No abstract

With improvement in cancer therapies, there has been an increasing emphasis on survivorship, including options for fertility preservation. Fertility preservation is the process of either protecting or saving gametes or reproductive tissues for potential future procreation. Methods and outcomes of fertility preservation have similarly been rapidly advancing. Before initiation of gonadotoxic therapy, health care providers must consider future fertility of patients and provide options for fertility preservation. Nonetheless, the cost of fertility preservation can be prohibitory. Depending on a patient's state of residence, insurance may be mandated to cover, or offer to cover, the cost of fertility preservation. State legislation continues to change; however, legislation at the federal level has been proposed to make this coverage more cohesive. This commentary reviews current state legislation regarding mandates to cover the cost of fertility preservation for patients at risk for iatrogenic infertility and outlines the importance of developing federal legislation to improve patient access to care.

Purpose: Transrectal ultrasound (TRUS) has been the gold standard of imaging for diagnosing prostate cancer for decades but is plagued by user error and undersampling. We aim to explore imaging modalities that are now being used in combination or alone for screening, diagnosis, and/or active surveillance of prostate cancer.Methods: A PubMed literature search was performed to include articles published up to April 2016. Data were extracted and analyzed.Results: Several large-scale studies have found an increased cancer detection rate in MRI-targeted lesions with an improved ability to target anterior lesions as well as an increased cancer detection in high-risk cancers using fusion platforms vs TRUS alone.Conclusions: To date, there have been few head-to-head trials to directly compare the use of multiparametric MRI (mpMRI), transrectal ultrasound, and MRI-ultrasound fusion modalities for accurate and reliable detection, active surveillance, or biopsy procedure success rates. Further investigation utilizing these modalities are needed before they can be relied upon in active surveillance management, although mpMRI appears to be currently the most reliable in monitoring and diagnosing prostate lesions.

AbstractThe preparation of thrombocyte concentrates with filtration before storage (in-line) makes it possible to avoid the presence of mononuclear cells in the concentrate and proinflammatory cytokines. Therefore, this filtration may result with decreased activation of trombocyte receptors in vitro, which may improve therapeutic efficiancy. Methods. We compared two groups, each with 30 therapeutic doses of concentrated thrombocytes. We prepared the first group using the classic model from the buffy coat and the other with concentrated thrombocyte samples filtrated during sampling, so-called in-line, with the WBC filter Imuflex (Terumo). Mononuclear cells (MNC), thrombocyte, and erythrocyte counts in the units of concentrated thrombocytes were obtained on an automatic cell counter, and we used flow cytometry to measure the expression of surface thrombocyte receptors. The results demonstrated that the trombocytes prepared with pre-storage filtration contained a very low level of mononuclear cells and markedly reduced trombocyte receptors. Conclusion. The number of MNC and expression of surface thrombocyte receptors were markedly lower in the concentrated thrombocyte units prepared with in-line filtration. The thrombocytes prepared in this way contain fewer mononuclear cells, are of higher quality, are more functional, and may produce a better therapeutic effect in vivo.

No abstract

No abstract

No abstract

OBJECTIVE: To compare clinical outcomes following transfer of euploid blastocysts biopsied on day 5 with those of embryos deemed unsuitable for biopsy on day 5 and that were biopsied on day 6.DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Warmed NGS-tested euploid single embryo transfers from autologous IVF cycles performed at our center from 10/ 2015 to 2/2020 were included. Implantation rates (IR) and ongoing pregnancy rates (OPR) beyond 12 weeks gestation were assessed. Transfers were grouped by blastocyst quality (good, fair and poor) and then stratified by day of biopsy. Relative risks (RR) and 95% confidence intervals (CI) were calculated within each blastocyst quality class using log-binomial regression adjusting for age. GEE modeling was used to account for patients contributing multiple cycles.RESULTS: 237 transfers from 191 patients were analyzed. See table below.Both the IR and OPR were increased for embryos biopsied on day 5 compared to those biopsied on day 6 when combining all transfers regardless of blastocyst quality (72.4% vs. 63.0%; 62.3% vs. 53.2%). However, these differences were not significant. When stratified by biopsy day and blastocyst quality, a similar trend was noted for good and poor quality embryos. Fair quality Day 5 embryos and good quality Day 6 embryos had equivalent IR and OPR (RR 0.97 95%CI 0.78, 1.20; RR 0.94 95%CI 0.75, 1.17). The IR of poor quality day 5 blastocysts was significantly increased compared with that of poor quality day 6 blastocysts (72.7% vs. 36.0%; RR 0.69 95%CI 0.53, 0.88).CONCLUSIONS: Although statistically not significant, the approximate 10% increase in IR and OPR between embryos biopsied on day 5 vs. day 6 is clinically significant and is useful for patient counseling. When the choice is available, a euploid embryo that was biopsied on day 5 should be transferred over one biopsied on day 6, regardless of blastocyst quality.