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Herman T, Török P, Laganà AS, Chiantera V, Venezia R, Jakab A. Hashimoto's Thyroiditis Negatively Influences Intracytoplasmic Sperm Injection Outcome in Euthyroid Women on T4 Substitution Therapy: A Retrospective Study. Gynecol Obstet Invest 2024; 89:150-158. [PMID: 38368857 DOI: 10.1159/000537836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/10/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE The objective of this study was to analyze the impact of thyroid autoimmunity (TAI) on reproductive outcome parameters of intracytoplasmic sperm injection (ICSI) cycles as compared to TAI-negative ICSI cycles. DESIGN In this single in vitro fertilization (IVF) center retrospective study, 86 infertile women with elevated thyroid peroxidase or TGAb levels, but euthyroid after thyroxine replacement (study group), were compared to 69 female patients with no thyroid abnormalities (controls). Following ICSI treatment fertilization rate (FR), clinical pregnancy rate (CPR), miscarriage rate (MR), and live birth rate (LBR) were analyzed. MATERIALS, SETTING, METHODS All subjects with various infertility factors were treated with ICSI in university-based IVF center. Patients in the study group received thyroxine replacement and were euthyroid at IVF treatment. Before the IVF cycles, endocrinological parameters were uniformly assessed: thyroid function and antibodies, reproductive hormones (anti-Müllerian hormone [AMH], follicular stimulating hormone [FSH], luteinizing hormone, E2, PRL, testosterone, DHEAS, 17-OHP, AD) and OGTT (0-60-120 min glucose and insulin). Following descriptive comparison of laboratory parameters, age-adjusted analyses of FR, CPR, MR, and LBR were performed. RESULTS TAI-positive women were older (mean age 35.31 ± 4.95 vs. 32.15 ± 4.87 years; p = 0.002), had higher FSH (8.4 ± 3.4 vs. 7.4 ± 2.32 U/L; p = 0.024), higher E2 (53.94 ± 47.61 vs. 42.93 ± 18.92 pg/mL; p = 0.025) levels, while AMH (2.88 ± 2.62 vs. 3.61 ± 1.69 ng/mL; p = 0.0002) was lower. There were no differences in TSH levels (1.64 ± 0.96 vs. 1.66 ± 0.65 µIU/mL; p = 0.652) between the two groups. FT3 (2.63 ± 0.58 vs. 2.98 ± 0.55 pg/mL; p = 0.002) was lower and FT4 (1.3 ± 0.29 vs. 1.13 ± 0.21 ng/dL; p = 0.0002) was higher in the TAI-positive group, reflecting clinically irrelevant differences. Egg cell counts (6 ± 3.8 vs. 7.5 ± 3.95; p = 0.015) were lower in TAI and remained so following age adjustment. Although the overall ICSI FR did not differ (62.9% vs. 69.1%, p = 0.12), it was lower for patients under 35 with TAI showing decreasing differences in line with age. The CPR (36.04% vs. 69.56%; p < 0.001) and LBR (23.25% vs. 60.86%; p < 0.001) were lower, the MR (35.48% vs. 12.5%; p = 0.024) was higher in the TAI group, and these differences remained after age adjustment. LIMITATIONS Since the higher age of the study group may interfere with the effect of TAI, age adjustment calculations were necessary to perform to eliminate this confounding factor. CONCLUSION Despite optimal thyroid supplementation in clinical or subclinical hypothyroidism, the presence of TAI negatively influences CPR and is connected to a higher MR, thus resulting in a lower LBR after ICSI. Decreased FR with ICSI in TAI patients may also contribute to poorer outcomes, especially in younger women.
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Affiliation(s)
- Tünde Herman
- Assisted Reproduction Center, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Péter Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Renato Venezia
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Erdélyi A, Pálfi E, Tűű L, Nas K, Szűcs Z, Török M, Jakab A, Várbíró S. The Importance of Nutrition in Menopause and Perimenopause-A Review. Nutrients 2023; 16:27. [PMID: 38201856 PMCID: PMC10780928 DOI: 10.3390/nu16010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Menopause is associated with an increased prevalence of obesity, metabolic syndrome, cardiovascular diseases, and osteoporosis. These diseases and unfavorable laboratory values, which are characteristic of this period in women, can be significantly improved by eliminating and reducing dietary risk factors. Changing dietary habits during perimenopause is most effectively achieved through nutrition counseling and intervention. To reduce the risk factors of all these diseases, and in the case of an already existing disease, dietary therapy led by a dietitian should be an integral part of the treatment. The following review summarizes the recommendations for a balanced diet and fluid intake, the dietary prevention of cardiovascular diseases, the role of sleep, and the key preventive nutrients in menopause, such as vitamin D, calcium, vitamin C, B vitamins, and protein intake. In summary, during the period of perimenopause and menopause, many lifestyle factors can reduce the risk of developing all the diseases (cardiovascular disease, insulin resistance, type 2 diabetes mellitus, osteoporosis, and tumors) and symptoms characteristic of this period.
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Affiliation(s)
- Aliz Erdélyi
- Hungarian Dietetic Association, 1034 Budapest, Hungary; (A.E.); (Z.S.)
- EndoCare Institute, Endocrinology Center, 1037 Budapest, Hungary; (L.T.); (K.N.)
| | - Erzsébet Pálfi
- Faculty of Health Sciences, Department of Dietetics and Nutritional Sciences, Semmelweis University, 1088 Budapest, Hungary
| | - László Tűű
- EndoCare Institute, Endocrinology Center, 1037 Budapest, Hungary; (L.T.); (K.N.)
- School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
| | - Katalin Nas
- EndoCare Institute, Endocrinology Center, 1037 Budapest, Hungary; (L.T.); (K.N.)
- School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
| | - Zsuzsanna Szűcs
- Hungarian Dietetic Association, 1034 Budapest, Hungary; (A.E.); (Z.S.)
- School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
| | - Marianna Török
- EndoCare Institute, Endocrinology Center, 1037 Budapest, Hungary; (L.T.); (K.N.)
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary;
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - Szabolcs Várbíró
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary;
- Department of Obstetrics and Gynecology, University of Szeged, 6725 Szeged, Hungary
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Herman T, Csehely S, Orosz M, Bhattoa HP, Deli T, Török P, Jakab A. Endokrin kórképek előfordulása és társulása in vitro fertilizációs programban részt vevő nők körében. Orv Hetil 2022; 163:712-719. [DOI: 10.1556/650.2022.32372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló.
Bevezetés: Az endokrin betegségekhez társuló ovulációs
diszfunkció gyakori vezető vagy társuló oka a női infertilitásnak, de optimális
reprodukciós korban oki vagy ovulációindukciós kezeléssel többnyire rendezhető a
fertilitás. Az in vitro fertilizációs (IVF-) kezelések vezető
indikációi jelenleg az andrológiai és a női életkorból adódó, petefészek-eredetű
infertilitás, de egyéb endokrin diszfunkció társulása befolyásolja a kezelési
eredményeket. Célkitűzés: Az endokrin betegségek gyakoriságának
vizsgálata az IVF-programban részt vevő párok nőtagjainál.
Módszer: Az IVF-program előtti alkalmassági vizsgálatok
során a vezető indikációtól függetlenül részletes endokrinológiai kivizsgálást
végeztünk 231 nőnél (átlagéletkor 34 év). A vizsgálatok kiterjedtek a
hypothalamus- és petefészek-funkcióra, a pajzsmirigyfunkcióra és
pajzsmirigy-autoimmunitásra, a mellékvese-funkcióra, a szénhidrát-anyagcserére
és az inzulinrezisztenciára. Az egyes endokrin betegségek előfordulásán túl azok
társulási gyakoriságát is elemeztük. Eredmények: Az IVF vezető
javallatainak megoszlása megfelelt a nemzetközi tendenciáknak, endokrin jellegű
volt 87 esetben (37,6%; csökkent petefészek-tartalék: 55 eset és krónikus
anovuláció: 32 eset). Társuló endokrin eltérést 141 esetben találtunk, így
összesen 161 nőt érintett az endokrin diszfunkció (69,7%; átlagéletkor 35 év).
Az endokrin diszfunkciók előfordulása gyakorisági sorrendben:
pajzsmirigy-diszfunkció (32,5%), csökkent petefészek-tartalék (23,8%),
pajzsmirigy-autoimmunitás (22,5%), polycystás ovarium szindróma (15,6%),
inzulinrezisztencia (22,5%), elhízás (23,8%), hyperprolactinaemia (13,4%). Az
endokrin betegségek társulása minden kórkép esetében fellelhető volt.
Hypogonadotrop hypogonadismus 2, congenitalis adrenalis hyperplasia 1 esetben
fordult elő. Nem találtunk endokrin eltérést 70 esetben (30,3%).
Következtetés: Vizsgálatunk igazolja az endokrin
diszfunkciók halmozott megjelenését és gyakori társulását az IFV-program
résztvevőinél, bármely indikáció esetén. A részletes endokrin kivizsgálás és az
IVF-kezelést végzők endokrin jártassága hozzájárulhat az IVF-kezelés
sikerességéhez. Orv Hetil. 2022; 163(18): 712–719.
Summary.
Introduction: Ovulatory dysfunction associated with endocrine
diseases is a common leading or associated cause of female infertility, but at
optimal reproductive age, causal or ovulation-induction treatment can usually
settle fertility. The leading indications for in vitro
fertilization (IVF) treatments are currently andrological and originated from
age-related ovarian infertility, but other accompanying endocrine dysfunctions
affect treatment outcomes. Objective: To investigate the
incidence of endocrine diseases in female members of couples participating in
IVF program. Method: During aptitude tests prior to the IVF
program, from the leading indication independently, a detailed endocrinological
examination was performed in 231 women (mean age: 34 years). The studies of
hypothalamic and ovarian function, thyroid function and thyroid autoimmunity,
adrenal function, carbohydrate metabolism and insulin resistance were covered.
In addition to the incidence of each endocrine disease, the frequency of their
association was analyzed. Results: The distribution of IVF lead
indications was in line with the international trends, it was endocrine nature
in 87 cases (37.6%; decreased ovarian reserve in 55 cases and chronic
anovulation in 32 cases). Associated endocrine abnormalities were found in 141
cases, and a total of 161 women was affected by endocrine dysfunction (69.7%;
mean age: 35 years). Endocrine dysfunction incidences in order of frequency were
thyroid dysfunction (32.5%), diminished ovarian reserve (23.8%), thyroid
autoimmunity (22.5%), polycystic ovarian syndrome (15.6%), insulin resistance
(22.5%), obesity (23.8%), hyperprolactinemia (13.4%). The endocrine disease
associations were found in all of the cases above. Hypogonadotropic hypogonadism
occurred in 2 cases, congenital adrenal hyperplasia occurred in 1 case. No
endocrine abnormalities were found in 70 cases (30.3%).
Conclusion: Our study confirms the cumulative appearance of
endocrine dysfunctions and frequent association in IVF participants with any
lead indication. The detailed endocrine examination and proficiency/skill in
reproductive endocrinology of IVF practitioners may contribute to IVF treatment
success. Orv Hetil. 2022; 163(18): 712–719.
