Pregnancy after kidney transplantation: a single-center experience and review of the literature.

After kidney transplantation (KT), pregnancy is possible, although the risk of maternal and fetal complications is much higher than in the general population. Outcome of 22 pregnancies in 17 patients transplanted in the Gdansk center in the period 1980-2012 was studied. Mean maternal age at pregnancy was 30 ± 5 (range, 23-39) years, interval between transplantation and conception 3.4 ± 2.5 (range, 0.6-11) years. Mean creatinine concentration before conception was 1.29 ± 0.36 (range, 0.8-2.45) mg/dL and was stable during 1 year preceding pregnancy (mean increase, 0.01 mg/dL). Nine of the 17 patients received 1 and 4 received ≥2 antihypertensive drugs, and 1 had proteinuria. Twelve of the 17 patients were primagravidas, 1 was pregnant 3 times, and 14 times. At the time of conception, 20 patients received CNI (14 cyclosporine, 6 tacrolimus), 15 antimetabolites (3 mycophenolate mofetil [MMF], 12 azathioprine), 1 mammalian target of rapamycin inhibitor (mTORi; sirolimus), and all prednisone. MMF and mTORi were discontinued before or during the 1st weeks of pregnancy. Maternal outcome: all survived the pregnancy. None experienced rejection or graft loss as a direct result of pregnancy. Maternal complications included edema (5/17), worsening of blood pressure control (5/17), and worsening (1/17) or new onset of proteinuria (2/17). Mean creatinine decrease during pregnancy was 0.06 mg/dL. Mean creatinine 1 year after pregnancy was 1.49 ± 0.53 mg/dL. There were 12 cesarean sections. Fetal outcomes: 17 live births (2 with serious congenital defects), 2 spontaneous and 1 induced abortion, 2 stillbirths. Mean pregnancy age and neonate birth weights were 35 ± 4 (range, 23-39) weeks and 2,552 ± 629 (range, 1,480-3,420) g, respectively. During mean 8.5 (range, 1-25) years of follow-up after pregnancy, 4/17 patients lost grafts. Grafts were lost in the 3rd to 7th years after pregnancy. We conclude that pregnancy does not exert a direct negative influence on patient and graft survivals; 68% of all pregnancies resulted in delivering healthy neonates.

Effect of nitrosative stress on extracellular nucleotide metabolism in endothelial cells.

Mechanisms of free radical injury involve chemical modification of proteins, lipid derivatives and nucleic acids and consequent loss of its function. However, specific targets and exact sequence of events has not been fully clarified. We determined whether extracellular enzymes that are involved in adenosine formation such as ecto-5'nucleotidase (e5N) and removal such as extracellular form of adenosine deaminase (eADA) could be affected by peroxynitrite. We used intact cell assay system that involves exposure of cultured HMEC-1 cells to substrates followed by HPLC analysis of conversion of substrates into products. We found that e5N and ADA activities decreased by 20-40% after incubation for 20 or 60 minutes with 30 µM peroxynitrite. Decrease of cellular ATP and NAD was also observed. We conclude that besides other cytotoxic effects modification of extracellular enzymes of nucleotide metabolism could be important target for free radical injury.

The presence of a supporting person during delivery affects cord blood haematopoietic stem cells.

Several randomised trials have shown that support during labour improves the outcomes of both mother and the newborn. There is a lack of information concerning the influence of the supporting person on cord blood haematopoietic stem cells (CB HSCs), thus, these cells have been determined to be a suitable graft source for haematopoietic transplantations. This study was aimed to examine the relation between the presence of the accompanying person during labour and some features of CB HSCs. Interestingly, we found that supported deliveries were characterised by lower CB volume and lower counts of HSCs and mononuclear cells in CB. We concluded that the presence of a supporting person during labour seems to affect the yield of HSCs.

Nanoscale surface analysis on second generation advanced high strength steel after hot dip galvanizing.

Second generation advanced high strength steel is one promising material of choice for modern automotive structural parts because of its outstanding maximal elongation and tensile strength. Nonetheless there is still a lack of corrosion protection for this material due to the fact that cost efficient hot dip galvanizing cannot be applied. The reason for the insufficient coatability with zinc is found in the segregation of manganese to the surface during annealing and the formation of manganese oxides prior coating. This work analyses the structure and chemical composition of the surface oxides on so called nano-TWIP (twinning induced plasticity) steel on the nanoscopic scale after hot dip galvanizing in a simulator with employed analytical methods comprising scanning Auger electron spectroscopy (SAES), energy dispersive X-ray spectroscopy (EDX), and focused ion beam (FIB) for cross section preparation. By the combination of these methods, it was possible to obtain detailed chemical images serving a better understanding which processes exactly occur on the surface of this novel kind of steel and how to promote in the future for this material system galvanic protection.

