Clinical Evaluation of the Safety and Feasibility of Whole Autologous Cord Blood Transplant as a Source of Stem and Progenitor Cells for Extremely Premature Neonates: Preliminary Report.

OBJECTIVES: This is a preliminary, single-center, prospective study in the field of autologous cord blood transplant. We investigated the feasibility, safety, and tolerability of autologous whole cord blood transplant in extremely premature infants as a potential therapeutic modality to prevent developing complications related to prematurity. MATERIALS AND METHODS: This preliminary prospective study (ClinicalTrials.gov identifier NCT02050971) included preterm infants born at less than 32 weeks of gestational age who developed anemia because of prematurity. Infants were assigned to 2 groups: (1) those receiving an autologous cord blood transfusion within 5 days postpartum (n = 5) and (2) those who obtained only an allogeneic red blood cell transfusion when necessary (n = 9; control group). Vital measurements were performed during and after transfusion, and peripheral blood pH, hematocrit, glucose, and calcium and potassium ion levels were measured over the next 4 days. RESULTS: Oxygen saturation was significantly increased throughout the cord blood transfusion and in the subsequent 48 hours. No significant differences were found in vital measurements, such as arterial blood pressure (mean, systolic, and diastolic) or heart rate over the first 48 hours posttransfusion. Similarly, no significant differences were found in biochemical analyses of blood with the exception of pH level. We found initial pH level to be significantly augmented in the cord blood recipient group by the first day after transplant, which remained significantly higher for next 24 hours compared with that shown in the control group. CONCLUSIONS: Collection, preparation, and short-term storage of unfrozen cord blood are feasible for clinical use. Our results showed general safety and tolerability of the procedure of whole autologous cord blood transplant in recruited preterm newborns. However, because our study group was small, these results need to be confirmed in further investigations with a larger patient cohort.

Mechanism of a molecular photo-switch adsorbed on Si(100).

We present a very compact molecular photoswitch on the technologically important Si(100) surface. Its adsorption configuration is determined by a combined scanning tunneling microscopy (STM) and density functional theory (DFT) study. The mechanisms of the isomerization reactions are discussed in view of DFT calculations and proven by in situ light irradiation.

Pregnancy delivery and puerperium in a patient with lysinuric protein intolerance--a case report.

The paper presents the course of pregnancy delivery and early postpartum period in a 23-year-old woman with lysinuric protein intolerance (LPI). The pregnancy was uneventful and resulted in a caesarean birth to a healthy baby at 37 weeks gestation. Nevertheless, the course of pregnancy in women with LPI is associated with a significantly increased risk of serious complications, including acute hyperammonemia, preeclampsia and postpartum bleeding, as well as fetus intrauterine growth retardation. In many cases, intensive metabolic monitoring and a proper diet with protein limitation and appropriate amino acids supplementation may significantly reduce the risk for both the mother and the newborn.

Circulating hematopoietic stem cell count is a valuable predictor of prematurity complications in preterm newborns.