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Affiliation(s)
- Tünde Herman
- Debreceni Egyetem, Klinikai Központ, Asszisztált Reprodukciós Centrum Debrecen Magyarország
| | - Szilvia Csehely
- Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Debrecen, Egyetem tér 1., 4032 Magyarország
| | - Mónika Orosz
- Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Debrecen, Egyetem tér 1., 4032 Magyarország
| | - Harjit Pal Bhattoa
- Debreceni Egyetem, Általános Orvostudományi Kar, Laboratóriumi Medicina Intézet Debrecen Magyarország
| | - Tamás Deli
- Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Debrecen, Egyetem tér 1., 4032 Magyarország
| | - Péter Török
- Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Debrecen, Egyetem tér 1., 4032 Magyarország
| | - Attila Jakab
- Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Debrecen, Egyetem tér 1., 4032 Magyarország
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De Silvestro A, Krüger B, Steger C, Feldmann M, Payette K, Krüger J, Kottke R, Hagmann C, Bosshart M, Bürki C, Dave H, Tuura R, Latal B, Jakab A, Knirsch W. Intraoperative Cerebral Desaturation during Neonatal Congenital Heart Surgery is Associated with Perioperative Brain Changes but not with Neurodevelopmental Outcome at 1 Year of Age. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1743021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A. De Silvestro
- Pediatric Cardiology, University Children's Hospital, Zürich, Switzerland
| | - B. Krüger
- Pediatric Anesthesiology, University Children's Hospital, Zürich, Switzerland
| | - C. Steger
- Center of MR Research, University Children's Hospital, Zürich, Switzerland
| | - M. Feldmann
- Child Development Center, University Children's Hospital, Zürich, Switzerland
| | - K. Payette
- Center of MR Research, University Children's Hospital, Zürich, Switzerland
| | - J. Krüger
- Pediatric Cardiology, University Children's Hospital, Zürich, Switzerland
| | - R. Kottke
- Center of MR Research, University Children's Hospital, Zürich, Switzerland
| | - C. Hagmann
- Neonatology, University Children's Hospital, Zürich, Switzerland
| | | | - C. Bürki
- Pediatric Anesthesiology, Zürich, Switzerland
| | - H. Dave
- Congenital Cardiovacular Surgery, University Children's Hospital, Zürich, Switzerland
| | - R. Tuura
- Center of MR Research, Zürich, Switzerland
| | - B. Latal
- Child Development Center, University Children's Hospital, Zürich, Switzerland
| | - A. Jakab
- Center of MR Research, University Children's Hospital, Zürich, Switzerland
| | - W. Knirsch
- Pediatric Cardiology, University Children's Hospital, Zürich, Switzerland
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Steger C, Feldmann M, Borns J, Latal B, Held U, Jakab A, Knirsch W, Tuura R. Perioperative Metabolic Changes in Neonates with Congenital Heart Disease Determined by MR Spectroscopy—A Prospective Case-Control Study. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1743025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C. Steger
- Center of MR Research, University Children's Hospital, Zürich, Switzerland
| | - M. Feldmann
- Child Development Center, University Children's Hospital, Zürich, Switzerland
| | - J. Borns
- Pediatric Cardiology, University Children's Hospital, Zürich, Switzerland
| | - B. Latal
- Child Development Center, University Children's Hospital, Zürich, Switzerland
| | - U. Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland, Zurich, Switzerland
| | - A. Jakab
- Center of MR Research, University Children's Hospital, Zürich, Switzerland
| | - W. Knirsch
- Pediatric Cardiology, University Children's Hospital, Zürich, Switzerland
| | - R. Tuura
- Center of MR Research, Zürich, Switzerland
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Csécsei K, Csehely S, Póka R, Zádori Z, Németh I, Ringelhan B, Molnár S, Jakab A. Haemangioma a méhnyakban: 4 eset ismertetése és irodalmi áttekintés. Orv Hetil 2022; 163:187-194. [DOI: 10.1556/650.2022.32317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/11/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. A haemangioma a női nemi szervekben viszonylag ritkán,
a méhnyakban pedig még ritkábban fordul elő. Kis mérete és szegényes megjelenése
miatt elkerülheti a figyelmet, előfordul azonban, hogy műtéti ellátást igénylő
vérzést okoz. Az évek során 4 esetben (ebből 2 esetben terhesség alatt)
diagnosztizáltunk méhnyak-haemangiomát (2 esetben cervicalis intraepithelialis
carcinomával társulva), melyeknek ismertetjük változatos tüneteit, kolposzkópos
megjelenését és a diagnózist biztosító szövettani (immunhisztokémiai)
illusztrációit, valamint a képlet terhesség alatti fejlődésének kolposzkópos
monitorizálását. 2 esetben capillaris (cavernosus) haemangiomát, 2 esetben
arteriovenosus malformatiót igazoltunk. Az általunk hozzáférhető szakirodalomban
nem találtunk magyar szerző(k)től beszámolót erről a cervicalis lokalizációjú,
ritka, jóindulatú, de gyakran veszélyes vascularis daganatról. Orv Hetil. 2022;
163(5): 187–194.
Summary. Hemangioma is relatively rare in the female genital organs
and even less common in the uterine cervix. Its small size and poor appearance
often result in a missed diagnosis, but it may cause bleeding that requires
surgery. Over the years, we have confirmed the diagnosis of cervical hemangioma
in 4 cases including two in pregnancy. 2 cases were associated with cervical
intraepithelial neoplasia. This case report describes the symptoms, colposcopic
appearance, and histological characteristics including immunohistochemical
findings, and the colposcopic monitoring of development of the condition during
pregnancy. In 2 cases, a capillary (cavernous) hemangioma, in 2 cases an
arteriovenous malformation was diagnosed. We did not find any report from
Hungarian author(s) about this rare, benign, but often dangerous vascular tumor
with cervical localization. Orv Hetil. 2022; 163(5): 187–194.
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Affiliation(s)
- Károly Csécsei
- Soproni Erzsébet Oktató Kórház, Szülészeti és Nőgyógyászati Osztály Sopron Magyarország
| | - Szilvia Csehely
- Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Debrecen Magyarország
| | - Róbert Póka
- Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Debrecen Magyarország
| | - Zoltán Zádori
- Jósa András Megyei Oktatókórház, Onkoradiológiai Osztály Nyíregyháza Magyarország
| | - István Németh
- Soproni Erzsébet Oktató Kórház, Patológiai Osztály Sopron Magyarország
| | - Birgit Ringelhan
- Soproni Erzsébet Oktató Kórház, Patológiai Osztály Sopron Magyarország
| | - Sarolta Molnár
- Debreceni Egyetem, Általános Orvostudományi Kar, Pathologiai Intézet Debrecen Magyarország
| | - Attila Jakab
- Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Debrecen Magyarország
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Erdodi B, Varadi L, Krasznai Z, Jakab A. VP04.24: The benefit of serum inflammatory markers and simple ultrasound features in the preoperative diagnosis of peri‐ and postmenopausal adnexal masses. Ultrasound Obstet Gynecol 2021. [DOI: 10.1002/uog.24084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- B. Erdodi
- Department of Obstetrics and Gynecology University of Debrecen Debrecen Hungary
| | - L. Varadi
- Department of Obstetrics and Gynecology University of Debrecen Debrecen Hungary
| | - Z. Krasznai
- Department of Obstetrics and Gynecology University of Debrecen Debrecen Hungary
| | - A. Jakab
- Department of Obstetrics and Gynecology University of Debrecen Debrecen Hungary
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Geiger J, Tuura R, Callaghan FM, Burkhardt BUE, Payette K, Jakab A, Kellenberger CJ, Valsangiacomo ER. Feasibility of non-gated dynamic fetal cardiac MRI for identification of fetal cardiovascular anatomy. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Purpose
We sought to retrospectively evaluate the feasibility of identifying the fetal cardiac and thoracic vascular structures with non-gated dynamic balanced steady-state free precession MRI sequences.
Methods
We retrospectively assessed the visibility of cardiovascular anatomy in 66 fetuses without suspicion of congenital heart defect (mean gestational age 27+/- 4, range 21-38 weeks). Non-gated dynamic balanced steady-state free precession (SSFP) sequences were acquired in three planes (axial, coronal and sagittal) of the fetal thorax (slice thickness 4-5mm, FOV 400, FA 60°, matrix 256x256). The images were analysed following a segmental approach in consensus reading by an experienced paediatric cardiologist and radiologist. An imaging score was defined by giving one point to each visualized structure. Basic diagnostic structures included the atria, ventricles, systemic veins, right and left ventricular outflow tracts (RVOT/LVOT), aortic arch, descending aorta (DAO), ductus arteriosus and thymus (12 points); advanced diagnostic features included the atrioventricular (AV) valves, pulmonary arteries and veins, supraaortic arteries and trachea, yielding a maximum score of 21 points. Image quality was rated from 0 (poor) to 2 (good). The influence of gestational age (GA), field strength, placenta position, and maternal panniculus on image quality and imaging score were tested.
Results
34 scans were performed at 1.5 T, 32 at 3 T. Heart position, atria and ventricles could be seen in all 66 fetuses. Basic diagnosis (>12 points) was achieved in 60 (90%) cases, with visualization of the IVC and SVC in 65 (98%) and 63 (95%), RVOT in 62 (94%), LVOT in 61 (92%), aortic arch in 60 (91%), DAO in 64 (97%), ductus arteriosus in 59 (89%) and thymus in 50 (76%) fetuses. The AV valves were recognised in 55 (83%), the pulmonary arteries in 35 (53%), at least one pulmonary vein in 46 (70%), the supraaortic arteries in 42 (64%), and the trachea in 59 (89%) fetuses. The mean imaging score was 16.8 +/- 3.7. Maternal panniculus (r -0.3; p 0.01) and gestational age (r 0.6; p < 0.001) correlated with imaging score. Field strength influenced image quality, with 1.5 T being better than 3T images (p 0.04), but not the total imaging score. Imaging score or quality were independent from placenta position.
Conclusions
Fetal heart MRI with a non-gated SSFP sequence in multiple planes enables recognition of basic cardiovascular anatomy. Advanced diagnostics may be limited by thick maternal panniculus, lower GA and higher field strength.
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Affiliation(s)
- J Geiger
- Children"s Hospital Zurich, Zurich, Switzerland
| | - R Tuura
- Children"s Hospital Zurich, Zurich, Switzerland
| | | | | | - K Payette
- Children"s Hospital Zurich, Zurich, Switzerland
| | - A Jakab
- Children"s Hospital Zurich, Zurich, Switzerland
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Abstract
Endometrial cancer is the most common gynecological malignancy with a relatively good overall prognosis. It traditionally has two subtypes: type 1 (endometrioid carcinoma) and type 2 (non-endometrioid carcinoma). The prognosis is excellent for stage I endometrioid cancer, with a 5-year survival rate of 96%. However, the prognosis is much worse for women with high-risk endometrial cancer. Effective preoperative staging is important in order to tailor treatment and achieve optimal long-term survival. The majority of asymptomatic polyps detected by ultrasound are treated surgically. Conventionally, dilatation and curettage was performed to obtain a histological diagnosis, but nowadays hysteroscopy with biopsy is starting to be considered as the gold standard. Hysteroscopic resection seems to reduce the risk of underdiagnosed (atypical endometrial hyperplasia) endometrial cancer. To avoid the spread of malignant cells, hysteroscopy should be performed with concern to keep intrauterine pressure low. In comparison with cervical injection, the hysteroscopic method has a better detection rate in the para-aortic area during sentinel lymph node mapping. In the assessment of cervical involvement, the accuracy of magnetic resonance imaging is significantly higher than the accuracy of hysteroscopy. In fertility-sparing cases, hysteroscopic endometrium resection with progesterone therapy is an acceptable option.
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Affiliation(s)
- P Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - S Molnár
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - R Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - A Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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10
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Abstract
Introduction: Most endometrial polyps represent focal hyperplasia of the endometrium. Endometrial polyps can be diagnosed by ultrasound, hysterocontrast sonography, hysterosalpingography, endometrial biopsy, and uterine curettage, but diagnostic hysteroscopy is considered the gold-standard method, with the greatest sensitivity and specificity and also with the opportunity for treatment at the same time.Study design: A retrospective study was conducted on 424 patients between 2006 and 2018. The polyps were verified during diagnostic hysteroscopy and were removed by resectoscopy or curettage. All samples underwent histological examination. The effectivity of the type of resection and the recurrence rate were evaluated.Results: The average age of the patients was 60.2 ± 9.3 years. Polyps were excised in 62.97% by resectoscopic polypectomy and in 37.03% by curettage. Malignancy was confirmed in 4.24% of cases. Histological verification of polyps was 79.4% in the resectoscopy group and 69.04% in the curettage group; the difference was significant (p < 0.01). The recurrence rate was 20.47% after resectoscopy and 27.12% following curettage.Conclusion: Hysteroscopy remains the best option and the gold-standard method among diagnostic procedures of endometrial pathology. In this study, there was a significant difference in matching hysteroscopic and histological findings in the two methods of polypectomy. The recurrence rate is also lower following resectoscopy.