X-ray photoelectron and scanning Auger electron spectroscopy study of electrodeposited ZnCr coatings on steel.

Zn-Cr alloyed coatings electrochemically deposited are of high interest for leading steel manufacturing companies because of their novel properties and high corrosion resistance compared with conventional Zn coatings on steel. For tuning and optimizing the properties of the electrodeposited Zn-Cr coatings, a broad range of the deposition conditions must be studied. For this reason, two different types of material were investigated in this study, one with a low electrolyte temperature and one with an elevated electrolyte pH, compared with the standard values. Because different corrosion performance and delamination behaviour of the layers were observed for the two types, advanced surface analysis was conducted to understand the origin of this behaviour and to discover differences in the formation of the coatings. The topmost surface, the shallow subsurface region, and the whole bulk down to the coating-steel interface surface were analysed in detail by X-ray photoelectron spectroscopy (XPS) and high-resolution scanning Auger electron spectroscopy to determine the elemental and the chemical composition. For better understanding of the resulting layer structure, multiple reference samples and materials were measured and their Auger and XPS spectra were fitted to the experimental data. The results showed that one coating type is composed of metallic Zn and Cr, with oxide residing only on the surface and interface, whereas the other type contains significant amounts of Zn and Cr oxides throughout the whole coating thickness.

Nanoscale analysis of surface oxides on ZnMgAl hot-dip-coated steel sheets.

In this work, the first few nanometres of the surface of ZnMgAl hot-dip-galvanised steel sheets were analysed by scanning Auger electron spectroscopy, angle-resolved X-ray photoelectron spectroscopy and atomic force microscopy. Although the ZnMgAl coating itself is exhibiting a complex micro-structure composed of several different phases, it is shown that the topmost surface is covered by a smooth, homogeneous oxide layer consisting of a mixture of magnesium oxide and aluminium oxide, exhibiting a higher amount of magnesium than aluminium and a total film thickness of 4.5 to 5 nm. Especially by the combined analytical approach of surface-sensitive methods, it is directly demonstrated for the first time that within surface imprints--created by industrial skin rolling of the steel sheet which ensures a smooth surface appearance as well as reduced yield-point phenomenon--the original, smooth oxide layer is partly removed and that a layer of native oxides, exactly corresponding to the chemical structure of the underlying metal phases, is formed.

Elastography of the uterine cervix: implications for success of induction of labor.

OBJECTIVES: To perform a preliminary investigation into the use of elastography for cervical assessment, in order to determine the effectiveness of this method for the evaluation of cervical consistency. METHODS: Elastography of the uterine cervix was performed in 29 patients before induction of labor, with tissue surrounding the internal os described using a numeric scale called the elastography index (EI). A color map from purple to red was produced with the hardest tissues displayed as purple and assigned a score of 0 points and progressively softer tissues displayed as blue (1 point), green (2 points), yellow (3 points) and red (4 points). The EI of tissue around the internal os, in the middle part of the cervical canal and around the external os were analyzed in relation to the success of induction of labor using the t-test. RESULTS: The mean EI of the internal os in the group of patients with successful induction of labor was 1.23, while in the group with failed induction of labor it was 0.39 (Student's t-test, P=0.024). No difference was found for the EI of the middle part of the cervical canal or for the EI of the external os in relation to the success of induction of labor (P>0.05). CONCLUSION: Elastography of the uterine cervix may be an objective method for assessment of softening of tissue in the region of the internal os before induction of labor. Standardization of the cervical properties observed on elastography during pregnancy may help to guide the use of prostaglandins or oxytocin for induction of labor.

Transcriptome analysis of in vivo and in vitro matured bovine MII oocytes.

In vitro maturation (IVM) of mammalian oocytes does not support the same rates of embryo development or pregnancy when compared to oocytes that have matured in vivo. Therefore, environment has a significant influence on the oocyte's ability to complete maturation and acquire the mRNA and proteins required for successful fertilization and normal embryonic development. The aim of this study was to analyze the MII oocyte transcriptome between in vivo and in vitro conditions. Total RNA was extracted, processed and hybridized to the Affymetrix GeneChip Bovine Genome Array. Following normalization of the microarray data, analysis revealed 10 differentially expressed genes after IVM compared to in vivo matured controls, including Aqp3, Sept7, Abhd4 and Siah2 (P<0.05). K-means cluster analysis coupled with associated gene ontology, identified several biological processes affected by IVM, including metabolism, energy pathways, cell organization and biogenesis, and cell growth and maintenance. Quantitative real-time PCR validated the microarray data and also revealed altered expression levels after IVM of specific putatively imprinted genes, Igf2r, Peg3 and Snrpn (P<0.05). Distinct IVM transcription patterns reflected the oocyte's response to its surrounding environment. Monitoring transcription levels of key oocyte maturation genes may subsequently assist in improving IVM success.

