Application of Perinatal Derivatives in Ovarian Diseases

Reproductive diseases could lead to infertility and have implications for overall health, most importantly due to psychological, medical and socio-economic consequences for individuals and society. Furthermore, economical losses also occur in animal husbandry. In both human and veterinary medicine, hormonal and surgical treatments, as well as assisted reproductive technologies are used to cure reproductive disorders, however they do not improve fertility. With ovarian disorders being the main reproductive pathology in human and bovine, over the past 2 decades research has approached regenerative medicine in animal model to restore normal function. Ovarian pathologies are characterized by granulosa cell and oocyte apoptosis, follicular atresia, decrease in oocyte quality and embryonic development potential, oxidative stress and mitochondrial abnormalities, ultimately leading to a decrease in fertility. At current, application of mesenchymal stromal cells or derivatives thereof represents a valid strategy for regenerative purposes. Considering their paracrine/autocrine mode of actions that are able to regenerate injured tissues, trophic support, preventing apoptosis and fibrosis, promoting angiogenesis, stimulating the function and differentiation of endogenous stem cells and even reducing the immune response, are all important players in their future therapeutic success. Nevertheless, obtaining mesenchymal stromal cells (MSC) from adult tissues requires invasive procedures and implicates decreased cell proliferation and a reduced differentiation capacity with age. Alternatively, the use of embryonic stem cells as source of cellular therapeutic encountered several ethical concerns, as well as the risk of teratoma formation. Therefore, several studies have recently focussed on perinatal derivatives (PnD) that can be collected non-invasively and, most importantly, display similar characteristics in terms of regenerating-inducing properties, immune-modulating properties and hypo-immunogenicity. This review will provide an overview of the current knowledge and future perspectives of PnD application in the treatment of ovarian hypofunction.

P–738 Fertility Preservation: Comparative analysis about the knowledge of the topic between two female populations in Argentina and the United States

Study question

Is there any difference in the knowledge that women in Córdoba (Argentina) and South Carolina (United States) have about fertility preservation, according to their socioeconomic and educational level?

Summary answer

Scarce knowledge about fertility preservation in both populations was registered. Only sectors of higher socioeconomic and educational level responded correctly with values close to 60%.

What is known already

There are numerous factors that may motivate the need to preserve fertility in young individuals. These factors can be grouped into two causes: social (postponement of motherhood, gender change, etc.), or medical (oncological or surgical treatments). In these situations, it is important that society in general has access to information about fertility and the possibilities of preserving it, if necessary. On the other hand, in each country and region in particular the information on this topic is distributed in different ways, which could generate differences in the level of knowledge on these issues in different population groups.

Study design, size, duration

Descriptive quantitative study. A total of 3,041 answers were obtained, 88.8% from Argentina and 10.00% from the United States. An 83.72% (2,521) of the answers were made by women.

Participants/materials, setting, methods

A closed-ended questionnaire of 20 questions was designed (segmentation and aspects of knowledge about fertility and its preservation) and distributed to different sectors of society through social networks. The survey was answered by people from Córdoba (Argentina) and South Carolina (US), of both sexes and different age groups, educational levels (basic/higher) and socioeconomic levels (medium-low/high). All answers were collected through SurveyMonkey and were analyzed using calculation programs and statistical tools (Excel 2016, Statistica 8.0).

Main results and the role of chance

Data showed that the 47.98% of Argentine women and 42.68% of American women surveyed do not know the age at which fertility begins to decline. The group with the highest percentage of incorrect answers (61.11%) for this question was that of Argentine women who had no previous experience with assisted fertility and come from the lower-middle social class. When asked about the knowledge about the factors that affect fertility, only 55% of Argentine women answered correctly, compared to 64.85% of American women. For the Argentine group, the proportion of correct answers increased to 62.23% for higher education level and to 56.60% for higher socioeconomic level. Regarding whether they know what fertility preservation procedure consists of, only 47.98% of Argentine women and 42.68% of American women answered correctly. On the other hand, 69.37% of the former and 63.18% of the latter do not know which biological materials can be cryopreserved. Finally, only 25.68% of women in Argentina know about the extent of their medical coverage in terms of fertility preservation procedures, while this percentage is 7.95% for the US population.

Limitations, reasons for caution

The comparison between the two countries may be challenged by the inequality in the response rate to the survey. However, even the smaller number of responses obtained in the USA is sufficient to obtain valid conclusions.

