PLACENTATION IN OOCYTE DONATION PREGNANCIES: EVALUATION OF UTERINE ARTERIES DOPPLER AND PLACENTAL HORMONES

Introduction and objective: The aim of our study was to investigate the hypothesis that placentation in oocyte donation pregnancies (OD) presents differences compared to pregnancies conceived naturally or through in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) technique using autologous oocytes, as a result of alteration in normal placental and fetal-maternal interaction responsible of physiological placentation, due to genetic or hormonal factor and abnormal uterine and placental perfusion. Methods: To verify this issue we performed 2 study concurrently. We first performed a longitudinal study to measure uterine artery doppler pulsatility index (PI) at first (11-13+6 weeks), second (19-21 weeks) and third trimester (30-32 weeks) and maternal serum levels of and 17-\u3b2 estradiol at 11-13+6 weeks in 55 OD pregnancies, in 48 (IVF/ICSI) pregnancies with autologous oocytes and 122 spontaneous pregnancies. The second was a retrospective study performed in order to analyze free \u3b2-human chorionic gonadotropin (hCG), pregnancy-associated plasma protein-A (PAPP-A) and nuchal translucency in 13624 spontaneously conceived pregnancies (Controls), 171 oocyte donation pregnancies (OD IVF/ICSI) and 76 IVF pregnancies with autologous oocytes (Autologous IVF/ICSI). Results: Mean uterine artery PI was significantly lower in OD in all trimester of pregnancy. First trimester: Controls 1,679 (DS 0,456), Autologous IVF/ICSI 1,706 (DS 0,481) and OD IVF/ICSI - oocyte recipients 1,415 (DS 0,486), showing the latter a reduced value [IC95% - p 0.001 (OD vs. Spontaneous conceived pregnancies) and p 0.007 (OD vs. Autologous IVF/ICSI)]; II trimester: Controls 0,96 (0,294), Autologous IVF/ICSI 1,15 (0,407), OD IVF/ICSI - oocyte recipients 0,80 (0,292) (p < 0.05). III trimester, only the analysis between OD and spontaneous conceived pregnancies showed the same trend (p 0.018). Free \u3b2-hCG levels were significantly higher both in OD IVF/ICSI pregnancies (1.44 \ub1 1.06 MoM) and Autologous IVF/ICSI (1.48 \ub1 1.02 MoM) compared to Controls (1.15 \ub1 0.84 MoM; p<0.05) and Age-matched Controls (1.18 \ub1 0.98 MoM; p<0.05). PAPP-A levels did not significantly differ among the four groups. Significantly lower nuchal translucency was detected in Controls (1.41 \ub1 0.36 mm) compared to OD IVF/ICSI (1.46 \ub1 0.44 mm; p<0.05), in Autologous IVF/ICSI (1.51 \ub1 0.34 mm; p<0.05) and Age-matched Controls (1.44 \ub1 0.42 mm; p<0.05). Conclusion: Oocyte donation has a significant impact either on biophysical and biochemical markers

Comportamiento Biológico de Implantes Tendinosos Autógenos Intraarticulares. Interfase con los distintos medios receptores

En el presente trabajo se ha efectuado un estudio experimental de la respuesta biológica de implantes intraarticulares de tendones autógenos insertados en canales óseos. Se ha seguido, mediante microscopía óptica y electrónica, la revascularización de los implantes, los cambios tendinosos intrínsecos y, fundamentalmente, la interfase establecida entre la estructura tendinosa y los distintos medios del lecho receptor. En las zonas bañadas por líquido sinovial se produce "sinovialización", con presencia de sinoviocitos A (aspecto macrofágico) y B (aspecto fibroblástico). En las zonas que delimitan con cartílago aparece una hendidura, cuya superficie tendinosa es también sinovializada. En la interfase hueso-tendón se pueden diferenciar zonas de aposición lateral y termino-terminales. Las primeras muestran fenómenos de remodelación (presencia de abundantes osteoblastos y osteoclastos) y dispositivos arciformes de las fibras colágenas que "anclan" el tendón a trabéculas óseas. En las zonas término-terminales se establece continuidad entre la colágena del tendón y del hueso. En las regiones en que el tendón se relaciona con el tejido adiposo de la médula ósea, se produce también continuidad entre fibras colágenas pertenecientes a ambos componentes.The authors presented an experimental work in rabbits. They rewiewed the revascularization an morfology ("Sinovialization" and "Ligamentation") of tendon autograft used to replace the anterior cruciate ligament (18 rabbits studied) by histological techniques

Comportamiento Biológico de Aloinjertos Tendinosos Intraarticulares.