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Affiliation(s)
- S Molnár
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Z Farkas
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - A Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - R Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - P Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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11
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Van Den Bosch T, Verbakel JY, Valentin L, Wynants L, De Cock B, Pascual MA, Leone FPG, Sladkevicius P, Alcazar JL, Votino A, Fruscio R, Lanzani C, Van Holsbeke C, Rossi A, Jokubkiene L, Kudla M, Jakab A, Domali E, Epstein E, Van Pachterbeke C, Bourne T, Van Calster B, Timmerman D. Typical ultrasound features of various endometrial pathologies described using International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding. Ultrasound Obstet Gynecol 2021; 57:164-172. [PMID: 32484286 DOI: 10.1002/uog.22109] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/10/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To describe the ultrasound features of different endometrial and other intracavitary pathologies inpre- and postmenopausal women presenting with abnormal uterine bleeding, using the International Endometrial Tumor Analysis (IETA) terminology. METHODS This was a prospective observational multicenter study of consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler and fluid-instillation sonography were performed. Endometrial sampling was performed according to each center's local protocol. The histological endpoints were cancer, atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia (EIN), endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma and other. For fluid-instillation sonography, the histological endpoints were endometrial polyp, intracavitary leiomyoma and cancer. For each histological endpoint, we report typical ultrasound features using the IETA terminology. RESULTS The database consisted of 2856 consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler was performed in all cases and fluid-instillation sonography in 1857. In 2216 women, endometrial histology was available, and these comprised the study population. Median age was 49 years (range, 19-92 years), median parity was 2 (range, 0-10) and median body mass index was 24.9 kg/m2 (range, 16.0-72.1 kg/m2 ). Of the study population, 843 (38.0%) women were postmenopausal. Endometrial polyps were diagnosed in 751 (33.9%) women, intracavitary leiomyomas in 223 (10.1%) and endometrial cancer in 137 (6.2%). None (0% (95% CI, 0.0-5.5%)) of the 66 women with endometrial thickness < 3 mm had endometrial cancer or atypical hyperplasia/EIN. Endometrial cancer or atypical hyperplasia/EIN was found in three of 283 (1.1% (95% CI, 0.4-3.1%)) endometria with a three-layer pattern, in three of 459 (0.7% (95% CI, 0.2-1.9%)) endometria with a linear endometrial midline and in five of 337 (1.5% (95% CI, 0.6-3.4%)) cases with a single vessel without branching on unenhanced ultrasound. CONCLUSIONS The typical ultrasound features of endometrial cancer, polyps, hyperplasia and atrophy and intracavitary leiomyomas, are described using the IETA terminology. The detection of some easy-to-assess IETA features (i.e. endometrial thickness < 3 mm, three-layer pattern, linear midline and single vessel without branching) makes endometrial cancer unlikely. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- T Van Den Bosch
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - J Y Verbakel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - L Wynants
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - B De Cock
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - M A Pascual
- Department of Obstetrics, Gynecology and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - F P G Leone
- Department of Obstetrics and Gynecology, Clinical Sciences Institute L. Sacco, University of Milan, Milan, Italy
| | - P Sladkevicius
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - A Votino
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Brussels, Belgium
| | - R Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - C Lanzani
- Department of Obstetrics and Gynecology, Clinical Sciences Institute L. Sacco, University of Milan, Milan, Italy
| | - C Van Holsbeke
- Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - A Rossi
- Department of Obstetrics and Gynecology, University of Udine, Udine, Italy
| | - L Jokubkiene
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - M Kudla
- Department of Perinatology and Oncological Gynecology, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
| | - A Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - E Domali
- First Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Athens, Greece
| | - E Epstein
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - C Van Pachterbeke
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Brussels, Belgium
| | - T Bourne
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK
| | - B Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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12
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Kirk E, Ankum P, Jakab A, Le Clef N, Ludwin A, Small R, Tellum T, Töyli M, Van den Bosch T, Jurkovic D. Terminology for describing normally sited and ectopic pregnancies on ultrasound: ESHRE recommendations for good practice. Hum Reprod Open 2020; 2020:hoaa055. [PMID: 33354626 PMCID: PMC7738750 DOI: 10.1093/hropen/hoaa055] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/09/2020] [Indexed: 11/24/2022] Open
Abstract
STUDY QUESTION What recommendations can be provided to improve terminology for normal and ectopic pregnancy description on ultrasound? SUMMARY ANSWER The present ESHRE document provides 17 consensus recommendations on how to describe normally sited and different types of ectopic pregnancies on ultrasound. WHAT IS KNOWN ALREADY Current diagnostic criteria stipulate that each type of ectopic pregnancy can be defined by clear anatomical landmarks which facilitates reaching a correct diagnosis. However, a clear definition of normally sited pregnancies and a comprehensive classification of ectopic pregnancies are still lacking. STUDY DESIGN SIZE DURATION A working group of members of the ESHRE Special Interest Group in Implantation and Early Pregnancy (SIG-IEP) and selected experts in ultrasound was formed in order to write recommendations on the classification of ectopic pregnancies. PARTICIPANTS/MATERIALS SETTING METHODS The working group included nine members of different nationalities with internationally recognised experience in ultrasound and diagnosis of ectopic pregnancies on ultrasound. This document is developed according to the manual for development of ESHRE recommendations for good practice. The recommendations were discussed until consensus by the working group, supported by a survey among the members of the ESHRE SIG-IEP. MAIN RESULTS AND THE ROLE OF CHANCE A clear definition of normally sited pregnancy on ultrasound scan is important to avoid misdiagnosis of uterine ectopic pregnancies. A comprehensive classification of ectopic pregnancy must include definitions and descriptions of each type of ectopic pregnancy. Only a classification which provides descriptions and diagnostic criteria for all possible locations of ectopic pregnancy would be fit for use in routine clinical practice. The working group formulated 17 recommendations on the diagnosis of the different types of ectopic pregnancies on ultrasound. In addition, for each of the types of ectopic pregnancy, a schematic representation and examples on 2D and 3D ultrasound are provided. LIMITATIONS REASONS FOR CAUTION Owing to the limited evidence available, recommendations are mostly based on clinical and technical expertise. WIDER IMPLICATIONS OF THE FINDINGS This document is expected to have a significant impact on clinical practice in ultrasound for early pregnancy. The development of this terminology will help to reduce the risk of misdiagnosis and inappropriate treatment. STUDY FUNDING/COMPETING INTERESTS The meetings of the working group were funded by ESHRE. T.T. declares speakers' fees from GE Healthcare. The other authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A. DISCLAIMER This Good Practice Recommendations (GPR) document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation. ESHRE's GPRs should be used for informational and educational purposes. They should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. Furthermore, ESHRE's GPRs do not constitute or imply the endorsement, recommendation or favouring of any of the included technologies by ESHRE.
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Affiliation(s)
| | - Emma Kirk
- Early Pregnancy and Emergency Gynaecology Unit, Royal Free Hospital London, London, UK
| | - Pim Ankum
- Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - Attila Jakab
- Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | | | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
| | - Rachel Small
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - Tina Tellum
- Department of Gynecology, Oslo University Hospital, Ullevål, Oslo, Norway
| | | | - Thierry Van den Bosch
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Belgium
- Laboratory for Tumor Immunology and Immunotherapy, Leuven, KU, Belgium
| | - Davor Jurkovic
- Department of OB/GYN, University College Hospital, London, UK
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13
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Aranyosi JK, Deli T, Erdei A, Toth G, Jakab A, Fodor M, Nagy EV, Ujhelyi B. Unusual onset of thyroid associated orbitopathy during pregnancy: case report and review of literature. BMC Endocr Disord 2020; 20:183. [PMID: 33317492 PMCID: PMC7737351 DOI: 10.1186/s12902-020-00663-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/09/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Thyroid associated orbitopathy (TAO) is the most common extrathyroidal complication of Graves' disease. The disease course ranges from mild, where symptomatic therapy is sufficient, to severe, where high dose steroid administration or orbital decompression surgery is required. Women of their reproductive age are more likely to be affected. Although pregnancy is a state of enhanced immune tolerance, TAO may develop or worsen in 0.2-0.4% of pregnant women. CASE PRESENTATION We present the case of a 19-year-old woman who has developed hyperthyroidism and progressive TAO during the second trimester of her third pregnancy, which has improved postpartum. The possible mechanisms and the importance of follow up in pregnancy is discussed. CONCLUSIONS Expectant mothers with Graves' disease require follow up of eye signs throughout pregnancy, preferably in the setting of a thyroid-eye clinic.
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Affiliation(s)
- Janos K Aranyosi
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, Debrecen, H-4032, Hungary
| | - Tamas Deli
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Annamaria Erdei
- Division of Endocrinology Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Geza Toth
- Department of Internal Medicine, Szent Lázár Hospital, Salgótarján, Hungary
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Mariann Fodor
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, Debrecen, H-4032, Hungary
| | - Endre V Nagy
- Division of Endocrinology Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Bernadett Ujhelyi
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, Debrecen, H-4032, Hungary.
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14
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Török P, Krasznai Z, Molnár S, Lampé R, Jakab A. Preoperative assessment of endometrial cancer. Transl Cancer Res 2020; 9:7746-7758. [PMID: 35117377 PMCID: PMC8797972 DOI: 10.21037/tcr-20-2068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/06/2020] [Indexed: 11/06/2022]
Abstract
Endometrial cancer (EC), the most common among gynaecological malignancies occurs predominantly after the menopause. The diagnosis is most commonly (in about 75-80%) set up at early stage when surgical therapy and if necessary postoperative radiotherapy results in an excellent prognosis, with a 90-95% 5-year overall survival (OS) and a locoregional recurrence rates of 4-8%. Accurate preoperative assessment of the lymph nodes would ideally identify those patients with advanced stage disease, who might benefit from more extensive surgical procedures and adjuvant therapies. magnetic resonance imaging (MRI), hysteroscopic excisional biopsy (HEB) and high resolution 2D or 3D ultrasound performed by expert operator are considered to add valuable information for preoperative staging of EC. The use of biomarkers could be beneficial in decreasing inter-observer variability between the histology of the diagnostic specimen and the final operative sample, as well as to avoid overtreatment in a part of the high-grade tumors with excellent prognosis. The goal of surgical management of EC is to remove the primary tumor and to identify definite prognostic factors to determine whether adjuvant therapy is required. Extended surgery, including para-aortic lymphadenectomy has a significant morbidity, and with the future selection of cases it can be safely avoided, we can decrease complications without compromising oncological safety. In the future, the importance of hysteroscopy guided sampling may increase to gain a representative sample for biomarker detection.
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Affiliation(s)
- Péter Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoárd Krasznai
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Szabolcs Molnár
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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15
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Kaul M, Storim J, End P, Cabanski M, Jakab A, Schuhler C, Funhoff E, Shaefer F, Dimanova E, Kistowska M, Kinhikar A, Maiolica A, Sinn A, Fuhr R, Cenni B. LOU064 : un inhibiteur covalent oral de la BTK hautement sélectif et puissant avec des effets pharmacodynamiques prometteurs au niveau de la peau. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Mokánszki A, Molnár Z, Varga Tóthné E, Bodnár B, Jakab A, Bálint BL, Balogh I. Altered microRNAs expression levels of sperm and seminal plasma in patients with infertile ejaculates compared with normozoospermic males. HUM FERTIL 2020; 23:246-255. [PMID: 30632823 DOI: 10.1080/14647273.2018.1562241] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Approximately 15% of couples are unable to conceive after one year of unprotected intercourse. Because sperm can be accessed with ease, it is reasonable to search for non-invasive biomarkers in semen. MicroRNAs are a family of short single-stranded non-coding RNA molecules that are capable of regulating gene expression and causing mRNA degradation. We studied the most common 11 spermatogenesis-related microRNAs expression levels in sperm and seminal plasma from patients with oligozoospermic or asthenozoospermic ejaculates, and in men with normozoospermic ejaculates. Five of these miRNAs were significantly upregulated and three were downregulated in infertile males compared to men with normozoospermic ejaculates. A statistically significant negative correlation was found between the sperm concentration and several microRNA expression level (let-7a, miR-7-1-3p, miR-141, miR-200a, and miR-429, p < 0.0001) both in sperm and in seminal plasma. We also found positive correlation between sperm concentration and some miRNA expression levels (miR-15b, miR-34b, and miR-122, p < 0.001) in sperm and in seminal plasma. This is the first study to demonstrate differences between sperm and seminal plasma miRNA expression level and to identify a correlation between the sperm concentration and miRNAs expression level. Therefore, these MiRNAs could have the potential be used as non-invasive biomarkers to diagnose males with impaired sperm production.