Successful pregnancy in a patient with medullary cystic disease and severe renal impairment.

We present a successful pregnancy in a 37-year-old women with severe renal impairment due to medullary cystic disease. She presented five years earlier with hypertension and chronic renal failure with creatinine was 2.1 mg/dl (Ccr 35 ml/min). She had had two successful pregnancies in the past, nine and seven years earlier. Diagnosis of medullary cystic disease (MCD) was made based on typical ultrasound appearance, sodium wasting and acidosis out of the proportion to the degree of renal failure. Over the next 5 years, a slow progression of chronic renal failure was observed with creatinine reaching 5.1 mg/dl (Ccr 15,4 ml/min), shortly before she became pregnant in December 2001. Her hypertension remained well-controlled and serum creatinine decreased at the beginning of the second trimester to 3.7 mg/dl with subsequent increase toward the end of the pregnancy. She required increasing doses of erythropoietin and intravenous iron supplementation to maintain hemoglobin levels. The polyhydramnios developed necessitating five procedures of amnio reduction. She was not treated by dialysis. A boy weighing 1,600 g was delivered by cesarean section in the 35th week of gestation. The mother's creatinine rose to 5.2 mg/dl (Ccr 15 ml/min) post partum and her renal function declined only slightly over the next 20 months. Our report illustrates that successful fetal and maternal outcome can be achieved even in cases of advanced renal failure preceding gestation. It appears that the type of renal disease influences the pregnancy course and outcome and thus should be considered in patient counseling and therapeutic decisions.

In vitro maturation and transfer of equine oocytes after transport of ovaries at 12 or 22 degrees C.

Transportation of equine ovaries would allow shipment of oocytes for research purposes or transfer after the death of a valuable mare. The objective of this study was to compare two temperatures for maintaining ovaries during a transport interval of 18-24 h. The goal was to obtain pregnancies after transport of ovaries, maturation of oocytes in vitro, and transfer of oocytes. Each shipment was composed of ovaries four to seven mares collected from an abattoir. From each mare, one ovary was packaged at approximately 12 degrees C, and the other was packaged at approximately 22 degrees C. Upon arrival at our laboratory, oocytes were collected and cultured for 24 h. For each transfer, between 9 and 15 oocytes from each group were placed into the oviducts of estrous mares through standing flank laparotomies. Recipients received human chorionic gonadotropin (hCG; 2000 IU, i.v.) 30-36 h before transfer (to synchronize ovulation). Recipients were inseminated 18-20 h before transfers with 2 x 10(9) progressively motile sperm. Uteri of recipients were examined with ultrasound to determine the number of developing embryos. On Day 16 ( ovulation = day 0), developing embryos were recovered by uterine lavage. Parentage verification was performed on recovered vesicles. Pregnancy rates were analyzed by Chi-square. The percentage of oocytes that developed into embryonic vesicles on Day 16 was not different between transport temperatures (22 degrees C, 13/73, 18% versus 12 degrees C, 11/73, 15%). In conclusion, pregnancies were obtained from in vitro matured oocytes that were recovered from ovaries transported for 18-24h at 12 or 22 degrees C.

Oocyte transfer in mares with intrauterine or intraoviductal insemination using fresh, cooled, and frozen stallion semen.

The objectives were to compare embryo development rates after oocyte transfer with: (1) intrauterine or intraoviductal inseminations of fresh semen versus intraoviductal insemination of frozen semen; (2) intraoviductal versus intrauterine inseminations of cooled semen. In Experiment I, oocytes were transferred into the oviduct, and recipients were inseminated into the uterus with 1 x 10(9) fresh spermatozoa, or into the oviduct with 2 x 10(5) fresh or frozen-thawed spermatozoa. In Experiment II, semen was cooled to 5 degrees C before intrauterine insemination with 2 x 10(9) spermatozoa or intraoviductal inseminations of 2 x 10(5) spermatozoa (deposited with the oocytes). In Experiment I, embryo development rates were similar (P>0.05) for intrauterine versus intraoviductal inseminations when fresh semen was used (8/14, 57% and 9/11, 82%, respectively). However, embryo development rates were lower (P<0.05) when frozen spermatozoa were placed within the oviduct (1/12, 8%). In Experiment II, embryo development rates were higher (P<0.05) when cooled semen was used for intrauterine (19/23, 83%) versus intraoviductal (4/16, 25%) inseminations. We concluded that intraoviductal insemination can be successfully performed using fresh spermatozoa. However, the use of cooled and frozen spermatozoa for intraoviductal inseminations was less successful, and needs further investigation.