En el presente trabajo, los autores han efectuado un estudio experimental de la respuesta biológica de aloinjertos tendinosos, implantados en el interior de la articulación de la rodilla. Se ha seguido mediante microscopía óptica y micoscopía electrónica, la revascularización de los implantes y los cambios tendinosos intrínsecos, tanto en la serie de aloinjertos en "fresco", como de aloinjertos congelados. En los aloinjertos en fresco, predomina la intensa respuesta inflamatoria -inmunitaria, siendo la respuesta reparadora de escasos signos de orientación del tejido fibroso definitivo. En la serie de injertos congelados, los fenómenos inflamatorios son escasos, predominando la angiogénesis.In this paper, the authors have studied the biological respons e of tendinous allografts, implanted inside the kne e articulation, in a experimental study. The revascularization of the grafts, and the intrinsic tendinous change s in both series, frozen and no frozen allografts, is studied with optical and electron microscopy. In the no frozen allografts, is more important the intensive inflamatory inmunitary response, with few signs of orientation of the definitive fibrous tissue. In the serie of frozen allografts, the inflamatory response is limited with predominanc e of the angiogénesis process

VP36.15: Evaluation of uterine artery pulsatility index and 17β estradiol serum concentration in first trimester pregnancies with oocyte donation

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Uterine artery Doppler pulsatility index at 11-38 weeks in ICSI pregnancies with egg donation

BACKGROUND: Uterine artery Doppler pulsatility index (UtA-PI) may be different in pregnancies with egg donation (ICSI-ED) as compared to conceptions with autologous intra-cytoplasmatic sperm injection (autologous ICSI) and to spontaneous conceptions (SC). METHODS: One hundred and ninety-four pregnant women with different modes of conception (MC) were prospectively evaluated: 53 ICSI-ED, 36 autologous ICSI and 105 SC. To evaluate the effects of different MC on PI, multivariable linear regression (MLR) models predicting UtA-PI were fitted after adjustment for maternal age, body mass index, race, parity, smoking status and gestational age. RESULTS: In the first trimester, at MLR, autologous ICSI was not associated with a significantly different UtA-PI [estimate (EST) 0.01; 95% confidence interval (CI) -0.19, 0.2; P=0.9] when compared to SC. Conversely, MC by ICSI-ED was associated with lower first trimester UtA-PI (EST -0.32; CI -0.55, -0.08; P=0.01) when compared to SC. At MLR, MC by autologous ICSI and by ICSI-ED were not associated with significant differences in the second and third trimester UtA-PI when compared to SC. CONCLUSION: ICSI-ED conception presented lower UtA-PI when compared to SC at 11+0-13+6 weeks but not at later assessments. Correction of UtA-PI measurement specifying the origin of oocyte may be useful in first trimester screening

Ultrasound in Infertility Setting: Optimal Strategy to Evaluate the Assessment of Tubal Patency

Tubal patency is a key element in women who are undergoing assisted reproductive techniques (ART), in order to attempt or exclude intrauterine insemination (IUI) cycles. Amongst the different procedures that can be used, without resorting to laparoscopy that remains the gold standard, hystero-salpingo-contrast sonography (HyCoSy) is an acceptable, time-efficient, and well tolerated option; it can be performed with administration of saline and air simultaneously or alternately (air/saline-HyCoSy), or with some other contrast agents, like SonoVue (sulfur hexafluoride microbubbles). In this paper, we describe two different studies: In the first one, our aim is to compare the efficiency of air/saline-HyCoSy with HyCoSy performed with contrast media (SonoVue), considering hysterosalpingography (HSG) and laparoscopy (LPS) as reference tests; in the second one, we estimate the pregnancy rate of a cohort of infertile women selected to undergo IUI cycles after tubal bilateral patency demonstration with air/saline-HyCoSy, to understand if this technique can be used as an efficient screening procedure in a Reproductive Unit

Lactate detection in the brain of growth-restricted fetuses with magnetic resonance spectroscopy

OBJECTIVE: The objective of the study was to determine the feasibility of detecting fetal brain lactate, a marker of fetal metabolic acidemia, using a noninvasive technique, proton magnetic resonance spectroscopy (1H MRS), in intrauterine growth-restricted (IUGR) fetuses. STUDY DESIGN: In vivo human fetal brain lactate detection was determined by 1H MRS in 5 fetuses with IUGR. Oxygenation and acid-base balance data were obtained at birth. RESULTS: 1H MRS analysis showed the presence of a lactate peak in the brain of the most severely affected IUGR fetus, with abnormal umbilical artery Doppler and fetal heart rate tracing. This finding was consistent with the low oxygen content and high lactic acid concentration observed in umbilical blood obtained at delivery. CONCLUSION: 1H MRS allows the noninvasive detection of cerebral lactate in IUGR fetuses. Lactate detected by 1H MRS may represent a possible marker of in utero cerebral injury or underperfusion