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Affiliation(s)
- Attila Mokánszki
- Faculty of Medicine, Department of Laboratory Medicine, Division of Clinical Genetics, University of Debrecen, Debrecen, Hungary
| | - Zsuzsanna Molnár
- Faculty of Medicine, Department of Laboratory Medicine, Division of Clinical Genetics, University of Debrecen, Debrecen, Hungary
| | - Emese Varga Tóthné
- Assisted Reproduction Center, Kaali Institute, Clinical Centre, University of Debrecen, Debrecen, Hungary
| | - Béla Bodnár
- Assisted Reproduction Center, Kaali Institute, Clinical Centre, University of Debrecen, Debrecen, Hungary
| | - Attila Jakab
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Bálint L Bálint
- Faculty of Medicine, Department of Biochemistry and Molecular Biology, University of Debrecen, Debrecen, Hungary
| | - István Balogh
- Faculty of Medicine, Department of Laboratory Medicine, Division of Clinical Genetics, University of Debrecen, Debrecen, Hungary
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17
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Pavo IJ, Gyongyosi M, Jakab A, Lukovic D, Zlabinger K, Gigerell A, Winkler J, Pavo N. P121918F-FDG perfusion-metabolism mismatch 3 days after acute myocardial infarction predicts worse outcome: molecular glucose steel phenomenon visualized by hybrid PET-MRI images. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The disturbance of cardiac energy substrate metabolism has a decisive role in the pathogenesis of adverse cardiac remodeling and heart failure. Under normoxic conditions, the free fatty acid metabolism is the predominant pathway by providing the highest energy per substrate molecule. Severe myocardial hypoxia leads to a switch from beta-oxidation to glucose metabolism to increase the ATP production per oxygen molecule. This metabolic disorder appears as perfusion-metabolism mismatch in 18F-fluorodeoxyglucose (18F-FDG) PET images, as increased 18F-FDG uptake in the under-perfused hypoxic myocardial area.
Purpose
The aim of our study was to evaluate the simultaneous perfusion, metabolism and function of the ischemic heart by hybrid 18F-FDG-PET-cMRI with late enhancement images in a translation animal model of heart failure.
Methods
Under general anesthesia, closed chest reperfused acute myocardial infarction (AMI) was induced in 36 domestic pigs by 90 min occlusion of the mid left anterior descending artery with a percutaneous intracoronary balloon, followed by reperfusion. Three days and 1 month after AMI, after 12h fasting, 18F-FDG-PET-cMRI were performed by using standardized acquisition protocols (n=30). Cardiac functional parameter, such as ejection fraction (EF), end-diastolic volume (EDV), infarct size, and mean tracer uptake of the infarcted area were quantitatively assessed. Six animals were euthanized after the 3-day 18F-FDG-PET-cMRI images to elaborate the differences in gene expression patterns in animals with perfusion-metabolic mismatch by using next generation sequencing (NGS) and pathway network analyses.
Results
Eight (group Mismatch) of the 30 animals (group Match) with 1-month follow-up showed high 18F-FDG uptake in the infarcted area (perfusion-metabolism mismatch) at the 3-day 18F-FDG-PET-cMRI-LE images (Figure). The animals in the Mismatch group had significantly lower EF at 3 days (34±8.8 vs 42±3%) and at the 1-month follow-up (35.8±6 vs 43±6.6%) and larger infarct size at day 3 (26.6±6.6 vs 22.1±4.4%) and 1 month (28±5.4 vs 20.3±4.3%) with higher EDV at 1 month. Mean tracer uptake of the infarcted area was significantly reduced in the Mismatch group at 1 month (56±23.1 vs 64.7±13.2%). NGS revealed downregulation of the cholesterol metabolism pathway, and upregulation of carbohydrate derivative catabolism pathway with highly activated innate immune system and genes responsible for cytokine activation in the infarcted area 3 days post-AMI in the Mismatch group, which explains the paradox high 18F-FDG tracer uptake in the infarction zone. Accordingly, the high energy demand of the severe hypoxic area led to “glucose steel phenomenon” at the molecular level, subtracting the 18F-FDG from the normally perfused non-ischemic myocardial regions.
Conclusions
18F-FDG-glucose perfusion-metabolism mismatch early after AMI visualized by hybrid 18F-FDG-PET-MRI images predict development of LV adverse remodeling.
Acknowledgement/Funding
Fibrotarget EU Grant Nr 602904
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Affiliation(s)
- I J Pavo
- Medical University of Vienna, Vienna, Austria
| | - M Gyongyosi
- Medical University of Vienna, Vienna, Austria
| | - A Jakab
- Medical University of Vienna, Vienna, Austria
| | - D Lukovic
- Medical University of Vienna, Vienna, Austria
| | - K Zlabinger
- Medical University of Vienna, Vienna, Austria
| | - A Gigerell
- Medical University of Vienna, Vienna, Austria
| | - J Winkler
- Medical University of Vienna, Vienna, Austria
| | - N Pavo
- Medical University of Vienna, Vienna, Austria
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18
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Takacs P, Kozma B, Erdodi B, Jakab A, Larson K, Poka R. Zinc-containing Vaginal Moisturizer Gel Improves Postmenopausal Vulvovaginal Symptoms: A Pilot Study. J Menopausal Med 2019; 25:63-68. [PMID: 31080791 PMCID: PMC6487289 DOI: 10.6118/jmm.2019.25.1.63] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/19/2019] [Accepted: 03/04/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives Although vaginal estrogen is highly effective in alleviating genitourinary symptoms of menopause (GSM), some women are reluctant to use hormonal treatment. Our aim was to evaluate the effect of a zinc-containing vaginal moisturizer gel on GSM. Methods Women with GSM were enrolled. Patients were asked to use the vaginal gel daily for 2 weeks. Vaginal Health Index (VHI) was calculated. Visual analogue scale (VAS) was obtained on vaginal pain, dryness, burning, itching, dyspareunia and dysuria before and 2 weeks after the completion of treatment. Vaginal cytology was obtained. Vulvovaginal symptom questionnaire (VSQ-21) was used to assess subjective symptoms. Results Thirty-seven women with GSM participated in the study. The VHI improved significantly (mean ± standard deviation, 13 ± 4 before vs. 17 ± 4 after treatment, P < 0.01). The patient reported VAS combined score was significantly lower after the treatment (18 ± 14 before vs. 7 ± 12 after treatment, P < 0.01). The largest improvement occurred in vaginal dryness. The maturation value did not change significantly. There were no signs of inflammation on vaginal cytology. VSQ-21 combined scores also improved significantly (7.9 ± 5.5 before vs. 2.7 ± 3.6 after the intervention, P < 0.01). Side effects were rare and minor. Conclusions Novel zinc-containing vaginal moisturizer gel significantly improves postmenopausal vulvovaginal symptoms without serious side effects.
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Affiliation(s)
- Peter Takacs
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Bence Kozma
- Department of Obstetrics and Gynecology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Balazs Erdodi
- Department of Obstetrics and Gynecology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Attila Jakab
- Department of Obstetrics and Gynecology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Kindra Larson
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Robert Poka
- Department of Obstetrics and Gynecology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
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Jakab A, Ruegger C, Bucher HU, Makki M, Huppi PS, Tuura R, Hagmann C. Network based statistics reveals trophic and neuroprotective effect of early high dose erythropoetin on brain connectivity in very preterm infants. Neuroimage Clin 2019; 22:101806. [PMID: 30991614 PMCID: PMC6451173 DOI: 10.1016/j.nicl.2019.101806] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 03/18/2019] [Accepted: 03/30/2019] [Indexed: 01/17/2023]
Abstract
Periventricular white matter injury is common in very preterm infants and it is associated with long term neurodevelopmental impairments. While evidence supports the protective effects of erythropoetin (EPO) in preventing injury, we currently lack the complete understanding of how EPO affects the emergence and maturation of anatomical brain connectivity and function. In this case-control study, connectomic analysis based on diffusion MRI tractography was applied to evaluate the effect of early high-dose EPO in preterm infants. A whole brain, network-level analysis revealed a sub-network of anatomical brain connections in which connectivity strengths were significantly stronger in the EPO group. This distributed network comprised connections predominantly in the frontal and temporal lobe bilaterally, and the effect of EPO was focused on peripheral and feeder connections of the core structural connectivity network. EPO resulted in a globally increased clustering coefficient, higher global and average local efficiency, while higher strength and increased clustering was found for regions in the frontal lobe and cingulate gyrus. The connectivity network most affected by the EPO treatment showed a steeper increase graph theoretical measures with age compared to the placebo group. Our results demonstrate a weak but widespread effect of EPO on the structural connectivity network and a possible trophic effect of EPO reflected by increasing network segregation, predominantly in local connections. Erythropoietin (EPO) is a potential neuroprotective agent in very preterm infants. EPO leads to increased structural brain connectivity in fronto-temporal regions. Clustering coefficient, local and global efficiency increases after EPO treatment.
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Affiliation(s)
- A Jakab
- Center for MR Research, University Children's Hospital Zurich, Zurich, Switzerland.
| | - C Ruegger
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - H U Bucher
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Malek Makki
- Center for MR Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - P S Huppi
- Division of Development and Growth, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - R Tuura
- Center for MR Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - C Hagmann
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland; Department of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
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Abstract
Rapid advance in oncology leads to increasing survival of oncologic patients. More and more of them live long enough to reach either the natural age of menopause or, as a side effect of their oncotherapy, experience the cessation of gonadal function, leading to premature ovarian insufficiency, with disturbing vasomotor symtoms and long-term negative cardiovascular and skeletal effects. Thus, an ever increasing number of cancer survivors search endocrinologic help in the form of hormone replacement therapy (HRT). The misinterpretation of the WHI (Women's Health Initiative) Study has lead to an irrational fear of female hormone replacement, both by the general population and medical professionals. It has seemed the logical and safe conclusion to many physicians to avoid HRT, supposing that this attitude definitely causes no harm, whereas the decision of prescribing estrogen alone or with progestins might bear oncologic and thromboembolic risks and may even lead to litigation in case of a potentially related complication. However, it was known even before the WHI results that premature menopause and hypogonadism decreases the life expectancy of women by years through its skeletal and cardiovascular effects, and this negative effect correlates with the length of the hypoestrogenaemic period. Therefore, the denial of HRT also needs to be supported by evidence and should be weighed againts the risks of HRT. Yet, the oncologic risk of HRT is extremely difficult to assess. In this work we review the latest evidence from in vitro experiments to clinical studies, regarding HRT in survivors of gynecologic and non-gynecologic cancers. Based on our literature research, we group tumours regarding the oncologic risk of properly chosen female hormone replacement therapy in cancer survivors as follows: ’HRT is advanageous’ (e.g. endometrial cancer type I, cervical adenocarcinoma, haematologic malignancies, local cutaneous malignant melanoma, colorectal cancer, hepatocellular cancer); ’HRT is neutral’ (e.g. BRCA 1/2 mutation carriers without cancer, endometrial cancer type II, uterinal carcinosarcoma and adenosarcoma, certain types of ovarian cancer, cervical, vaginal and vulvar squamous cell carcinoma, prolactinoma, kidney cancer, pancreatic cancer, thyroid cancer); ’HRT is relatively contraindicated’ for various reasons (e.g. leiomyosarcoma, certain types of ovarian tumours, brain tumours, advanced metastatic malignant melanoma, lung cancer, gastric cancer, bladder cancer); ’HRT is diasadvantageous and thus contraindicated’ (e.g. breast cancer, endometrial stroma sarcoma, meningioma, glioma, hormone receptor positive gastric and bladder cancer).