Wider implications of the findings: The level of misinformation registered in this study could imply reduced chances of achieving pregnancy in the future, especially for older women, those who wish to postpone motherhood or those who must undergo cancer treatments. This work provides important information in the politics designing promoting information access on fertility preservation.

Trial registration number

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P–739 Fertility and its Preservation: Comparative Analysis about the Knowledge between Two Populations of Doctors and Health Professionals from Argentina and the United States

Study question

Is there any difference in the knowledge that doctors and health professionals from Córdoba (Argentina) and South Carolina (USA) have about fertility preservation or about when it should be applied?

Summary answer

Both populations have enough knowledge about some aspects of fertility preservation, but its training must be improved so they can give adequate counseling

What is known already

During the last decades, it has been observed that more young individuals need/decide to preserve fertility, whether for social or medical reasons. This presents a new challenge for the medical community, since, faced with this situation, it is important that society in general has access to information about fertility and the possibilities of preserving it, if necessary. To this end, it is essential that doctors and other health professionals have valid knowledge of the subject and are able to communicate it to their patients.

Study design, size, duration

Descriptive quantitative study. A total of 721 answers were obtained, 88.7% from Argentina and 11.3% from the United States. 28.43% (205) were doctors and 71.57% (516) were other health professionals.

Participants/materials, setting, methods

A closed-ended questionnaire of 20 questions was designed (segmentation and aspects about fertility preservation) and distributed to society through social networks. The survey was answered by people from Córdoba (Argentina) and South Carolina (US), of both sexes and different age, educational and socioeconomic levels. Only those with a medical degree or involved in some medical-related activity were selected. All answers were collected through SurveyMonkey and analyzed using calculation programs and statistical tools (Excel–2016, Statistica 8.0).

Main results and the role of chance

Data showed percentages of correct answers greater than 70% in all groups for the questions that analyze what factors can affect fertility, what situations can determine the need to preserve it, and what is the appropriate age for a woman to cryopreserve her eggs. On average, 82.4% of doctors and 72.87% of other health professionals know when it is the right time for patients diagnosed with cancer to receive information about the possibility of preserving their fertility. However, on average between both countries, only 34.63% of doctors has information about the legal medical coverage of their patients, while the 39.51% is completely unaware of their country’s laws. Finally, the percentages of professionals who do not know what material can be cryopreserved in girls who need to undergo oncological treatments reach 46.34 and 64.33% (doctors and other health professionals respectively).

Limitations, reasons for caution

The comparison between the two countries may be challenged by the inequality in the response rate to the survey. However, even the smaller number of responses obtained in the USA is sufficient to obtain valid conclusions.

Wider implications of the findings: Both populations have sufficient information about factors which affect fertility and its preservation, especially in cancer situations. Misinformation in health personnel about these aspects directly affects possibilities of achieving future pregnancies for patients. Continuous updating and guidance should be a priority, as well as information dissemination and adequate medical counseling.

Trial registration number

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Clinical anatomy of the meniscus in animal models: pros and cons

Nowadays, despite the possibility to use in vitro or computer models in research, animal models are still essential. Different animal models are available for meniscal repair investigation. Although a unique perfect model for the structure of the human's knee does not exist, the choice of the proper animal model is crucial for a correct research. The principal animal models in the meniscal repair are sheep, goats, pigs and dogs. Each of these has pros and cons for their utilization. Analysing each pro and con is essential for optimizing the choice of the animal model, which depends on the experimental question, avoiding unnecessary waste of resources and minimizing the animal suffering, according to the Russell and Burch's three "Rs" principles (Reduce, Refine and Recycle). In this concise review, we resume the meniscus anatomical features of the main large animals, to help choose the most suitable animal model for subsequent studies on meniscal repair.

Floods, Hurricanes, and Other Catastrophes: A Challenge for the Immune System of Livestock and Other Animals

Climate change involves different dramatic phenomena including desertification and wildfires, severe storms such as hurricanes and blizzards, increased sea levels resulting in flooding coastal cities and rise of atmospheric CO₂ concentration. The alteration of the climate in a specific region affects the life of indigenous animals and humans. The climate changes influence living beings both directly and indirectly. The immune system of animals dramatically suffers the climate instability, making animals more susceptible to infectious and not infectious diseases. Different species of livestock animals respond with similar mechanisms to global warming, but some of them are more susceptible depending on their age, metabolism, and genetic conditions. The selection and study of autochthonous species and breeds, more easily adapted to specific environmental conditions could be an interesting strategy to face livestock rearing in the future.

