RESUMO
STUDY QUESTION: Are in vitro maturation (IVM) rates of cumulus-oocyte complexes (COCs), retrieved from breast cancer patients seeking urgent fertility preservation (FP) before neoadjuvant chemotherapy, different between those recovered in the follicular or in the luteal phase of the cycle? SUMMARY ANSWER: The present investigation reveals no major difference in the number of COCs recovered or their IVM rates whatever the phase of the cycle at which egg retrieval is performed, suggesting that IVM is a promising tool for breast cancer patients seeking urgent oocyte cryopreservation. WHAT IS KNOWN ALREADY: FP now represents a standard of care for young cancer patients having to undergo gonadotoxic treatment. Mature oocyte cryopreservation after IVM of COCs has been proposed for urgent FP, especially in women, who have no time to undergo ovarian stimulation, or when it is contraindicated. STUDY DESIGN, SIZE, DURATION: From January 2011 to December 2014, we prospectively studied 248 breast cancer patients awaiting neoadjuvant chemotherapy, aged 18-40 years, candidates for oocyte vitrification following IVM, either at the follicular or the luteal phase of the cycle. PARTICIPANTS/MATERIALS, SETTING, METHODS: Serum anti-Müllerian hormone and progesterone levels and antral follicle count (AFC) were measured prior to oocyte retrieval. Patients were sorted into two groups according to the phase of the cycle during which eggs were harvested (Follicular phase group, n = 127 and Luteal phase group, n = 121). Number of COCs recovered, maturation rates after 48 h of culture and total number of oocytes cryopreserved were assessed. Moreover, the oocyte retrieval rate (ORR) was calculated by the number of COCs recovered ×100/AFC. MAIN RESULTS AND THE ROLE OF CHANCE: In the Follicular and the Luteal phase groups, women were comparable in terms of age, BMI and markers of follicular ovarian status. There was no significant difference in the number of COCs recovered (mean ± SEM), 9.3 ± 0.7 versus 11.1 ± 0.8, and ORR (median (range)) 43.1 (1-100) versus 47.8 (7.7-100)%. Moreover, maturation rates after 48 h of culture (median (range)) were comparable in the follicular and luteal phase groups, 66.7 (20-100) versus 64.5 (0-100)%. Finally, the total number of oocytes cryopreserved (mean ± SEM) was similar in both groups (6.2 ± 0.4 versus 6.8 ± 0.5). LIMITATIONS, REASONS FOR CAUTION: Despite the intact meiotic competence of immature oocytes recovered during the follicular or the luteal phase, there is a dramatic lack of data regarding the outcome of IVM oocytes cryopreserved in cancer patients. WIDER IMPLICATIONS OF THE FINDINGS: IVM of oocytes may be an interesting method of FP in urgent situations. Improving the culture conditions will be needed to increase the maturation rates and the overall potential of in vitro matured oocytes. STUDY FUNDING/COMPETING INTERESTS: None. TRIAL REGISTRATION NUMBER: N/A.
Assuntos
Neoplasias da Mama/complicações , Preservação da Fertilidade/métodos , Fase Folicular , Técnicas de Maturação in Vitro de Oócitos , Fase Luteal , Adolescente , Adulto , Hormônio Antimülleriano/sangue , Criopreservação , Feminino , Humanos , Recuperação de Oócitos , Progesterona/sangue , Fatores de TempoAssuntos
Hormônio Antimülleriano/sangue , Síndrome do Ovário Policístico/diagnóstico , Adolescente , Adulto , Biomarcadores/sangue , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/diagnóstico por imagem , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , UltrassonografiaAssuntos
Fosfatase Alcalina/análise , Doenças Ósseas Metabólicas/enzimologia , Osso e Ossos/enzimologia , Adolescente , Fatores Etários , Densidade Óssea , Osso e Ossos/metabolismo , Criança , Pré-Escolar , Feminino , Humanos , Técnicas Imunoenzimáticas , Lactente , Recém-Nascido , Masculino , Valores de Referência , Fatores SexuaisAssuntos
Asma/sangue , Mediadores da Inflamação/sangue , Leptina/sangue , Leucócitos/enzimologia , Obesidade/sangue , Peroxidase/sangue , Adolescente , Asma/epidemiologia , Biomarcadores/sangue , Criança , Comorbidade , Feminino , Humanos , Masculino , Obesidade/epidemiologia , Prognóstico , Estudos RetrospectivosAssuntos