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Affiliation(s)
- Tamás Deli
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Mónika Orosz
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Green RW, Valentin L, Alcazar JL, Chiappa V, Erdodi B, Franchi D, Frühauf F, Fruscio R, Guerriero S, Graupera B, Jakab A, di Legge A, Ludovisi M, Mascilini F, Pascual MA, van den Bosch T, Epstein E. Endometrial cancer off-line staging using two-dimensional transvaginal ultrasound and three-dimensional volume contrast imaging: Intermethod agreement, interrater reliability and diagnostic accuracy. Gynecol Oncol 2018; 150:438-445. [DOI: 10.1016/j.ygyno.2018.06.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/30/2018] [Accepted: 06/24/2018] [Indexed: 12/14/2022]
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Gara E, Ong SG, Winkler J, Zlabinger K, Lukovic D, Jakab A, Merkely B, Wu JC, Gyongyosi M, Pavo N. 240Mesenchymal stem cells transfected with minicircle-HIF-1a decreases LV adverse remodelling via release of cardioprotective miRNAs and pro-angiogenic factors. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Gara
- Semmelweis University, Heart Center, Budapest, Hungary
| | - S G Ong
- School of Medicine, Stanford Cardiovascular Institute, Stanford, United States of America
| | - J Winkler
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - K Zlabinger
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - D Lukovic
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - A Jakab
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - B Merkely
- Semmelweis University, Heart Center, Budapest, Hungary
| | - J C Wu
- School of Medicine, Stanford Cardiovascular Institute, Stanford, United States of America
| | - M Gyongyosi
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - N Pavo
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
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Lukovic D, Zlabinger K, Spannbauer A, Gugerell A, Pavo N, Traxler D, Jakab A, Bergler-Klein J, Gyongyosi M, Winkler J. 403Induction of interferon-related genes limits the cardiotoxicity of liposomal doxorubicin in pigs. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Lukovic
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - K Zlabinger
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - A Spannbauer
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - A Gugerell
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - N Pavo
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - D Traxler
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - A Jakab
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - J Bergler-Klein
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - M Gyongyosi
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - J Winkler
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
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Meuwly E, Feldmann M, von Rhein M, Dave H, Tuura R, Latal B, Jakab A, Knirsch W. Regional Brain Volumes Predict One-Year Neurodevelopmental Outcome in Children with Severe Congenital Heart Disease. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- E. Meuwly
- Child Development Center, University Children's Hospital, Zürich, Switzerland
| | - M. Feldmann
- Child Development Center, University Children's Hospital, Zürich, Switzerland
| | - M. von Rhein
- Child Development Center, University Children's Hospital, Zürich, Switzerland
| | - H. Dave
- Children's Research Center, University Children's Hospital, Zürich, Switzerland
| | - R. Tuura
- Children's Research Center, University Children's Hospital, Zürich, Switzerland
| | - B. Latal
- Child Development Center, University Children's Hospital, Zürich, Switzerland
| | - A. Jakab
- Children's Research Center, University Children's Hospital, Zürich, Switzerland
| | - W. Knirsch
- Children's Research Center, University Children's Hospital, Zürich, Switzerland
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Jakab A, Meuwli E, von Rhein M, Tuura R, Scheer I, Latal B, Knirsch W. Longitudinal MRI Portrays Impaired Cerebral Growth and Its Association to Neurodevelopmental Outcome in Newborns with Congenital Heart Disease Undergoing Cardiopulmonary Bypass Surgery. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A. Jakab
- Center for MR-Research, University Children's Hospital Zurich, Zürich, Switzerland
| | - E. Meuwli
- Child Development Centre, University Children's Hospital Zurich, Zürich, Switzerland
| | - M. von Rhein
- Child Development Centre, University Children's Hospital Zurich, Zürich, Switzerland
| | - R. Tuura
- Center for MR-Research, University Children's Hospital Zurich, Zürich, Switzerland
| | - I. Scheer
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Zürich, Switzerland
| | - B. Latal
- Child Development Centre, University Children's Hospital Zurich, Zürich, Switzerland
| | - W. Knirsch
- Division of Pediatric Cardiology, University Children's Hospital Zurich, Zürich, Switzerland
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Lőrincz J, Jakab A, Török P. Vaginal Fibroma: An Unusual Vaginal Tumor. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Judit Lőrincz
- Department of Obstetrics and Gynecology, Kenézy Gyula County Hospital, Debrecen, Hungary
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Clinical Center, University of Debrecen Medical and Health Science Center, Debrecen, Hungary
| | - Péter Török
- Department of Obstetrics and Gynecology, Clinical Center, University of Debrecen Medical and Health Science Center, Debrecen, Hungary
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Abstract
Purpose Plasminogen activator activity (PAA) in tears of pregnant women was investigated at various gestation times to assess the availability of plasminogen activator for aiding potential corneal wound healing processes during pregnancy. Methods PAA was measured by a spectrophotometric method. The analysis used 91 tear samples from pregnant and non-pregnant women, supplemented with 10 additional tear PAA measurements from non-pregnant women obtained in a previous study. Results Tear levels of PAA in pregnant women formed a bimodal distribution. Either the tear PAA level was zero or non-zero during pregnancy. When non-zero, the tear PAA level was dissociated from gestation time and not different than non-pregnant and post-pregnant levels. The frequency of occurrence of zero level tear PAA increased with gestation: 16%, 17% and 46% had zero tear PAA in samples taken from women in the first, second and third trimester, respectively. Conclusions Overall, of the tear samples taken from women during pregnancy, a total of 26% were at zero tear PAA. The remaining tear samples had non-zero tear PAA values throughout gestation equivalent to non-pregnant tear PAA values, suggesting local control of the source of PAA in tears. Given the importance of the plasminogen activator system in tears to wound healing in the cornea, and the high occurrence of zero tear PAA in our sample of pregnant women, elective corneal surgery would be contraindicated. If corneal surgery is nevertheless necessary, the tear PAA level would be worth checking and patients with low level should be closely observed during the postoperative period.
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Affiliation(s)
- Adrienne Csutak
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- * E-mail:
| | - Zita Steiber
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - József Tőzsér
- Department of Biochemistry & Molecular Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - András Berta
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - David M. Silver
- Johns Hopkins University, Bethesda, Maryland, United States of America
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Abstract
Abstract: Most common organic cause of infertility is the blockage of the Fallopian tubes. Several methods were introduced to evaluate tubal patency. Hysterosalpingography is a conventional radiology procedure using contrast medium, which gives an accurate image of the uterine cavity and the Fallopian tubes, but radiation exposure is necessary. Hystero-contrast-sonography similarly examines the uterine cavity and tubal patency by ultrasonography, and it enables to detect pelvic pathology, too. Transvaginal hydrolaparoscopy is a minimal invasive direct method using endoscope introduced into the abdominal cavity through the posterior vaginal fornix, both ovaries and tubal patency can be observed. Laparoscopy is the “gold standard” procedure in the tubal testing, however it is a more invasive procedure. A cost-effective testing method is the selective tubal pertubation performed via office hysteroscopy. Recent outpatient methods to detect tubal patency have high negative predictive values and recommended to be the first choice in infertility work-up. Orv. Hetil., 2017, 158(9), 324–330.
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Affiliation(s)
- Judit Lőrincz
- Szülészeti és Nőgyógyászati Osztály, Kenézy Gyula Kórház és Rendelőintézet Debrecen, Bartók Béla út 2–26., 4031
| | - Attila Jakab
- Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Péter Török
- Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
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Orosz M, Jakab A, Poka R, Csehely S, Deli T. Special aspects of pregnancy care in PCOS patients. Eur J Obstet Gynecol Reprod Biol 2016. [DOI: 10.1016/j.ejogrb.2016.07.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Farkas E, Papp EK, Csehely S, Orosz M, Deli T, Molnar Z, Poka R, Jakab A. Laboratory and etiology characteristics of PCOS phenotypes. Eur J Obstet Gynecol Reprod Biol 2016. [DOI: 10.1016/j.ejogrb.2016.07.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Csehely S, Kovacs A, Orosz M, Deli T, Farkas E, Bacsko G, Poka R, Jakab A. Perinatal outcome of pregnancies after assisted reproduction and natural conception. Eur J Obstet Gynecol Reprod Biol 2016. [DOI: 10.1016/j.ejogrb.2016.07.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Medinger M, Krenger W, Jakab A, Halter J, Buser A, Bucher C, Passweg J, Tzankov A. Numerical impairment of nestin(+) bone marrow niches in acute GvHD after allogeneic hematopoietic stem cell transplantation for AML. Bone Marrow Transplant 2015; 50:1453-8. [PMID: 26301968 DOI: 10.1038/bmt.2015.189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/25/2015] [Accepted: 07/10/2015] [Indexed: 01/12/2023]
Abstract
The nestin(+) perivascular bone marrow (BM) stem cell niche (N(+)SCN) may be involved in GvHD. To investigate whether acute GvHD (aGvHD) reduces the number of N(+)SCN, we examined patients with AML who had undergone allogeneic hematopoietic stem cell transplantation. In the test cohort (n=8), the number of N(+)SCN per mm(2) in BM biopsies was significantly reduced in aGvHD patients at the time of aGvHD compared with patients who did not have aGvHD (1.2±0.78 versus 2.6±0.93, P=0.04). In the validation cohort (n=40), the number of N(+)SCN was reduced (1.9±0.99 versus 2.6±0.90 N(+)SCN/mm(2), P=0.05) in aGvHD patients. Receiver operating curves suggested that the cutoff score that best discriminated between patients with and without aGvHD was 2.29 N(+)SCN/mm(2). Applying this cutoff score, 9/11 patients with clinically relevant aGvHD (⩾grade 2) and 13/20 with any type of GvHD had decreased N(+)SCN numbers compared with only 10/29 patients without clinically relevant aGvHD (P=0.007) and 6/20 patients without any type of GvHD (P=0.028). In patients tracked over time, N(+)SCN density returned to normal after aGvHD resolved or remained stable in patients who did not have aGvHD. Our results show a decrease in the number of N(+)SCN in aGvHD.
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Affiliation(s)
- M Medinger
- Hematology, University Hospital Basel, Basel, Switzerland
| | - W Krenger
- GMP Facility, University Hospital Basel, Basel, Switzerland
| | - A Jakab
- Hematology, University Hospital Basel, Basel, Switzerland
| | - J Halter
- Hematology, University Hospital Basel, Basel, Switzerland
| | - A Buser
- Hematology, University Hospital Basel, Basel, Switzerland
| | - C Bucher
- Hematology, University Hospital Basel, Basel, Switzerland
| | - J Passweg
- Hematology, University Hospital Basel, Basel, Switzerland
| | - A Tzankov
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
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Sivasubramanian R, Chakraborty A, Rouzade-Dominguez M, Neelakantham S, Jakab A, Mensinga T, Legangneux E, Woessner R, Ufer M. Effect of mavoglurant (AFQ056) on the Pharmacokinetics of a combined oral contraceptive containing ethinyl estradiol and Levonorgestrel in healthy Women. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Molnár Z, Benyó M, Bazsáné Kassai Z, Lévai Í, Varga A, Jakab A. [Influence of malignant tumors occurring in the reproductive age on spermiogenesis: studies on patients with testicular tumor and lymphoma]. Orv Hetil 2014; 155:1306-11. [PMID: 25109916 DOI: 10.1556/oh.2014.29951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The application of chemo- and radiotherapy results in good survival prognosis for young men with malignant tumors, but long-term gonadoxic effect has to be considered. In addition, malignant disease itself has a negative impact on spermiogenesis. AIM The aim of the authors was to examine the spermiogenetic effect of the most common tumors occurring in the reproductive age in men: testicular cancer, Hodgkin disease and non-Hodgkin disease. METHOD Spermiogram of men with testicular cancer (N = 68), Hodgkin disease (N = 37) and non-Hodgkin disease (N = 14) who were referred for sperm cryopreservation were analysed in the Reproductive Andrology Laboratory of the authors. RESULTS Azoospermia was found in 11.8% of all patients (N = 119), while 58.8% of the patients had oligozoospermia even before the treatment. Sperm concentration of men with testicular cancer was significantly lower than those with lymphomas (32.8 M/mL vs. 24.9 M/mL, p = 0.03). There was no difference in sperm concentration between the Hodgkin and non-Hodgkin lymphoma groups. CONCLUSIONS Spermiogenetic defect is more pronounced in men with testicular cancer than those with lymphomas. Cryopreservation before treatment for fertility preservation should be offered for all reproductive aged men with malignant disease, especially for those with testicular cancer.