[Application of pcr in paternity determination in pregnancy preceded by rape]. / Zastosowanie reakcji lancuchowej polimerazy (PCR) we wczesnej ciazy w badaniu spornego ojcostwa zwiazanego z gwaltem.

Authors present a case of PCR (Polymerase Chain Reaction) technique application for the paternity determination in pregnancy preceded by the rape. Diagnostic material was obtained in the 10th week of pregnancy by the use of transabdominal Chorionic Villous Sampling under the echo-guidance and its DNA feature was compared against the DNA material obtained from the vagina after the rape and the material from mother and her husband. The PCR technique revealed in chorionic villi the presence of allele that were present in material deriving from mother and her husband as well as no even single allele from the material of violator. Exclusion of violator as a father of the foetus effected in decision of continuing the pregnancy.

[Appendiceal mucinous carcinoma]. / Rak sluzowy wyrostka robaczkowego.

Appendiceal carcinoma is very rare. Preoperative diagnosis of this kind of neoplasm is difficult. Even at operation in under half of cases this diagnosis is considered. We present a case of a woman admitted to the hospital with diagnosis of adnexal tumor of the right ovary. The diagnosis of adnexal mass was confirmed by ultrasound examination. Laparotomy was performed and tumor of appendix was found. There was also a small tumor (2 cm) in small bowel and some increased lymphatic nodules. Uterus with adnexis, tumor of appendix, part of small bowel and colon were resected. Because of infiltration of the neoplasm a part of the bladder was resected as well. There were no complications after operation. She received chemotherapy with 5-FU. After 9 months computed tomography revealed no changes in abdomen. Diagnosis of pelvic masses when they do not origin of adnexis is usually very difficult. In many cases proper diagnosis is made only during laparotomy.

[A case of cystic adenomatoid lung malformation treated by thoracocentesis]. / Przypadek wrodzonego torbielowatego gruczolakowatego zwyrodnienia pluc u plodu leczony drenazem plodowo-owodniowym.

A case of Cystic Adenomatoid Lung Malformation (CALM) treated by serial thoracocenteses followed by implantation of the feto-amniotic shunt is presented. The idea was to prevent prolonged lung compression leading to lung growth retardation and maturation restriction. Postnatally the baby presented good respiratory condition. She underwent lung lobectomy in the 2nd day of life. The histological assessment confirmed the ultrasound diagnosis of CALM. The postoperative period was not complicated. The method of feto-amniotic shunting is presented as promising in the treatment of CALM prenatally.

[Management of breech delivery and its influence on the newborn]. / Sposób postepowania a stan i losy noworodków z porodów w polozeniumiednicowym plodu.

Authors analyse the newborns general well-being after the breech delivery in the two-years periods in 1983-84 and 1993-94. During this period of time the routine delivery by the caesarean section in primiparas was introduced. The statistically significant improvement in the general state on newborns measured by the Apgar score was observed in primiparas. All other data were comparatively similar.

[Conjoined twins--diagnostic and therapeutic strategies]. / Bliznieta nierozdzielone--strategia diagnostyczno--terapeutyczna.

The authors have analysed three cases of twin pregnancies complicated by the conjoined of the fetuses. Based on own experience and informations from the literature the general diagnostic and therapeutic strategy of dealing with this condition has been purposed.

[Comparison of Doppler examination results for utero-placental blood flow and plate-villous index--morphologic determinant of placental barrier in pregnant patients with diabetes]. / Porównanie wyników badan Dopplerowskich przeplywu maciczno-lozyskowego i wskaznika plytkowo-kosmkowego--morfologicznego wykladnika bariery lozyskowej u pacjentek ciezarnych z cukrzyca.

The resistance index (RI) of the uteroplacental blood flow of both uterine arteries was evaluated in diabetic women in the perinatal period. Consecutively morphometric examination of placenta was proceeded after the delivery and the average number of epithelial plates in villi was calculated (so called "plate-villous index"). The correlation between the uterine arteries' blood flows and the plate-villous indices was calculated since the number of the epithelial plates determines the placenta barrier. There was poor correlation found between resistance indices and the average number of epithelial plates.