Staphylococcus aureus intra-mammary infection affects the expression pattern of IL-R8 in goat

IL-1R8 is a member of Interleukin-1 receptor family acting as a negative regulator of inflammation reliant on ILRs and TLRs activation. IL-1R8 role has never been evaluated in acute bacterial mastitis. We first investigated IL-1R8 sequence conservation among different species and its pattern of expression in a wide panel of organs from healthy goats. Then, modulation of IL-1R8 during natural and experimental mammary infection was evaluated and compared in blood, milk and mammary tissues from healthy and Staphylococcus aureus infected goats. IL-1R8 has a highly conserved sequence among vertebrates. Goat IL-1R8 was ubiquitously expressed in epithelial and lymphoid tissues with highest levels in pancreas. IL-1R8 was down-regulated in epithelial mammary cells following S. aureus infection. Interestingly it was up-regulated in leukocytes infiltrating the infected mammary tissues suggesting that it could represent a target of S. aureus immune evasion.

Reduced FOXM1 Expression Limits Trophoblast Migration and Angiogenesis and Is Associated With Preeclampsia

Trophoblast cells are often compared to highly invasive carcinoma cells due to their capacity to proliferate in hypoxic conditions and to exhibit analogous vascular, proliferative, migratory, and invasive capacities. Thus, genes that are important for tumorigenesis, such as forkhead box M1 ( FOXM1) may also be involved in processes of trophoblast invasion. Indeed, we found Foxm1 protein and messenger RNA (mRNA) levels decreased as gestational age increased in rat's placentae. Accordingly, when mimicking early placental events in vitro, protein and mRNA expression of FOXM1 increased from 21% to 8% O₂, reaching its highest expression at 3% oxygen tension, which reflects early implantation environment, and dropping to very low levels at 1% O₂. Remarkably, FOXM1 silencing in JEG-3 cells was able to significantly decrease migration by 27.9%, in comparison with those cells transfected with control siRNA. Moreover, angiogenesis was compromised when conditioned media (CM) from FOXM1-siRNA -JEG-3 (3% O₂) was added to human umbilical vein endothelial cells (HUVEC) cells; however, when CM of JEG-3 cells overexpressing FOXM1 at 1% O₂ was added, the ability of HUVEC to form tubule networks was restored. Additionally, quantitative real-time polymerase chain reaction (PCR) assays of FOXM1 knockdown and overexpression experiments in JEG-3 cells revealed that the depletion of FOXM1 at 3% O₂ and overexpression of FOXM1 at 1% O₂ led to downregulation and upregulation of vascular endothelial growth factor transcriptional (VEGF) levels, respectively. Conversely, we also observed deregulation of FOXM1 in placentae derived from pregnancies complicated by preeclampsia (PE). Therefore, we demonstrate that FOXM1 may be a new regulatory protein of early placentation processes and that under chronic hypoxic conditions (1% O₂) and in patients with severe PE, its levels decrease.

Assessment of treatment patterns associated with injectable disease-modifying therapy among relapsing-remitting multiple sclerosis patients

Background

Availability of oral disease-modifying therapy (DMT) for relapsing–remitting multiple sclerosis (RRMS) may affect injectable DMT (iDMT) treatment patterns.

Objective

The objective of this paper is to evaluate iDMT persistency, reasons for persistency lapses, and outcomes among newly diagnosed RRMS patients.

Methods

Medical records of 300 RRMS patients initiated on iDMT between 2008 and 2013 were abstracted from 18 US-based neurology clinics. Eligible patients had ≥3 visits: pre-iDMT initiation, iDMT initiation (index), and ≥1 visit within 24 months post-index. MS-related symptoms, relapses, iDMT treatment patterns (i.e. persistency, discontinuation, switching, and restart), and reasons for non-persistency were tracked for 24 months.

Results

At 24 months, iDMT persistency was 61.0%; 28.0% of patients switched to another DMT, 8.0% discontinued, and 3.0% stopped and restarted the same iDMT. The most commonly identified reasons for non-persistency were perceived lack of efficacy (22.2%), adverse events (18.8%), and fear of needles/self-injecting (9.4%). At 24 months, 38.0% of patients had experienced a relapse and 11.0% had changes in MRI lesion counts. Patients without MS-related symptoms at index reported increases in the incidence of these symptoms at 24 months.

Conclusions

Non-persistency with iDMT remains an issue in the oral DMT age. Many patients still experienced relapses and disease progression, and should consider switching to more effective therapies.