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Affiliation(s)
- Zsuzsanna Molnár
- Debreceni Egyetem, Általános Orvostudományi Kar Szülészeti és Nőgyógyászati Klinika Debrecen Nagyerdei krt. 98. 4032 Debreceni Egyetem, Általános Orvostudományi Kar Laboratóriumi Medicina Intézet Debrecen
| | - Mátyás Benyó
- Debreceni Egyetem, Általános Orvostudományi Kar Urológiai Klinika Debrecen
| | - Zsuzsa Bazsáné Kassai
- Debreceni Egyetem, Általános Orvostudományi Kar Szülészeti és Nőgyógyászati Klinika Debrecen Nagyerdei krt. 98. 4032
| | - Írisz Lévai
- Debreceni Egyetem, Általános Orvostudományi Kar Szülészeti és Nőgyógyászati Klinika Debrecen Nagyerdei krt. 98. 4032 University of Kent at Medway School of Sport and Exercise Sciences Chatham, Kent UK
| | - Attila Varga
- Debreceni Egyetem, Általános Orvostudományi Kar Urológiai Klinika Debrecen
| | - Attila Jakab
- Debreceni Egyetem, Általános Orvostudományi Kar Szülészeti és Nőgyógyászati Klinika Debrecen Nagyerdei krt. 98. 4032
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Mokánszki A, Tóthné EV, Bodnár B, Tándor Z, Molnár Z, Jakab A, Ujfalusi A, Oláh É. Is sperm hyaluronic acid binding ability predictive for clinical success of intracytoplasmic sperm injection: PICSI vs. ICSI? Syst Biol Reprod Med 2014; 60:348-54. [DOI: 10.3109/19396368.2014.948102] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Molnar Z, Mokanszki A, Kassai Bazsane Z, Bhattoa HP, Benyo M, Olah E, Jakab A. Sperm concentration, hyaluronic acid-binding capacity, aneuploidy and persistent histones in testicular cancer. Hum Reprod 2014; 29:1866-74. [DOI: 10.1093/humrep/deu179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
INTRODUCTION Polycystic ovary syndrome is the most common endocrine disease in women. Psychic consequences are significant; patients have difficulties to be pregnant and the disease disturbs the quality of life. Due to complications associated with polycystic ovary syndrome, studies on psychological state and disease perception of patients appear to be important. AIM The aim of the authors was to assess how the disease influences quality of life and changes in body image. METHOD The authors used the Illness Intrusiveness Ratings Scale, Health-Related-Quality-of-Life Questionnaire for Women with Polycystic Ovary Syndrome and their own body image questionnaire. 121 women took part in the study. RESULTS There was a negative correlation between illness intrusiveness and quality of life (r = -0.353) and a positive correlation between body image and quality of life (r = 0.614). A significant difference was observed in body satisfaction between patients who had visible body changes and those who had metabolic disturbances (p<0.05). Overweight patients who lost weight with lifestyle changes had significantly better quality of life (p<0.05). CONCLUSIONS These results appear to be convincing in that in addition to gynecological care, psychotherapy could be offered to patients with polycystic ovary syndrome.
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Affiliation(s)
- Orsolya Micskei
- Debreceni Egyetem, Népegészségügyi Kar Magatartástudományi Intézet Debrecen
| | - Tamás Deli
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Szülészeti és Nőgyógyászati Klinika Debrecen
| | - Attila Jakab
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Szülészeti és Nőgyógyászati Klinika Debrecen
| | - Antal Bugán
- Debreceni Egyetem, Népegészségügyi Kar Magatartástudományi Intézet Debrecen
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Molnár Z, Berta E, Benyó M, Póka R, Kassai Z, Flaskó T, Jakab A, Bodor M. Fertility of testicular cancer patients after anticancer treatment--experience of 11 years. Pharmazie 2014; 69:437-441. [PMID: 24974577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Testicular cancer affects men mostly in their reproductive age with a cure rate over 90%. Preserved fertility is one of the main concerns of the survivors. To further elucidate the question of fertility after anticancer treatment for testicular cancer, we performed a survey among patients who underwent sperm cryopreservation procedure in our department. A structured questionnaire was designed to collect data on demography, anticancer treatment, histological type of cancer, family planning intentions and fertility prior to and after treatment. During a period of 11 years 86 men underwent semen cryopreservation before starting chemo-or radiotherapy. Fifty-nine of them consented to participate in the study. The average length of follow up was 4.6 +/- 3.8 years. In case of 11.9% of the patients their banked sperm was used, which led to live birth in 57% of the couples. The partners of 6 patients became pregnant after in vitro fertilization (IVF) resulting in 4 live births and 2 miscarriages. The spontaneous pregnancy rate was 22%. Spontaneous pregnancy occurred in 13 partners resulting in 18 pregnancies followed by 12 live births, 2 artificial abortions and 4 miscarriages. We could not prove any association between preserved fertility and anticancer treatment or the histological type of the cancer. In conclusion, although spontaneous pregnancy rate is remarkably high after anticancer treatment for testicular cancer, the risk of infertility after receiving gonadotoxic treatment cannot be predicted. Cryopreservation is a safe and effective method to preserve fertility in these cases. As a result we strongly recommend discussing the advantages of semen cryopreservation with all patients awaiting treatment for testicular cancer.
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Szucs M, Osvath P, Laczko I, Jakab A. Adequacy of hyaluronan binding assay and a new fertility index derived from it for measuring of male fertility potential and the efficacy of supplement therapy. Andrologia 2014; 47:519-24. [DOI: 10.1111/and.12296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2014] [Indexed: 01/13/2023] Open
Affiliation(s)
- M. Szucs
- Department of Urology and Andrology; Kenézy Gyula Hospital; Debrecen Hungary
| | - P. Osvath
- Department of Urology and Andrology; Kenézy Gyula Hospital; Debrecen Hungary
| | - I. Laczko
- Department of Urology and Andrology; Kenézy Gyula Hospital; Debrecen Hungary
| | - A. Jakab
- Department of Obstetrics and Gynecology; University of Debrecen; Debrecen Hungary
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Carchenilla MSC, Agudo D, Rubio S, Becerra D, Bronet F, Garcia-Velasco JA, Pacheco A, Lardone M, Piottante A, Parada-Bustamante A, Argandona F, Florez M, Espinoza A, Ebensperger M, Castro A, Cohen-Bacrie M, Belloc S, Dalleac A, Amar E, Izard V, Hazout A, Cohen-Bacrie P, de Mouzon J, Muzzonigro F, Crivello AM, Stanghellini I, Bernardini L, Ferraretti AP, Magli C, Gianaroli L, Martin PS, Duvison MH, Silva MD, Gosalvez J, Martin FS, Pomante A, Muzzonigro F, Colombo F, Mattioli M, Barboni B, Ferraretti AP, Magli MC, Gianaroli L, Hacifazlioglu O, Findikli N, Goktolga U, Bahceci M, Jakab A, Mokanszki A, Varga A, Benyo M, Kassai Z, Olah E, Molnar Z, Gundogan GI, Bozkurt HH, Irez T, Domingo A, Anarte C, Presilla N, Calvo I, Aguirre O, Oroquieta A, Agirregoikoa JA, De Pablo JL, Barrenetxea G, Moragues I, Medrano ML, Montoya A, Ramos B, Torres MJG, Aizpurua J, Ibala SR, Ghedir H, Mehri A, Zidi I, Brahem S, Mehdi M, Ajina M, Saad A, Medrano ML, Moragues I, Gomez-Torres MJ, Montoya A, Aizpurua J, Cavaco JE, Rato L, Alves MG, Dias TR, Lopes G, Socorro S, Oliveira PF, Lobascio AM, Minasi MG, Greco E, Bungum M, Bungum A, Silver N, Zahiri M, Movahedin M, Mowla SJ, Noruzinia M, Huleihel M, Abarbanel Y, Haber EP, Azab M, Lan D, Lunenfeld E, Smith MJ, Neri QV, Harvey L, Rosenwaks Z, Palermo GD, Alhalabi M, Samawi S, Droubi H, Khalaf M, Taha A, Khatib R, Bednarowska-flisiak A, Wcislo M, Liss J, Swider A, Szczyglinska J, Grzymkowska M, Bruszczynska A, Glowacka J, Kitowska-Marszalkowska K, Krapchev M, Mirecka A, Wisniewska K, Lukaszuk K, Natali I, Tamburrino L, Cambi M, Marchiani S, Noci I, Maggi M, Forti G, Baldi E, Muratori M, Ferraretto X, Pasquet B, Damond F, Matheron S, Epelboin S, Yahi S, Demailly P, Rougier N, Yazbeck C, Delaroche L, Longuet P, Llabador M, Estellat C, Patrat C, Wcislo M, Liss J, Swider A, Szczyglinska J, Grzymkowska M, Bruszczynska A, Glowacka J, Krapchev M, Mirecka A, Kitowska-Marszalkowska K, Wisniewska K, Lukaszuk K, Askarijahromi M, Movahedin M, Amanlu M, Mowla SJ, Mazaheri Z, Christensen P, Sills ES, Fischer R, Naether OGJ, Walsh D, Rudolf K, Coull G, Baukloh V, Labouriau R, Birck A, Parisi F, Parrilla B, Oneta M, Savasi V, Veleva L, Milachich T, Bochev I, Antonova I, Shterev A, Vlaisavljevic V, Breznik BP, Kovacic B, Serrano M, Gonzalvo MC, Clavero A, Fernandez MF, Mozas J, Martinez L, Fontes J, Carrillo S, Lopez-Regalado ML, Lopez-Leria B, Orozco I, Mantilla A, Castilla JA, Mskhalaya G, Zakharova E, Zaletova V, Kasatonova E, Melnik Y, Efremov E, Breznik BP, Kovacic B, Vlaisavljevic V, Schiewe MC, Verheyen G, Tournaye H, Phletincx I, Sims CA, Rothman C, Borges E, Setti AS, Braga DPAF, Vingris L, Iaconelli A, Dupont C, Faure C, Sermondade N, Gautier B, Herbemont C, Aknin I, Klein JP, Cedrin-Durnerin I, Wolf JP, Czernichow S, Levy R, Rondanino C, Chauffour C, Ouchchane L, Artonne C, Janny L, Lobaccaro JM, Volle DH, Brugnon F, Colacurci N, Piomboni P, Ruvolo G, Lombardo F, Verde EL, De Leo V, Lispi M, Papaleo E, De Palo R, Gandini L, Longobardi S, Yokota Y, Yokota M, Yokota H, Araki Y, Araki Y, Alshahrani S, Durairajanayagam D, Sharma R, Sabanegh E, Agarwal A, Hattori H, Nakajo Y, Ikeno T, Sato Y, Kyoya T, Kyono K, Li B, Li JB, Xiao XF, Ma YF, Wang J, Liang XX, Zhao HX, Jiang F, Yao YQ, Wang XH, Roan NR, Liu H, Muller J, Avila-Herrera A, Pollard KS, Lishko P, Kirchhoff F, Munch J, Witkowska HE, Greene WC, Mangiarini A, Paffoni A, Restelli L, Guarneri C, Somigliana E, Ragni G, Anarte C, Domingo A, Calvo I, Presilla N, Aguirre O, Bou R, Aleman M, Guardiola F, Agirregoikoa JA, De Pablo JL, Barrenetxea G, Camargo C, Oliveira JBA, Petersen CG, Mauri AL, Massaro FC, Nicoletti A, Nascimento AM, Vagnini LD, Martins AMVC, Cavagna M, Baruffi RLR, Franco JG. Andrology. Hum Reprod 2013. [DOI: 10.1093/humrep/det206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mokánszki A, Ujfalusi A, Balogh E, Molnár Z, Sápy T, Jakab A, Varga A, Oláh E. [Citogenetic and molecular genetic studies in infertility in eastern Hungary]. Orv Hetil 2013; 154:52-61. [PMID: 23291203 DOI: 10.1556/oh.2013.29510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In developed countries 10-15% of the couples are affected by infertility. In half of them genetic factors can be identified. AIMS We studied genetic alterations in infertility in Hungarian patients. METHODS Cyogenetic analyses were performed in 195 females and 305 males. In 17 females FMR1 mutations, in 150 males Y microdeletions, and aneuploidy were studied in the sperm of 28 males. In a carrier male sperm meiotic segregation was studied. RESULTS The most common aberrations in females were X chromosome aneuploidia and inversion (3.6%), while the same in males Klinefelter-syndrome (3.3%) and autosomal translocations (2%). In two females FMR1 premutation was found. While Y microdeletions were identified only in azoospermic and severe oligozoospermic men, partial microdeletions could also be detected in normozoospermic males. A higher aberration rate was found in cases with abnormality in both the number and motility of sperm. In a male patient with 46,XY,t(3;6)(q21;q23) karyotype, 53.2% of spem carried unbalanced chromosome assortment. CONCLUSIONS Knowledge of abnormalities may help in genetic counseling and choosing the most effective reproduction technique.