Síndrome de Down , Complicações na Gravidez/tratamento farmacológico , Trissomia , Gêmeos , Adolescente , Adulto , Biomarcadores , Gonadotropina Coriônica Humana Subunidade beta/sangue , Síndrome de Down/sangue , Síndrome de Down/diagnóstico , Síndrome de Down/imunologia , Feminino , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Programas de Rastreamento/métodos , GravidezRESUMO
AIM: The tissue-Trans-Glutaminase (t-TG) has been reported to be the target for endomysial antibodies in coeliac disease. Coeliac disease if untreated, although clinically silent, predispose for other autoimmune disease, large scale screening methods are needed for an early diagnosis. The recently introduced ELISA methods to detect tTG antibodies, that used as antigen Guinea Pig tissue transglutaminase provide an efficient alternative to the anti-endomysial (EMA) immunofluorescent method and are suitable for screening. Our aim was to compare the commercial kit utilizing tTG from guinea pig (GP-tTG) to the standard method that we developed in our laboratory and with the new method that employed human recombinant tTG (hr-tTG). METHODS: We tested serum samples from 16 untreated celiac patients, 10 coeliac patients in gluten free diet, 22 subjects with other disease and 32 healthy controls, for a total number of 80 sera, with 3 commercial kit which employed GP-tTG and 1 that employed hr-tTG, as reference method we used an ELISA method developed in our laboratory and the immunofluorescence method to detect EMA. RESULTS: Results show that methods employing human tTG had a sensibility of 100% with a specificity of 98% and a predictive value of 94%, instead methods employing GP-tTG show inferior results. CONCLUSION. We conclude that is better using hr-tTG as antigen in screening methods for coeliac disease.
Assuntos
Autoanticorpos/sangue , Doença Celíaca/sangue , Doença Celíaca/diagnóstico , Kit de Reagentes para Diagnóstico , Proteínas Recombinantes/imunologia , Transglutaminases/imunologia , Adolescente , Adulto , Animais , Criança , Pré-Escolar , Cobaias , Humanos , Lactente , Sensibilidade e EspecificidadeRESUMO
BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the tolerability and effectiveness of a non-myeloablative conditioning regimen followed by autologous hematopoietic stem cell infusion for the treatment of severe autoimmune diseases. DESIGN AND METHODS: From 1996 patients with severe autoimmune disease not responsive to conventional immunosuppressive treatment were selected. The patients' blood or marrow cells were harvested after incubation with vincristine and methylprednisolone. Two different immunoablative conditioning regimens were employed. The first used cyclophosphamide (2500 mg/m2 in one day) and antilymphocyte globulin (ALG) (15 vials/m2 in three days) and the second used fludarabine (300 mg/m2 in two courses of 5 days) plus ALG (25 vials/m2 in 5 days). RESULTS: Nineteen patients (14 female, 5 male) with severe autoimmune diseases were treated. Nine had a rheumatologic disorder (5 juvenile chronic arthritis, 1 rheumatoid arthritis, 1 systemic vasculitis, 1 Sjögren's syndrome, 1 Behçt's disease), 4 a neurologic disorder (3 multiple sclerosis, 1 myasthenia), 3 a haematologic disease (2 pure red cell aplasia, 1 autoimmune thrombocytopenia), 2 had a gastrointestinal disease (1 Crohn's disease, 1 autoimmune enteropathy) and 1 had a multiple autoimmune disorder. There was no regimen-related toxicity and no opportunistic infections occurred. Ninety percent of the patients improved and/or had a complete remission after the procedure. Fifty percent of the subjects went into complete or partial remission after a median follow-up of 15 months (range 3-25) while 50% relapsed after a median follow-up of 11 months, (range 6-16). The incidence of relapse in the group treated with fludarabine was lower (30%). INTERPRETATION AND CONCLUSIONS: A non-myeloablative conditioning regimen was able to induce persistent remission in some patients with severe autoimmune diseases. There was no mortality or morbidity related to the procedure. The extent of remission does, however, remain to be established.