Providing patients with pharmacogenetic test results affects adherence to statin therapy: results of the Additional KIF6 Risk Offers Better Adherence to Statins (AKROBATS) trial

Despite the clinical benefit of statin therapy and the numerous strategies used to improve adherence, no strategy has used direct communication of genetic test results to the patient as an adherence and persistence motivator. We investigated in a real-world setting the effect of a process of providing KIF6 test results and risk information directly to 647 tested patients on 6-month statin adherence (proportion of days covered (PDC)) and persistence compared with concurrent non-tested matched controls. Adjusted 6-month statin PDC was significantly greater in tested patients: 0.77 (95% confidence interval (CI) 0.72-0.82) vs controls 0.68 (95% CI 0.63-0.73), P<0.0001. Significantly more tested patients were adherent (PDC⩾0.80) (63.4% (59.6-67.1%) vs 45.0% (41.1-48.8%), P<0.0001) and persisted on therapy (69.1% (65.4-72.5%) vs 53.3% (49.4-57.1%), P<0.0001). Similar results were observed in a secondary comparison with 779 unmatched patients who declined testing. The Additional KIF6 Risk Offers Better Adherence to Statins trial provides the first evidence that pharmacogenetic testing may modify patient adherence.

Rosiglitazone and pioglitazone increase fracture risk in women and men with type 2 diabetes

AIM

The objectives of the study were to determine whether thiazolidinedione (TZD) use is associated with an increased risk of fracture in men and women with type 2 diabetes mellitus and to compare the effects of pioglitazone and rosiglitazone.

MATERIALS AND METHODS

A research database of integrated pharmacy and medical claims was analysed using Cox models adjusted for age, gender, chronic obstructive pulmonary disease, asthma, osteoporosis, stroke, prior fracture and chronic disease score. Patients were followed for 540 days.

RESULTS

There was a 39% higher [adjusted hazard ratio (HR), 1.39; 95% confidence interval (CI), 1.32-1.46] incidence of fractures in men and women exposed to a TZD (n = 69047; age = 56 +/- 5 years; 59% men; 48% rosiglitazone) compared with that in control patients (n = 75352; age = 56 +/- 5 years; 51% men). Men treated with a TZD had a higher likelihood of fracture than control patients (adjusted HR rosiglitazone, 1.47; 95% CI, 1.38-1.56; adjusted HR pioglitazone, 1.43; 95% CI, 1.34-1.52). The HRs associated with pioglitazone (adjusted HR, 1.43; 95% CI, 1.34-1.52) and rosiglitazone (adjusted HR, 1.47; 95% CI, 1.38-1.56) were almost identical. TZD use was associated with a higher fracture risk in women aged above and below 50 years and in men aged above 50 years.

CONCLUSIONS

Our findings add support to the growing literature that TZD treatment is associated with an increased risk of fractures in both men and women, that effects of rosiglitazone and pioglitazone are similar and that fracture risk is increased even in younger women.

Helicobacter pylori and gastric adenocarcinoma

Gastric cancer is the second most common cause of cancer death worldwide. A large body of evidence supports a causal role of Helicobacter pylori in the majority of gastric malignancies. Great strides have been made in understanding the pathogenesis of this relationship, but much remains to be learned. Moreover, because of the high prevalence of infection, the lack of definitive trials, and the challenges of H. pylori treatment, there remains no consensus on the role of routine screening and treatment of this infection to prevent cancer. This article reviews the current knowledge on H. pylori and gastric cancer and presents some of the clinical and public health challenges associated with this pathogen.

Helicobacter pylori and gastric adenocarcinoma

Gastric cancer is the second most common cause of cancer death worldwide. A large body of evidence supports a causal role of Helicobacter pylori in the majority of gastric malignancies. Great strides have been made in understanding the pathogenesis of this relationship, but much remains to be learned. Moreover, because of the high prevalence of infection, the lack of definitive trials, and the challenges of H. pylori treatment, there remains no consensus on the role of routine screening and treatment of this infection to prevent cancer. This article reviews the current knowledge on H. pylori and gastric cancer and presents some of the clinical and public health challenges associated with this pathogen.