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Affiliation(s)
- Attila Mokánszki
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Gyermekgyógyászati Intézet, Klinikai Genetikai Központ Debrecen Nagyerdei krt. 98. 4032
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Mokánszki A, Molnár Z, Ujfalusi A, Balogh E, Bazsáné ZK, Varga A, Jakab A, Oláh É. Correlation study between sperm concentration, hyaluronic acid-binding capacity and sperm aneuploidy in Hungarian patients. Reprod Biomed Online 2012; 25:620-6. [PMID: 23063816 DOI: 10.1016/j.rbmo.2012.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 08/17/2012] [Accepted: 08/21/2012] [Indexed: 11/17/2022]
Abstract
Infertile men with low sperm concentration and/or less motile spermatozoa have an increased risk of producing aneuploid spermatozoa. Selecting spermatozoa by hyaluronic acid (HA) binding may reduce genetic risks such as chromosomal rearrangements and numerical aberrations. Fluorescence in-situ hybridization (FISH) has been used to evaluate the presence of aneuploidies. This study examined spermatozoa of 10 oligozoospermic, 9 asthenozoospermic, 9 oligoasthenozoospermic and 17 normozoospermic men by HA binding and FISH. Mean percentage of HA-bound spermatozoa in the normozoospermic group was 81%, which was significantly higher than in the oligozoospermic (P<0.001), asthenozoospermic (P<0.001) and oligoasthenozoospermic (P<0.001) groups. Disomy of sex chromosomes (P=0.014) and chromosome 17 (P=0.0019), diploidy (P=0.03) and estimated numerical chromosome aberrations (P=0.004) were significantly higher in the oligoasthenozoospermic group compared with the other groups. There were statistically significant relationships (P<0.001) between sperm concentration and HA binding (r=0.658), between sperm concentration and estimated numerical chromosome aberrations (r=-0.668) and between HA binding and estimated numerical chromosome aberrations (r=-0.682). HA binding and aneuploidy studies of spermatozoa in individual cases allow prediction of reproductive prognosis and provision of appropriate genetic counselling. Infertile men with normal karyotypes and low sperm concentrations and/or less motile spermatozoa have significantly increased risks of producing aneuploid (diminished mature) spermatozoa. Selecting spermatozoa by hyaluronic acid (HA) binding, based on a binding between sperm receptors for zona pellucida and HA, may reduce the potential genetic risks such as chromosomal rearrangements and numerical aberrations. In the present study we examined sperm samples of 45 men with different sperm parameters by HA-binding assay and fluorescence in-situ hybridization (FISH). Mean percentage of HA-bound spermatozoa in the normozoospermic group was significantly higher than the oligozoospermic, the asthenozoospermic and the oligoasthenozoospermic groups. Using FISH, disomy of sex chromosomes and chromosome 17, diploidy and estimated numerical chromosome aberration frequencies were significantly higher in the oligoasthenozoospermic group compared with the three other groups. A significant positive correlation was found between the sperm concentration and the HA-binding capacity, and significant negative correlations between the sperm concentration and the estimated numerical chromosomes aberrations as well as between the HA-binding ability and the estimated numerical chromosome aberrations were identified. We conclude that HA-binding assay and sperm aneuploidy study using FISH may help to predict the reproductive ability of selected infertile male patients and to provide appropriate genetic counselling.
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Affiliation(s)
- Attila Mokánszki
- Clinical Genetic Center, Department of Pediatrics, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
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Jakab A, Blanc R, Berényi EL, Székely G. Generation of individualized thalamus target maps by using statistical shape models and thalamocortical tractography. AJNR Am J Neuroradiol 2012; 33:2110-6. [PMID: 22700756 DOI: 10.3174/ajnr.a3140] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Neurosurgical interventions of the thalamus rely on transferring stereotactic coordinates from an atlas onto the patient's MR brain images. We propose a prototype application for performing thalamus target map individualization by fusing patient-specific thalamus geometric information and diffusion tensor tractography. MATERIALS AND METHODS Previously, our workgroup developed a thalamus atlas by fusing anatomic information from 7 histologically processed thalami. Thalamocortical connectivity maps were generated from DTI scans of 40 subjects by using a previously described procedure and were mapped to a standard neuroimaging space. These data were merged into a statistical shape model describing the morphologic variability of the thalamic outline, nuclei, and connectivity landmarks. This model was used to deform the atlas to individual images. Postmortem MR imaging scans were used to quantify the accuracy of nuclei predictions. RESULTS Reliable tractography-based markers were located in the ventral lateral thalamus, with the somatosensory connections coinciding with the VPLa and VPLp nuclei; and motor/premotor connections, with the VLpv and VLa nuclei. Prediction accuracy of thalamus outlines was higher with the SSM approach than the ACPC alignment of data (0.56 mm versus 1.24; Dice overlap: 0.87 versus 0.7); for individual nuclei: 0.65 mm, Dice: 0.63 (SSM); 1.24 mm, Dice: 0.4 (ACPC). CONCLUSIONS Previous studies have already applied DTI to the thalamus. As a further step in this direction, we demonstrate a hybrid approach by using statistical shape models, which have the potential to cope with intersubject variations in individual thalamus geometry.
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Affiliation(s)
- A Jakab
- Computer Vision Laboratory, Swiss Federal Institute of Technology, Zürich, Switzerland.
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Mokánszki A, Ujfalusi A, Balogh E, Sümegi A, Antal-Szalmás P, Bazsáné ZK, Molnár Z, Varga A, Sápy T, Jakab A, Oláh É. Meiotic segregation study of a novel t(3;6)(q21;q23) in an infertile man using fluorescence in situhybridization (FISH). Syst Biol Reprod Med 2012; 58:160-4. [DOI: 10.3109/19396368.2012.670868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Akakubo N, Kagawa N, Yabuuchi A, Silber SJ, Yamaguchi S, Nagumo Y, Takai Y, Ishihara S, Takehara Y, Kato O, Kocent J, Hu JCY, Neri QV, Rosenwaks Z, Palermo GD, Armuand G, Rodriguez-Wallberg K, Wettergren L, Lampic C, Martinez-Soto JC, Domingo JC, Cordovilla B, Gadea J, Landeras J, Sadri-Ardekani H, Akhondi MM, van der Veen F, de Rooij DG, Repping S, van Pelt AMM, Vanacker J, Luyckx V, Dolmans MM, Amorim CA, Van Langendonckt A, Donnez J, Camboni A, Camboni A, Amorim CA, Vanacker J, Dolmans MM, Van Langendonckt A, Donnez J, Gavella M, Lipovac V, Siftar Z, Garaj-Vrhovac V, Gajski G, Gook D, Borg J, Edgar DH, Brink-van der Vlugt JJ, Van der Velden VHJ, Noordijk A, Timmer-Bosscha H, Tissing WJE, Land JA, Hollema H, Van Echten-Arends J, Alvarez JG, Gosalvez A, Velilla E, Lopez-Teijon M, Lopez-Fernandez C, Gosalvez J, Kristensen SG, Rasmussen A, Yding Andersen C, Raziel A, Friedler S, Gidoni Y, Ben Ami I, Kaufman S, Omansky A, Strassburger D, Komarovsky D, Bern O, Kasterstein E, Komsky A, Maslansky B, Ron-El R, Fujimoto A, Osuga Y, Ichinose M, Oishi H, Harada M, Koizumi M, Takemura Y, Yano T, Taketani Y, Molnar Z, Mokanszki A, Benyo M, Bazsane Kassai Z, Olah E, Jakab A, Rodriguez-Wallberg KA, Vonheim E, Gumus E, Persson I, Lundqvist M, Karlstrom PO, Hovatta O, Pasqualotto FF, Teixeira R, Medeiros GS, Canabarro C, Tonezer J, Grando APC, Borges Jr. E, Pasqualotto EB, Westphal JR, Bastings L, Beerendonk CCM, Braat DDM, Peek R, Courbiere B, Berthelot-Ricou A, Di Giorgio C, De Meo M, Roustan A, Botta A, Perrin J, Abir R, Orvieto R, Friedman O, Ben-Haroush A, Fisch B, Lawrenz B, Henes J, Henes M, Neunhoeffer E, Schmalzing M, Fehm T, Koetter I. POSTER VIEWING SESSION - MALE AND FEMALE FERTILITY PRESERVATION. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kasapoglu I, Ata B, Ozerkan K, Uncu Y, Celik N, Uncu G, Ferrero S, Morotti M, Leone Roberti Maggiore U, Nicoletti AJ, Venturini PL, Remorgida V, Torok P, Jakab A, Major T, Lessey BA, Bushnell GA, Miller SE, Price TA, Azumaguchi A, Henmi H, Saito M, Itabashi E, Turkgeldi L, Turkgeldi E, Riris S, Cutner A, MacDonald N, Mould T, Olaitan A, Saridogan E. SELECTED ORAL COMMUNICATION SESSION SESSION 06: ENDOMETRIOSIS AND SURGERY Monday 4 July 2011 10:00 - 11:30. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Matsumoto Y, Goto S, Hashimoto H, Kokeguchi S, Shiotani M, Okada H, Cohen - Bacrie P, Hazout A, Belloc S, De Mouzon J, Menezo Y, Dumont M, Junca AM, Cohen-Bacrie M, Alvarez S, Olivennes F, Prisant N, Weltin M, Geissler W, Clussmann C, Strowitzki T, Eggert-Kruse W, Endou Y, Fjii Y, Motoyama H, Quintana FQ, Zaloa Larreategui ZL, Iratxe Penalba IP, Sara Ortega SO, Monica Martin MM, Guillermo Quea GQ, Jose Serna JS, Showell MG, Brown J, Yazdani A, Stankiewicz MT, Hart RJ, Zumoffen C, Munuce MJ, Caille A, Ghersevich S, Lendinez AM, Perez-Nevot B, Palomares AR, Serrano Garballo A, Rodriguez A, Reche A, Mayor-Olea A, Ruiz-Galdon M, Reyes-Engel A, Mendiola J, Jorgensen N, Andersson AM, Calafat AM, Redmon JB, Drobnis EZ, Wang C, Sparks A, Thurston SW, Liu F, Swan SH, Tarasconi AC, Tarasconi BV, Tarasconi DV, Silva EMV, Fujii Y, Endou Y, Motoyama H, Crha I, Pribyl J, Skladal P, Zakova J, Ventruba P, Pohanka M, De La Fuente G, Pacheco A, Velasco JAG, Requena A, Pacheco Castro A, San Celestino Carchenilla M, Salvanes R, Arnanz A, Balmori C, Pellicer A, Garcia-Velasco JA, Hashimoto H, Ishikawa T, Goto S, Kokeguchi S, Fujisawa M, Shiotani M, Kranz S, Hersemeyer K, Hentrich A, Tinneberg HR, Konrad L, Simon L, Lutton D, McManus J, Lewis SEM, San Celestino Carchenilla M, Pacheco Castro A, Rubio S, Simon Sanjurjo P, Pellicer A, Garcia-Velasco JA, Lewis S, Lutton D, McManus J, Simon L, Buzzi J, Valcarcel A, Lombardi E, Oses R, Rawe V, Young E, Magendzo A, Lizama S, Duque G, Mackenna A, Lutton D, Simon L, McManus J, Lewis SEM, Monqaut A, Zavaleta C, Lopez G, Lafuente R, Brassesco M, Condorelli R, La Vignera S, La Rosa S, Barone N, Vicari E, Bellanca S, D'Agata R, Calogero AE, Enciso M, Iglesias M, Galan I, Gosalvez A, Gosalvez J, Curaba M, Poels J, Van Langendonckt A, Donnez J, Wyns C, Garcez M, Salvador M, Pasqualotto EB, Braga DPAF, Borges E, Pasqualotto FF, Aoki T, Figueira RCS, Maldonado LGL, Pasqualotto FF, Iaconelli A, Borges E, Frassini R, Mandelli