Experience of using time lapse microscopy in the IVF program in patients with good ovarian reserve

Abstract

The aim of this study is to evaluate the outcomes of single embryo transfer in patients with good ovarian reserve in the IVF program using time-lapse microscopy. This is a retrospective cohort study in a private IVF center in Russia. Comparison was done between 90 IVF cycles using time-lapse (study group) and 113 IVF cycles using standard culture (control group). Within each group, subgroups were selected with selective transfer of one embryo for 5 days (5SET) and elective transfer of one embryo for 5 days (5eSET). The primary outcome of the study was pregnancy rate. Secondary outcomes were miscarriage rates, live birth. Pregnancy rate did not significantly differ between the groups – 64.2% in the study group and control group. In the study group, the delivery rate was 54% in the subgroup 5eSET and 51.1% in the subgroup 5SET (p?=?.940). In the control group, the type of the embryo transfer significantly influenced on the delivery rate: in the 5eSET subgroup the birth rate was 54.4%, and in the 5SET subgroup it was 34.3% (p?=?.055; by Fisher's exact method p?=?.052). There were no adverse effects of the intervention. Selection of a single blastocyst based on information derived from time-lapse monitoring can help embryo selection for transfer.     

Operative management of high-grade dysplastic L5 spondylolisthesis with the use of external transpedicular fixation: advantages and drawbacks

Purpose

The aim of our study was to analyze clinical and radiographic outcomes of operative management of L5 high-grade dysplastic spondylolisthesis with the apparatus for external transpedicular fixation (AETF), and to compare the results of its use for reduction and spondylodesis.

Methods

There were 13 patients with L5 dysplastic spondylolisthesis of grade 4 (Meyerding grading) and having a mean age of 25.0?±?3.6 years. The management included two stages: gradual reduction with the AETF, followed by either isolated anterior spondylodesis with the same AETF (group 1, n?=?8), or by spondylodesis using a combined method (internal transpedicular instrumentation and posterior lumbar interbody fusion [PLIF]) (group 2, n?=?5). Clinical evaluation included pain (VAS scale) and functional status (Oswestry questionnaire [ODI]). Reduction and fusion completeness were assessed radiographically after treatment and at a mean follow-up of 2.1?±?0.4 years.

Results

Initial slippage was reduced by 51.6 % with AETF and was of grade 1 or 2. Reduction made up 31.1 % at follow-ups (grade 2 or 3). Pain decreased by 57.6 % (p?<?0.01). The functional status improved. ODI decreased by 37.7 % (p?<?0.01) after treatment and by 41.7 % (p?<?0.01) at follow-ups. Fusion at the level of the involved segment was poor in group 1. All the cases fused in group 2.

Conclusions

The use of AETF for L5 high-grade dysplastic spondylolisthesis provides gradual controlled reduction of the slipped vertebra, decompression of cauda equine roots, and recovery of the local sagittal spinal column balance. It creates conditions for achieving stability of lumbosacral segments with combined spondylodesis (internal transpedicular instrumentation and PLIF). AETF is not suitable for spondylodesis due to a high rate of pseudarthrosis.

     

Transforming growth factor-beta and breast cancer: Lessons learned from genetically altered mouse models

Transforming growth factor (TGF)-βs are plausible candidate tumor suppressors in the breast. They also have oncogenic activities under certain circumstances, however. Genetically altered mouse models provide powerful tools to analyze the complexities of TGF-βaction in the context of the whole animal. Overexpression of TGF-β can suppress tumorigenesis in the mammary gland, raising the possibility that use of pharmacologic agents to enhance TGF-β function locally might be an effective method for the chemoprevention of breast cancer. Conversely, loss of TGF-β response increases spontaneous and induced tumorigenesis in the mammary gland. This confirms that endogenous TGF-βs have tumor suppressor activity in the mammary gland, and suggests that the loss of TGF-β receptors seen in some human breast hyperplasias may play a causal role in tumor development.