Dietary responses to a multiple sclerosis diagnosis: a qualitative study

Background/objectives: Multiple sclerosis (MS) is an immune-mediated disease with no known cure and insufficient evidence to support a special therapeutic diet to alter symptom management or disease progression. Several studies have reported dietary changes made by people with MS, but there has been limited investigation into experiences surrounding diet in those recently diagnosed. This study explored responses to diet after a recent diagnosis of MS in people living in Western Australia. Subjects/methods: Eleven adults with MS (mean time since diagnosis 8 months) participated in semi-structured interviews focusing on responses to diet since MS diagnosis. Interviews were transcribed, coded and analysed using grounded theory principles. Results: Three theme responses emerged; (1) the perceived incompatibility of lack of/or generalised dietary advice with disease seriousness at the time of diagnosis; (2) extensive personal research and information seeking with difficulty judging credibility, and (3) self-experimentation with diet to either control MS symptoms or to cure MS. Conclusions: Given the seriousness of the disease, there is a perceived gap in dietary information provided at the time of diagnosis. Healthcare professionals should address concerns with alternative therapeutic diets advertised to treat or cure MS, and clearly convey the reasoning for the general healthy dietary recommendations. This would better align advice with the perceptions about the role of diet in MS, assist people with MS in need of information and minimise dietary self-experimentation. Future research should explore the importance of diet for those who have had MS for a longer period of time

High Resistance of Plasmodium falciparum to Sulphadoxine/Pyrimethamine in Northern Tanzania and the Emergence of dhps Resistance Mutation at Codon 581

BACKGROUND: Sulphadoxine-pyrimethamine (SP) a widely used treatment for uncomplicated malaria and recommended for intermittent preventive treatment of malaria in pregnancy, is being investigated for intermittent preventive treatment of malaria in infants (IPTi). High levels of drug resistance to SP have been reported from north-eastern Tanzania associated with mutations in parasite genes. This study compared the in vivo efficacy of SP in symptomatic 6-59 month children with uncomplicated malaria and in asymptomatic 2-10 month old infants. METHODOLOGY AND PRINCIPAL FINDINGS: An open label single arm (SP) standard 28 day in vivo WHO antimalarial efficacy protocol was used in 6 to 59 months old symptomatic children and a modified protocol used in 2 to 10 months old asymptomatic infants. Enrolment was stopped early (87 in the symptomatic and 25 in the asymptomatic studies) due to the high failure rate. Molecular markers were examined for recrudescence, re-infection and markers of drug resistance and a review of literature of studies looking for the 581G dhps mutation was carried out. In symptomatic children PCR-corrected early treatment failure was 38.8% (95% CI 26.8-50.8) and total failures by day 28 were 82.2% (95% CI 72.5-92.0). There was no significant difference in treatment failures between asymptomatic and symptomatic children. 96% of samples carried parasites with mutations at codons 51, 59 and 108 in the dhfr gene and 63% carried a double mutation at codons 437 and 540. 55% carried a third mutation with the addition of a mutation at codon 581 in the dhps gene. This triple: triple haplotype maybe associated with earlier treatment failure. CONCLUSION: In northern Tanzania SP is a failed drug for treatment and its utility for prophylaxis is doubtful. The study found a new combination of parasite mutations that maybe associated with increased and earlier failure. TRIAL REGISTRATION: ClinicalTrials.gov NCT00361114

Reproductive assistance in HIV serodiscordant couples

BACKGROUND Three quarters of individuals infected with human immunodeficiency virus (HIV) are in their reproductive years and may consider pregnancy planning. Techniques have been developed which can minimize the risk of HIV transmission in these couples, and the current literature on this topic is reviewed here. METHODS We reviewed the literature for the following topics: risk of HIV transmission, effects of HIV infection on fertility, reproductive assistance in industrialized and low-income countries, pre-exposure chemoprophylaxis (PrEP) and timed intercourse in HIV-discordant couples for both male and female positivity. Relevant publications were identified through searches of the EMBASE Medline and PubMed databases, the Google-indexed scientific literature and periodic specialized magazines from the on-line Library Service of the University of Milan, Italy. RESULTS In serodiscordant couples in which the man is positive, the primary method used to prevent HIV transmission is 'sperm washing', followed by IUI or IVF. Data show that sperm washing in HIV-positive men has not produced seroconversion in women or their offspring; however, the evidence is limited. Recently, increasing evidence describing PrEP for HIV prevention has been published and PrEP could be an alternative to ART for fertile couples. Usually HIV-infected women undergo self-insemination around the time of ovulation. Few studies have been published on IVF outcome in HIV-infected women. CONCLUSIONS Assisted reproduction programmes should be integrated into global public health services against HIV. For HIV serodiscordant couples with infected men, sperm washing should be the first choice. However, timed intercourse and PrEP for HIV prevention has been reported. Recent data highlight the possible impairment of fertility in HIV-infected women. Efforts to design a multicentric study should be strengthened