J, Pasqualotto EB, Borges E, Figueira RCS, Braga DPAF, Pasqualotto FF, Borges E, Pasqualotto FF, Figueira RCS, Setti AS, Braga DPAF, Cortezzi SS, Iaconelli A, La Vignera S, Vicari E, Di Mauro M, Burrello N, Condorelli R, D'Agata R, Calogero AE, Kashir J, Jones C, Young C, Ruas M, Grasa P, Rietdorf K, Heytens E, Heindryckx B, Yoon SY, Fissore RA, Deane CM, Nikiforaki D, Tee ST, de Sutter P, Parrington J, Coward K, Visser L, Westerveld GH, van Daalen SKM, van der Veen F, Lombardi MP, Repping S, Cubillos S, Sanchez S, Pedraza J, Charria G, Aparicio H, Gongora A, Caldino F, Cuneo S, Ou JP, Zhao WE, Liu YF, Xu YW, Zhou CQ, Al-Asmar Pinar N, Peinado V, Gruhn J, Susiarjo M, Gil-Salom M, Martinez-Jabaloyas JM, Pellicer A, Remohi J, Rubio C, Hassold T, Peinado V, Al-Asmar N, Gruhn J, Rodrigo L, Gil-Salom M, Martinez-Jabaloyas JM, Pellicer A, Remohi J, Hassold TJ, Rubio C, Bungum M, Forsell N, Giwercman A, Amiri I, Sheikh N, Najafi R, Godarzi M, Farimani M, Makukh H, Tyrkus M, Zastavna D, Nakonechnuy A, Khayat SS, Schileiko LV, Kurilo LF, Garcia-Herrero S, Garrido N, Martinez-Conejero JA, Romany L, Pellicer A, Meseguer M, Dorphin B, Lefevre M, Gout C, Oger P, Yazbeck C, Rougier N, De Stefani S, Scala V, Benedetti S, Tagliamonte MC, Zavagnini E, Palini S, Bulletti C, Canestrari F, Subiran N, Pinto FM, Candenas ML, Agirregoitia E, Irazusta J, Cha EM, Lee JH, Park IH, Lee KH, Kim MH, Jensen MS, Rebordosa C, Thulstrup AM, Toft G, Sorensen HT, Bonde JP, Henriksen TB, Olsen J, Bosco L, Speciale M, Manno M, Amireh N, Roccheri MC, Cittadini E, Wu P, Lee YM, Chen HW, Tzeng CR, Llacer J, Ten J, Lledo B, Rodriguez-Arnedo A, Morales R, Bernabeu R, Garcia-Peiro A, Martinez-Heredia J, Oliver-Bonet M, Ribas J, Abad C, Amengual MJ, Gosalvez J, Navarro J, Benet J, Moutou C, Gardes N, Nicod JC, Becker N, Bailly MP, Galland I, Pirello O, Rongieres C, Wittemer C, Viville S, Elmahaishi W, Smith B, Doshi A, Serhal P, Harper JC, Rennemeier C, Kammerer U, Dietl J, Staib P, Elgmati K, Nomikos M, Theodoridou M, Calver B, Swann K, Lai FA, Georgiou I, Lazaros L, Xita N, Kaponis A, Plachouras N, Hatzi E, Zikopoulos K, Ferfouri F, Clement P, Molina Gomes D, Albert M, Bailly M, Wainer R, Selva J, Vialard F, Takisawa T, Usui K, Kyoya T, Shibuya Y, Hattori H, Sato Y, Ota M, Kyono K, Chiu PC, Lam KK, Lee CL, Chung MK, Huang VW, O WS, Tang F, Ho PC, Yeung WS, Kim CH, Lee JY, Kim SH, Suh CS, Shin YK, Kang YJ, Jung JH, Cha CY, Hwang ES, Mukaida T, Nagaba M, Takahashi K, Elkaffash D, Sedrak M, Huhtaniemi I, Abdel-Al T, Younan D, Cassuto NG, Bouret D, Hammoud I, Yazbeck C, Barak Y, Seshadri S, Bates M, Vince G, Jones DI, Ben Khalifa M, Montjean D, Menezo Y, Cohen-Bacrie P, Belloc S, De Mouzon J, Alvarez S, Aubriot FX, Olivennes F, Cohen M, Prisant N, Boudjema E, Magli MC, Crippa A, Baccetti B, Ferraretti AP, Gianaroli L, Singer T, Neri QV, Hu JC, Maggiulli R, Kollman Z, Rauch E, Schlegel PN, Rosenwaks Z, Palermo GD, Zorn B, Skrbinc B, Matos E, Golob B, Pfeifer M, Osredkar J, Sabanegh E, Sharma RK, Thiyagarajan A, Agarwal A, Robin G, Boitrelle F, Marcelli F, Marchetti C, Mitchell V, Dewailly D, Rigot JM, Rives N, Perdrix A, Travers A, Milazzo JP, Mousset-Simeon N, Mace B, Jakab A, Molnar Z, Benyo M, Levai I, Kassai Z, Golob B, Zorn B, Ihan A, Kopitar A, Kolbezen M, Vaamonde D, Da Silva-Grigoletto ME, Garcia-Manso JM, Vaamonde-Lemos R, Oehninger SC, Walis G, Monahan D, Neri QV, Ermolovich E, Rosenwaks Z, Palermo GD, Fadlon E, Abu Elhija A, Abu Elhija M, Lunenfeld E, Huleihel M, Costantini-Ferrando M, Maggiulli R, Neri QV, Hu JCY, Monahan D, Rosenwaks Z, Palermo GD, Alvarez JG, Gosalvez A, Velilla E, Lopez-Teijon M, Lopez-Fernandez C, Gosalvez J, Tempest HG, Sun F, Oliver-Bonet M, Ko E, Turek P, Martin RH, Zomeno-Abellan MT, Ramirez A, Gutierrez-Adan A, Martinez JC, Landeras J, Ballesta J, Aviles M, Lafuente R, Lopez G, Monqaut A, Brassesco M, Ganaiem M, Binder S, Abu Elhija M, Lunenfeld E, Meinhardt A, Huleihel M, Sousa L, Grangeia A, Carvalho F, Sousa M, Barros A, Sifer C, Sermondade N, Hafhouf E, Poncelet C, Benzacken B, Levy R, Wolf JP, Crisol L, Aspichueta F, Hernandez ML, Exposito A, Matorras R, Ruiz-Larrea MB, Ruiz-Sanz JI, Jallad S, Atig F, Ben Amor H, Saad ALI, Kerkeni A, Ajina M, Othmane ALI, Koscinski I, Ladureau L, Wittemer C, Viville S, Scarselli F, Casciani V, Lobascio M, Minasi MG, Rubino P, Colasante A, Arizzi L, Litwicka K, Iammarrone E, Ferrero S, Mencacci C, Franco G, Zavaglia D, Nagy ZP, Greco E, Ohgi S, Takahashi M, Kishi C, Suga K, Yanaihara A, Chamley LW, Wagner A, Shelling AN. Andrology (Male Fertility, Spermatogenesis). Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Berta E, Samson L, Lenkey A, Erdei A, Cseke B, Jenei K, Major T, Jakab A, Jenei Z, Paragh G, Nagy EV, Bodor M. Evaluation of the thyroid function of healthy pregnant women by five different hormone assays. Pharmazie 2010; 65:436-439. [PMID: 20614692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A normal function of the thyroid gland during pregnancy is essential. Any change can affect both the pregnant woman and the fetus. Thyroid hormones play a crucial role in the brain development of the fetus, thus proper maternal free thyroid hormone levels are important especially during the first trimester. We compared the free thyroid hormone levels FT3 and FT4 in forty pregnant women with no thyroidal disease by five different assays available on the market. The blood samples were collected between the 8th and 22nd weeks of pregnancy. The correlation coefficient "r" between different assays was 0.908-0.975 for TSH, 0.676-0.892 for FT4 and 0.480-0.789 for FT3. These data show that the inter-assay results varied widely in the studied population. One reasonable explanation may be that during pregnancy the serum levels of the thyroid hormone binding proteins are altered and "free" hormone measurements by immunoassays are influenced by these alterations. Thus, the results may show higher or lower thyroid hormone values depending upon the assay used. Therefore, it is strongly suggested that every laboratory should establish its own pregnant reference ranges for the tests used for the evaluation of thyroid function, based on values of the population served.
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Affiliation(s)
- E Berta
- Division of Endocrinology, Department of Medicine, University of Debrecen Medical and Health Science Center, Debrecen, Hungary
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Huszar G, Jakab A, Sakkas D, Ozenci CC, Cayli S, Delpiano E, Ozkavukcu S. Fertility testing and ICSI sperm selection by hyaluronic acid binding: clinical and genetic aspects. Reprod Biomed Online 2007; 14:650-63. [PMID: 17509211 DOI: 10.1016/s1472-6483(10)61060-7] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The testis-expressed chaperone protein, HspA2 (previously creatine kinase M isoform) was established as a measure of human sperm cellular maturity, function and fertility. The presence of HspA2 in the synaptonemal complex is likely to link low HspA2 expression and increased frequency of chromosomal aneuploidies in arrested-maturity spermatozoa. A relationship also exists between HspA2 expression in elongating spermatids and the associated spermatogenetic events, including plasma membrane remodelling and the formation of zona pellucida and hyaluronic acid (HA) binding sites. The HA receptor of mature spermatozoa, when coupled with HA-coated slides and/or Petri dishes, allows visual observation of sperm-HA binding, providing a basis for sperm maturity testing, a major improvement in semen evaluation, and selection of mature spermatozoa for intracytoplasmic sperm injection (ICSI). Thus, in HA-selected spermatozoa the frequency of chromosomal disomy and diploidy is reduced 4- to 6-fold compared with semen sperm fractions. This reduction is similar to the increase in numerical chromosomal aberrations in ICSI children. Combined studies of sperm shape and chromosome probes demonstrated that sperm morphology does not aid selection of haploid spermatozoa. The HA-mediated sperm selection is a novel and efficient technique that may alleviate potential problems related to ICSI fertilization with visually selected spermatozoa.
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Affiliation(s)
- Gabor Huszar
- The Sperm Physiology Laboratory, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine. 333 Cedar Street, New Haven, CT 06510, USA.
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Huszar G, Ozkavukcu S, Jakab A, Celik-Ozenci C, Sati GL, Cayli S. Hyaluronic acid binding ability of human sperm reflects cellular maturity and fertilizing potential: selection of sperm for intracytoplasmic sperm injection. Curr Opin Obstet Gynecol 2006; 18:260-7. [PMID: 16735824 DOI: 10.1097/01.gco.0000193018.98061.2f] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The current concepts of sperm biochemical markers and the central role of the HspA2 chaperone protein, a measure of sperm cellular maturity and fertilizing potential, are reviewed. RECENT FINDINGS Because HspA2 is a component of the synaptonemal complex, low HspA2 levels and increased frequency of chromosomal aneuploidies are related in diminished maturity sperm. We also suggest a relationship between HspA2 expression in elongating spermatids and events of late spermiogenesis, such as cytoplasmic extrusion and plasma membrane remodeling that aid the formation of the zona pellucida binding and hyaluronic acid binding sites. The presence of hyaluronic acid receptor on the plasma membrane of mature sperm, coupled with hyaluronic acid coated glass or plastic surfaces, facilitates testing of sperm function and selection of single mature sperm for intracytoplasmic sperm injection. The frequencies of sperm with chromosomal disomy are reduced approximately fourfold to fivefold in hyaluronic acid selected sperm compared with semen sperm, comparable to the increase in such abnormalities in intracytoplasmic sperm injection offspring. Hyaluronic acid binding also excludes immature sperm with cytoplasmic extrusion, persistent histones, and DNA chain breaks. SUMMARY Hyaluronic acid mediated sperm selection is a novel technique that is comparable to sperm zona pellucida binding. Hyaluronic acid selected sperm will also alleviate the risks related to intracytoplasmic sperm injection fertilization with sperm of diminished maturity that currently cause worldwide concern.
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Affiliation(s)
- Gabor Huszar
- The Sperm Physiology Laboratory, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
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