Nephrotoxicity of alternative medicine practice

The use of alternative medicine is highly prevalent around the world; in many areas, this is so because of lack of access to, or trust in, Western medicine, and also because they are considered "natural" and therefore safe. The kidney is an organ vulnerable to toxic insults by virtue of its anatomy and function. Reports of nephrotoxicity associated with alternative medicine use encompass all forms of renal dysfunction, ranging from electrolyte abnormalities and proteinuria to acute and CKD, renal failure, and death. In countries where intensive care and dialysis support are not available, mortality is high. Mechanisms of alternative medicine-associated kidney injury include direct nephrotoxicity, which may be augmented by underlying predisposing conditions such as dehydration; contamination, or adulteration of remedies; inappropriate use or preparation of a remedy; or interactions with other medications. The use of alternative medicines is underreported to clinicians. Because many patients strongly believe in the powers of alternative medicines, it is important that alternative medicines not be demonized as a whole, but that their use and consequences be closely observed and reported to build a more comprehensive understanding of their impact in our clinical practice and to foster research on the potential harm or, in some cases, possible benefits

Fertility preservation in cancer patients : from cryopreserved ovarian tissue to isolated follicles

Ovarian tissue cryopreservation (OTC) and transplantation is a well established procedure to preserve fertility in young cancer patients. Although more than 30 live births have been achieved in adult patients so far, there are some concerns that need to be addressed when contemplating this approach: (i) Do ovarian follicles in cryopreserved ovarian tissue from prepubertal patients have the capacity to survive and develop properly after transplantation and exogenous stimulation? (ii) Is there a risk of reintroducing malignant cells after autotransplantation of cryopreserved ovarian tissue from patients with advanced-stage breast cancer? (iii) Would it be possible to offer an alternative option to patients who cannot undergo transplantation of frozen-thawed ovarian tissue? The aim of this thesis was to answer these specific questions. For this reason, it was divided into three parts: Transplantation of cryopreserved ovarian tissue from prepubertal patients After 21 weeks of transplantation to immunodeficient mice and exogenous hormonal stimulation, prepubertal ovarian follicles were able to survive and grow up to the antral stage, proving their sensitivity to gonadotropins. Follicular density was high in prepubertal ovarian tissue and remained so after transplantation, with a preserved primordial follicle pool, suggesting a longer lifespan of grafted ovarian tissue. Safety of ovarian tissue transplantation: the specific issue of breast cancer patients While transplantation of frozen-thawed ovarian tissue from early-stage breast cancer patients is reportedly to be safe, our study with advanced-stage breast cancer patients confirms that there is a potential risk of reimplanting metastatic cells in these subjects, as some cells expressing the MGB2 gene were detected after grafting. However, the real malignant potential of these cells is not known, as transplantation of frozen-thawed ovarian tissue from advanced-stage breast cancer patients to immunodeficient mice did not evidence tumor development after 6 months of grafting. Artificial ovary For patients running the potential risk of ovarian invasion by malignant cells, a safe alternative would be transplantation of isolated ovarian follicles, encapsulated in a biocompatible matrix. In order to develop a biodegradable ovary with a fibrin-based scaffold through establishment of a central composite design evaluating different formulations of fibrinogen and thrombin (F/T), two combinations (F12.5/T1 and F25/T4) were identified. These concentrations appear to promote survival and proliferation of isolated human ovarian cells (OCs), with high degradation of the fibrin network and positive evolution of stromal cell density. Isolated murine OCs and follicles in these two F/T combinations were able to successfully survive and develop up to the antral stage after one week of autografting. In conclusion, OTC is the only available option to preserve ovarian tissue in prepubertal girls and when gonadotoxic treatments cannot be delayed. When there is a risk of reimplanting malignant cells, a fibrin-based matrix appears to be a promising candidate for construction of a biodegradable scaffold to transplant isolated ovarian follicles and OCs (artificial ovary).(MED - Sciences médicales) -- UCL, 201

Cryopréservation de tissu ovarien et transplantation chez les patientes cancéreuses

Selon des rapports précédents, +/- 700000 nouveaux cancers touchent chaque année la population féminine aux USA. Les analyses statistiques estiment que 790000 nouveaux cas de cancers chez la femme seront déclarés en 2012. Un diagnostic de cancer invasif aura été posé chez une femme sur 47 à l'âge de 40 ans. Depuis 1996, nous proposons systématiquement une cryopréservation de tissu ovarien avant les traitements par chimiothérapie et par radiothérapie potentiellement gonadotoxiques à toute patiente âgée de < 35 ans. Plus de 500 patientes ont bénéficié de cette procédure

Risk of transferring malignant cells with transplanted frozen-thawed ovarian tissue.

