Avoiding the use of human chorionic gonadotropin combined with oocyte vitrification and GnRH agonist triggering versus coasting: a new strategy to avoid ovarian hyperstimulation syndrome

In this observational trial, we compared the impact on two different strategies, egg vitrification (n = 152) obtained after triggering final oocyte maturation with GnRH agonists and transferring the embryos at a later stage, with classical coasting (n = 96) to avoid OHSS in patients at risk due to high response to COH. Our results show that oocyte vitrification after GnRH agonists triggering is a highly attractive, safe, and efficient alternative to postpone embryo transfer in patients at high risk of OHSS, resulting in decreased risk for the patient and a better cycle outcome (pregnancy rate 50% vs 29.5%).     

Pathologic pulmonary findings in children with the acquired immunodeficiency syndrome: a study of ten cases

Lung tissue and tissue from the lymphoreticular system obtained at open biopsy and/or autopsy were studied in ten children with the acquired immunodeficiency syndrome (AIDS). One or both parents of nine of the children had AIDS or risk factors for AIDS. The remaining child had hemophilia. The following pulmonary lesions were seen: 1) diffuse alveolar damage (DAD), 2) Pneumocystis carinii and/or cytomegalovirus pneumonitis, 3) lymphoid interstitial pneumonitis (LIP), and 4) desquamative interstitial pneumonitis (DIP). Combinations of such factors as mechanical ventilation, oxygen therapy, and opportunistic infection played a role in the pathogenesis of DAD. Opportunistic infections were related to the defective cell-mediated immunity in these children. The clinical, epidemiologic, immunologic, and pathologic features of the thymuses of these patients indicate that the immune deficiency was unlikely to have been of congenital origin. The immunologic abnormalities may also have been related to the pathogenesis of LIP and DIP. Neither LIP nor DIP has been described in adults with AIDS. Open lung biopsy is of practical importance in the diagnosis and treatment of pulmonary disease in children with AIDS.     

Induction of immunosuppressive molecules and regulatory T cells counteracts the antitumor effect of interleukin-12-based gene therapy in a transgenic mouse model of liver cancer

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) often lacks curative treatment; therefore new efficient therapies are needed. In this work we aimed at evaluating the antitumor effect of interleukin-12 (IL-12)-based gene therapy on HCC occurring spontaneously in mice. METHODS: A plasmid-vector expressing IL-12 in a liver-specific and doxycycline (Dox)-inducible manner was transferred by hydrodynamic injection to the liver of L-PK/c-myc mice with HCC. IL-12 expression was induced by administering Dox (3 cycles of 1 month duration separated by 1 month rest). RESULTS: Dox administration increased serum IL-12 and IFN-gamma and induced tumor lymphocytic infiltration in all treated mice which was accompanied by tumor stabilization or regression in 40% of animals. The antitumor effect did not correlate with levels of IL-12 or IFN-gamma nor with the intensity of tumor mononuclear infiltration. However, tumors from non-responder mice showed more abundance of Foxp3+ regulatory T cells and higher expression of the immunosuppressive molecules PD-1, PD-L1, VEGF, CTLA-4, IDO, and IL-10 than those that responded to therapy. CONCLUSIONS: Although long-term induction of IL-12 expression in the liver can inhibit HCC growth, the efficacy of the treatment appears to be limited by the activation of immunosuppressive mechanisms.     

Evaluation of four rapid methods for hemoglobin screening of whole blood donors in mobile collection settings.

INTRODUCTION: Predonation hemoglobin measurement is a problematic requirement in mobile donation settings, where accurate determination of venous hemoglobin by hematology analyzers is not available. OBJECTIVE: We have evaluated hemoglobin screening in prospective donors by the semiquantitative copper sulphate test and by capillary blood samples analyzed by three portable photometers, HemoCue, STAT-Site((R)) MHgb, and the CompoLab HB system. METHODS: Capillary blood samples were obtained from 380 donors and tested by the copper sulphate test and by at least one of the named portable photometers. Predonation venous hemoglobin was also determined in all donors using a Coulter Max-M analyzer. RESULTS: The three photometers provided acceptable reproducibility (CV below 5%), and displayed a significant correlation between the capillary blood samples and the venous hemoglobin (R(2) 0.5-0.8). HemoCue showed the best agreement with venous hemoglobin determination, followed by STAT-Site((R)) MHgb, and the CompoLab HB system. The copper sulphate test provided the highest rate of donors acceptance (83%) despite unacceptable hemoglobin levels, and the lowest rate for donor deferral (1%) despite acceptable hemoglobin levels. The percentage of donors correctly categorized for blood donation by the portable hemoglobinometers was 85%, 82%, and 76% for CompoLab HB system, HemoCue and STAT-Site((R)), respectively. CONCLUSION: Our data suggest that hemoglobin determination remains a conflictive issue in donor selection in the mobile setting. Without appropriate performance control, capillary hemoglobin screening by either the copper sulphate method or by the novel portable hemoglobinometers could be inaccurate, thus potentially affecting both donor safety and the blood supply.     

Lung cancer surgery in the elderly

Non-small cell lung cancer (NSCLC) is a typical disease of the elderly, and is becoming increasingly more common as a result of the gradual aging of the population. Although patient age is known to be an independent prognostic factor of postoperative survival, lung resection should not be denied on the basis of age alone.In patients of this kind, careful evaluation and selection is very important.In early-stage NSCLC, surgery is the treatment of choice. In the advanced stages of the disease treatment usually comprises primary radiotherapy or combined radio-chemotherapy.Preoperative preparation and postoperative care are very important in chest surgery, and particularly in elderly patients.The 5-year survival rate in octogenarians exceeds 40%, but is much lower in pneumonectomized patients (close to 10%).In conclusion, elderly patients should be offered the best treatment possible, bearing in mind that surgery offers the best results when the disease is resectable.