Assuntos
Doenças Autoimunes/terapia , Transplante de Células-Tronco Hematopoéticas , Imunossupressores/administração & dosagem , Vidarabina/análogos & derivados , Adolescente , Adulto , Soro Antilinfocitário/administração & dosagem , Doenças Autoimunes/imunologia , Criança , Ciclofosfamida/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante Autólogo , Resultado do Tratamento , Vidarabina/administração & dosagemAssuntos
Doadores de Sangue , Granulócitos/transplante , Leucaférese , Leucopenia/terapia , Adolescente , Anticoagulantes/farmacologia , Sedimentação Sanguínea/efeitos dos fármacos , Contagem de Células , Criança , Pré-Escolar , Heparina/farmacologia , Humanos , Lactente , Substitutos do Plasma/farmacologia , Poligelina/farmacologiaRESUMO
The same ex vivo marrow's treatment that we used in mismatched BMT (incubation with vincristine and methylprednisolone) was used in two patients with chronic GVHD and in one patient with PRCA. The conditioning regimen with cyclophosphamide and ALG was aimed to kill only the patient's lymphocytes, and did not cause a deep myeloid aplasia. The patients achieved a clear improvement of their symptoms.
Assuntos
Doenças Autoimunes/terapia , Purging da Medula Óssea , Transplante de Medula Óssea/efeitos adversos , Doença Enxerto-Hospedeiro/terapia , Metilprednisolona , Vincristina , Feminino , Doença Enxerto-Hospedeiro/etiologia , Teste de Histocompatibilidade , Humanos , Masculino , Pessoa de Meia-Idade , Transplante Autólogo , Transplante HomólogoRESUMO
Experience with the collection of autologous blood during the last part of pregnancy in 57 women is reported. The authors confirm the safety of the autologous transfusion program but come to the conclusion that, with current entrance criteria, the cost-benefit ratio seems unfavourable. Therefore they suggest: a) the sole involvement of women with real potential hemorrhagic complications (placenta previa, multiple pregnancy); b) the collection, when possible, of at least 2 units of autologous blood.
Assuntos
Doadores de Sangue , Transfusão de Sangue Autóloga/efeitos adversos , Gravidez/sangue , Adulto , Doadores de Sangue/estatística & dados numéricos , Preservação de Sangue , Transfusão de Sangue Autóloga/economia , Transfusão de Sangue Autóloga/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Humanos , Itália , Gravidez/estatística & dados numéricos , Terceiro Trimestre da Gravidez , SegurançaAssuntos
Volume Sanguíneo , Contagem de Plaquetas , Transfusão de Plaquetas , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
The computer's use permits an easy evaluation and a fast revision for urinalysis too. In the present experience, we report a study about the comparison among computerized data, the clinical requirement and the quality of urinalysis, sent to the laboratory of the Children's Hospital "Burlo Garofolo" of Trieste (Italy).
Assuntos
Diagnóstico por Computador , Urina/análise , Bilirrubina/urina , Estudos de Avaliação como Assunto , Glicosúria/diagnóstico , Hematúria/diagnóstico , Humanos , Concentração de Íons de Hidrogênio , Corpos Cetônicos/urina , Proteinúria/diagnóstico , Urobilinogênio/urinaRESUMO
The increments in serum concentrations of unconjugated bilirubin and free fatty acids (FFA) were measured 24 and 48 h after reduction of the caloric intake (400 cal/day) in 17 patients with Gilbert's syndrome (GS) and in 12 healthy control subjects. In males, both normal and with GS, the rise in serum bilirubin was statistically higher (p less than 0.01) as compared to females. On the contrary, no sex difference was found in FFA concentrations. A linear correlation (p less than 0.01) between bilirubin and FFA serum levels was present in normal males and in patients with Gilbert's syndrome of both sexes. Because bilirubin and FFA partly share a common, bilitranslocase-mediated, hepatic uptake mechanism, data reported support the hypothesis that a bilitranslocase function may be one of the metabolic defects in Gilbert's syndrome.
Assuntos
Bilirrubina/sangue , Ácidos Graxos não Esterificados/sangue , Doença de Gilbert/sangue , Hiperbilirrubinemia Hereditária/sangue , Adulto , Jejum , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores SexuaisRESUMO
The authors describe the application of a technique called Patient Flow Analysis aimed at the improvement of Clinic Personnel efficiency and reduction of patient waiting time. Results were satisfactory and encourage further experiences.