; (B) three cases in which, while the translocations appeared to be balanced, microarray analysis identified previously unrecognised imbalance on chromosomes unrelated to the translocation; (C) four cases in which the translocation breakpoints appeared simple and balanced at the resolution used.CONCLUSIONS: This high level of unexpected rearrangement complexity, if generally confirmed in the study of further patients, will have an impact on current diagnostic investigations of this type and provides an argument for the more widespread adoption of microarray analysis or other high resolution genome-wide screens for chromosome imbalance and rearrangement.</p

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: A 7-day cohort study of elective surgery

The incidence and impact of postoperative complications are poorly described. Failure-to-rescue, the rate of death following complications, is an important quality measure for perioperative care but has not been investigated across multiple health care systems. Methods. We analysed data collected during the International Surgical Outcomes Study, an international 7-day cohort study of adults undergoing elective inpatient surgery. Hospitals were ranked by quintiles according to surgical procedural volume (Q1 lowest to Q5 highest). For each quintile we assessed in-hospital complications rates, mortality, and failure-to-rescue. We repeated this analysis ranking hospitals by risk-adjusted complication rates (Q1 lowest to Q5 highest). Results. A total of 44 814 patients from 474 hospitals in 27 low-, middle-, and high-income countries were available for analysis. Of these, 7508 (17%) developed one or more postoperative complication, with 207 deaths in hospital (0.5%), giving an overall failure-to-rescue rate of 2.8%. When hospitals were ranked in quintiles by procedural volume, we identified a threefold variation in mortality (Q1: 0.6% vs Q5: 0.2%) and a two-fold variation in failure-to-rescue (Q1: 3.6% vs Q5: 1.7%). Ranking hospitals in quintiles by risk-adjusted complication rate further confirmed the presence of important variations in failureto- rescue, indicating differences between hospitals in the risk of death among patients after they develop complications. Conclusions. Comparison of failure-to-rescue rates across health care systems suggests the presence of preventable postoperative deaths. Using such metrics, developing nations could benefit from a data-driven approach to quality improvement, which has proved effective in high-income countries

Kuluttajabarometri maakunnittain 2000, 2. neljännes

Suomen virallinen tilasto (SVT

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries The International Surgical Outcomes Study group

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700