BACKGROUND: The frequency of preterm labour has risen over the last few years. Hence, there is growing interest in the identification of markers that may facilitate prediction and prevention of premature birth complications. Here, we studied the association of the number of circulating stem cell populations with the incidence of complications typical of prematurity. METHODS: The study groups consisted of 90 preterm (23-36 weeks of gestational age) and 52 full-term (37-41 weeks) infants. Non-hematopoietic stem cells (non-HSCs; CD45-lin-CD184+), enriched in very small embryonic-like stem cells (VSELs), expressing pluripotent (Oct-4, Nanog), early neural (ß-III-tubulin), and oligodendrocyte lineage (Olig-1) genes as well as hematopoietic stem cells (HSCs; CD45+lin-CD184+), and circulating stem/progenitor cells (CSPCs; CD133+CD34+; CD133-CD34+) in association with characteristics of prematurity and preterm morbidity were analyzed in cord blood (CB) and peripheral blood (PB) until the sixth week after delivery. Phenotype analysis was performed using flow cytometry methods. Clonogenic assays suitable for detection of human hematopoietic progenitor cells were also applied. The quantitative parameters were compared between groups by the Mann-Whitney test and between time points by the Friedman test. Fisher's exact test was used for qualitative variables. RESULTS: We found that the number of CB non-HSCs/VSELs is inversely associated with the birth weight of preterm infants. More notably, a high number of CB HSCs is strongly associated with a lower risk of prematurity complications including intraventricular hemorrhage, respiratory distress syndrome, infections, and anemia. The number of HSCs remains stable for the first six weeks of postnatal life. Besides, the number of CSPCs in CB is significantly higher in preterm infants than in full-term neonates (p < 0.0001) and extensively decreases in preterm babies during next six weeks after birth. Finally, the growth of burst-forming unit of erythrocytes (BFU-E) and colony-forming units of granulocyte-macrophage (CFU-GM) obtained from CB of premature neonates is higher than those obtained from CB of full-term infants and strongly correlates with the number of CB-derived CSPCs. CONCLUSION: We conclude that CB HSCs are markedly associated with the development of premature birth complications. Thus, HSCs ought to be considered as the potential target for further research as they may be relevant for predicting and controlling the morbidity of premature infants. Moreover, the observed levels of non-HSCs/VSELs circulating in CB are inversely associated with the birth weight of preterm infants, suggesting non-HSCs/VSELs might be involved in the maturation of fetal organism.

Uterine rupture in the second trimester of pregnancy as an iatrogenic complication of laparoscopic myomectomy.

Uterine rupture is one of the most dangerous obstetric emergencies carrying a high risk for the mother and the fetus. Reports about uterine rupture in pregnancy following previous laparoscopic surgery have not been frequent; however, an increasing rate of the occurrence of this complication has been observed and reviewed in contemporary literature. We report a case of a spontaneous uterine rupture at 22 weeks of gestation in a 25-year old primigravida, who had had a laparoscopic removal of a small, peduncular, asymptomatic myoma located in the right uterine horn 20 months earlier. Ultrasound examination and subsequent urgent laparotomy confirmed a spontaneous uterine rupture with a nonviable fetus in the peritoneal cavity. Women planning to become pregnant should be qualified for laparoscopic myomectomy with special carefulness. Special attention must be paid to the potential solutions that limit the risk of postoperative uterine rupture, if the absolute necessity for the enucleation of myomas during the reproductive age occurs and a decision about laparoscopic intervention is made.

Circulating endothelial progenitor cells in premature infants: is there an association with premature birth complications?

BACKGROUND: The most common morbidities in preterm infants are associated with vascular pathology. Endothelial progenitor cells (EPCs) have been implicated in repair of the vasculature, but their role in the pathogenesis of prematurity complications is not clear. OBJECTIVES: We prospectively investigated an association between the number of EPCs circulating in blood during delivery as well as 2 and 6 weeks afterwards, the level of growth factors regulating their migration/homing, and the incidence of premature birth complications. PATIENTS AND METHODS: The study groups consisted of 90 preterm and 52 full-term infants. Early-EPCs (CD133+CD34+CD144+) and late-EPCs (CD133-CD34+CD144+) were analysed in cord blood (CB) and peripheral blood (PB). RESULTS: We found higher early- and late-EPC counts in the CB of premature infants compared with full-term babies. The number of circulating early- and late-EPCs was inversely associated with the Apgar score of preterm infants. A positive association between the early-EPC count and the risk of respiratory distress syndrome, retinopathy of prematurity, bronchopulmonary dysplasia, and infections was found. Nevertheless, multivariate analysis revealed that a higher number of EPCs was not an independent predictor of prematurity complications, which were directly related to lower gestational age. The EPC count in full-term infants maintained a constant, relatively low level over the 6-week follow-up, whereas the EPC population in preterm infants gradually decreased during this period. Furthermore, the number of CB late-EPCs in preterm infants positively correlated with VEGF concentration. CONCLUSIONS: EPCs may play a considerable role in vascular development in preterm infants.