Diaphragmatic or transdiaphragmatic thoracic involvement in hepatic hydatid disease: surgical trends and classification

We performed a retrospective study of 19 patients who had been operated on for hepatic hydatid disease with diaphragmatic or transdiaphragmatic (D-TD) thoracic involvement chosen from a total of 444 patients who underwent operations for hepatic hydatid disease. In all cases D-TD involvement was confirmed by ultrasonography, CT, or MRI scan. We propose a new classification (grades 1-5) based on the degree of development of D-TD involvement. Before 1984 exposure was obtained by thoracophrenolaparotomy (nine cases) and later by right subcostal incision. Only four patients required atypical pulmonary resection. In 13 cases the diaphragm was repaired, and all 24 hepatic cysts were treated with total (16 cases) or partial (8 cases) cystopericystectomy. There was no operative mortality, and the most serious morbidity consisted of a biliary fistula and a biliobronchial fistula. For treatment of these patients we recommended right subcostal incision and total or near-total cystopericystectomy as a first choice of surgical technique.

[The versatility of anterograde/retrograde cardioplegia in heart surgery]

Eighty patients underwent open-heart surgery from March 1990 to March 1993. We used combined aortic root (antegrade)/coronary sinus (retrograde) perfusion for cardioplegia delivery as a means of myocardial protection. The special retroplegia cannula was introduced to the coronary sinus (CS) in 67 patients by the transatrial (blind intubation) after one cannula cava insertion; the CS was cannulated under direct vision by right atriotomy after bicaval cannulation in 13 patients. Varied and prolonged cardiac procedures were done using cooled crystalloid cardioplegia (4 centigrades + potassium) except in one patient with severe ventricular damage in whom warm blood cardioplegia was infused. There was no CS or cardiac vein damage or disruption. There was no A-V blockade. The CS was intubated easily in all cases and cardioplegia solution readily infused. Coronary sinus pressure never exceeded 40 mm Hg. Overall hospital mortality (30 days postoperative) was 3.75% (3 cases). Sepsis was the cause of death in 2 patients and stroke in one. Inotropes were used in few cases as a means of renal protection. We conclude that the combined antegrade/retrograde cardioplegia delivery can be used routinely in most patients undergoing open-heart surgery.

[Calcified embolism of the coronary artery due to the degeneration of a bioprosthesis in the aortic position]

We present a case of arterial coronary embolism by calcified material of a bioprosthesis of bovine pericardium of the INC in aortic position 8 years after its implantation. Echocardiogram and catheterization with coronarography demonstrated prosthetic aortic dysfunction and normal coronaries. The patient complained of stable angor and dyspnea. During coronarography there was an increase of symptoms together with ECG changes and after a few hours with enzymatic increase. The patient was brought urgently to surgery where mitroaortic prosthesis was changed with mechanic prosthesis. As surgical findings: absence of a leaflet of prosthesis in aortic position with free fragmented calcium in periannular region and two remaining leaflet completely calcified, prosthesis in mitral position of normal appearance. We conclude that ischemia or myocardial infarction in presence of normal coronaries in patients with bovine pericardial bioprosthesis in aortic position can be secondary to calcium embolism, originated by mineralization process of a degenerated bioprosthesis several years after its implantation.

Ross operation using a bovine bioprosthetic valve with autologous pericardial conduit in the pulmonary position

Between 1 February 1992 and 1 March 1993, we performed Ross's aortic replacement in 7 men and 4 women with rheumatic heart disease. The patients' ages ranged from 22 to 60 years (mean, 41 years). All 11 patients had aortic valve disease; 2 also had mitral valve disease. In all patients, the right ventricular outflow tract was reconstructed using an autologous pericardial conduit containing a bovine cardiac valve bioprosthesis manufactured at our institution. The 2 patients who had mitral valve disease underwent a concomitant mitral valvuloplasty. In 1 patient, minimal aortic regurgitation was documented by means of transesophageal echocardiography immediately after the cessation of cardiopulmonary bypass, but no hemodynamic compromise was noted. In another patient, mediastinal exploration was required for bleeding, 3.5 hours postoperatively. The follow-up period ranged from 6 to 16 months (mean, 11.3 months). Results were assessed by means of clinical and transesophageal echocardiographic studies. No infection or technical failure was encountered. No patient died. All patients remain asymptomatic, and follow-up echocardiography has revealed no transaortic or transpulmonary gradient. The Ross operation was chosen for this group of patients because it avoids the use of mechanical valves and subsequent anticoagulant therapy. Most of our patients have a low income and a history of noncompliance with the strict postoperative drug regimen. Although the short-term results have been excellent with the Ross operation and our combination bioprosthesis, long-term evaluation is needed.