Ovarian tissue cryopreservation and transplantation is a real option to preserve and restore fertility in young cancer patients. However, there is a concern regarding the possible presence of malignant cells in the ovarian tissue, which could lead to recurrence of the primary disease after reimplantation. A review of the existing literature was done to evaluate the risk of transplanting malignant cells in case of the main malignant indications for ovarian tissue cryopreservation. For ovarian tissue from patients with hematologic malignancies, it is of paramount importance to identify minimal residual disease before ovarian tissue transplantation. Indeed, these pathologies, reviewed here in detail, are considered to be most at risk of ovarian metastasis

First transplantation of isolated murine follicles in alginate

AIM: Our aim is to develop an artificial ovary allowing survival and growth of isolated follicles and ovarian cells, to restore fertility in women diagnosed with pathologies at high risk of ovarian involvement. MATERIALS & METHODS: For this, alginate beads containing isolated preantral follicles and ovarian cells were autografted to immunocompetent mice. One week after grafting, the beads were invaded by proliferating murine cells (12.1%) and capillaries. RESULTS: The recovery rate of follicles per graft ranged from 0% to 35.5%. Of the analyzed follicles, 77% were Ki67-positive and 81%, TUNEL-negative. Three antral follicles were also identified, evidencing their ability to grow in the matrix. CONCLUSION: Our results suggest that an artificial ovary is now conceivable, opening new perspectives to restore fertility in women

A novel approach in the intraoperative management of ovotesticular DSD

Ovotesticular disorder of sex development (OTD) management remains challenging. In OTD, cautious gonadal evaluation and separation of ovarian and testicular components might be required to avoid virilization of a patient with female identity. Herein we report our minimal invasive approach in this very rare condition. The gonads are externalized under laparoscopic control through trocar openings. Intraoperative ovotesticular ultrasonography (US) is used for clear identification of ovarian and testicular tissue which can then be safely separated. We strongly promote the use of a minimal invasive approach in the management of these patients undergoing long term treatment and often multiple procedures.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Should we isolate human preantral follicles before or after cryopreservation of ovarian tissue?

To evaluate the survival and growth potential of human preantral follicles isolated before and after cryopreservation

First step in developing a 3D biodegradable fibrin scaffold for an artificial ovary

BACKGROUND: Although transplantation of cryopreserved ovarian tissue is a promising approach to restore fertility in cancer patients, it is not advisable for women at risk of ovarian involvement due to the threat of reintroducing malignant cells. The aim of this study was therefore to find an alternative for these patients by development of an artificial ovary. METHODS: For construction of the artificial ovary matrix, we used a central composite design to investigate nine combinations of fibrinogen (mg/ml) and thrombin (IU/mL) (F/T): F1/T4, F12.5/T1, F12.5/T20, F25/T0.1, F25/T4, F25/T500, F50/T1, F50/T20 and F100/T4. From the first qualitative analyses (handling and matrix size), five combinations (F12.5/T1, F25/T4, F50/T20, F50/T1 and F100/T4) yielded positive results. They were further evaluated in order to assess fibrin matrix degradation and homogeneous cell encapsulation (density), survival and proliferation (Ki67), and atresia (TUNEL) before and after 7 days of in vitro culture. To determine the best compromise between maximizing the dynamic density (Y1) and minimizing the apoptosis rate (Y2), we used the desirability function approach. RESULTS: Two combinations (F12.5/T1 and F25/T4) showed greater distribution of cells before in vitro culture, reproducible degradation of the fibrin network and adequate support for isolated human ovarian stromal cells, with a high proportion of Ki67-positive cells. SEM analysis revealed a network of fibers with regular pores and healthy stromal cells after in vitro culture with both F/T combinations. CONCLUSION: This study reports two optimal F/T combinations that allow survival and proliferation of isolated human ovarian cells. Further studies are required to determine if such a scaffold will also be a suitable environment for isolated ovarian follicles

Symptom fluctuations and daily physical activity in patients with chronic fatigue syndrome: a case-control study

Objectives: To compare the activity pattern of patients with chronic fatigue syndrome (CFS) with healthy sedentary subjects and examine the relationship between the different parameters of performed activity (registered by an accelerometer device) and symptom severity and fluctuation (registered by questionnaires) in patients with CFS. Design: Case-control study. Participants were asked to wear an accelerometer device on the nondominant hand for 6 consecutive days. Every morning, afternoon, and evening patients scored the intensity of their pain, fatigue, and concentration difficulties on a visual analog scale. Setting: Patients were recruited from a specialized chronic fatigue clinic in the university hospital, where all subjects were invited for 2 appointments (for questionnaire and accelerometer adjustments). In between, activity data were collected in the subject's normal home environment. Participants: Female patients (n=67) with CFS and female age-matched healthy sedentary controls. Interventions: Not applicable. Main Outcome Measures: Accelerometry (average activity counts, peak activity counts, ratio peak/average, minutes spent per activity category) and symptom severity (intensity of pain, fatigue, and concentration difficulties). Results: Patients with CFS were less active, spent more time sedentary, and less time lightly active (P.05), peak activity, and the staggering of activities (ratio peak/average) on 1 day were not different between groups (P>.05). Negative correlations (-.242 varying to -.307) were observed for sedentary activity and the ratio with symptom severity and variation on the same and the next day. Light, moderate, and vigorous, as well as the average activity and the peak activity, were positively correlated (.242 varying to .421) with symptom severity and variation. Conclusions: The more patients with CFS are sedentary and the better activity is dispersed, the fewer symptoms and variations they experience on the same and next day. Inversely, more symptoms and variability is experienced when patients were more active that day or the previous day. The direction of these relations cannot be determined in a cross-sectional study and requires further study

A new step toward the artificial ovary: survival and proliferation of isolated murine follicles after autologous transplantation in a fibrin scaffold.

Objective: To create an artificial ovary to provide an alternative way of restoring fertility in patients who cannot benefit from transplantation of cryopreserved ovarian tissue due to the threat of reintroducing malignant cells