[The influence of patient-controlled epidural analgesia on labor progress and neonatal outcome]. / Wplyw analgezji zewnatrzoponowej sterowanej przez pacjentke na przebieg porodu oraz stan urodzeniowy noworodków.

AIM: The aim of the study was to check the influence of patient control epidural analgesia on labor progress and neonatal outcome. MATERIAL AND METHODS: 144 parturients were included into the clinical trial. In 73 cases patient control epidural analgesia was used and in 71 cases pethidine (meperidine) solution was given intravenously. Apgar score, umbilical artery pH, pain intensity the time of the first, second and third stage of labor the rate of episiotomy and uterine postpartum abrasions and the rate of caesarean sections and vaginal operative delivery were compared. RESULTS: The time of the second stage of labor was significantly longer in the study group (40.99 vs 26.49 min, p- < 0.005), the neonatal outcome was comparable in both groups. There were no differences in the time of the first and the second stage of labor in primiparas and multiparas analyzed separately. Visual Analogue Score was lower in the study group (Ch(2)-12,48, p-0.25), especially in the subgroups of primiparas and multiparas. CONCLUSIONS: Patient control epidural analgesia does not affect the time of the first and second stage of labor, oxytocin augmentation of labor may be the reason of that. This method is a more effective way of relieving labor pain. An increase of operative delivery is not observed after patient control epidural analgesia on condition that low doses and concentrations of analgesic drugs are used.

Light driven reactions of single physisorbed azobenzenes.

We present a successful attempt of decoupling a dye molecule from a metallic surface via physisorption for enabling direct photoisomerization. Effective switching between the isomers is possible by exposure to UV light via the rotation pathway.

Maternal plasma lipopolysaccharide binding protein (LBP) concentrations in pregnancy complicated by preterm premature rupture of membranes.

OBJECTIVES: To compare maternal plasma LBP concentrations in pregnancies complicated by preterm premature rupture of membranes (pPROM), and PROM at term, with their levels in uncomplicated pregnancy, and to determine whether LBP concentrations are of value in the diagnosis of subclinical intra-amniotic infection (IAI) in the prediction of the length of the pPROM-to-delivery interval, and in the prediction of neonatal congenital infection. STUDY DESIGN: Thirty-one patients with pPROM, 35 with PROM at term, 33 healthy women at preterm gestation and 35 healthy women at term were included. In the pPROM group, analysis of maternal plasma LBP concentrations with reference to leukocytosis, C-reactive protein, vaginal fluid culture, neonatal infection and pPROM-to-delivery interval was carried out. RESULTS: LBP concentrations in the four studied groups were comparable. Although in 58.1% of pPROM cases at least one laboratory parameter of infection was observed, the only difference concerned the subgroup with CRP above 10mg/L, in which LBP concentrations were higher. Comparison of LBP concentrations in patients delivered within 24 and 72h of pPROM and after these times showed no differences, or between patients who gave birth to newborns with and without congenital infection. The predictive values of these measurements were poor. CONCLUSION: The predictive value of maternal LBP determinations in the diagnostics of pPROM cases suspected of IAI is unsatisfactory. LBP measurements performed shortly after pPROM, are not of value either in the prediction of newborn's infection, or in the prognosis of latency period duration.

[The role of circulating endothelial progenitor cells in the progression of retinopathy of prematurity--a prospective study]. / Rola krazacych komórek progenitorowych sródblonka w rozwoju retinopatii wczesniaczej--badanie prospektywne.

PURPOSE: Retinopathy of prematurity (ROP) is the primary cause of visual impairment in preterm infants. There are available data confirming that circulating endothelial progenitor cells (EPCs) are involved in forming the growing network of blood vessels in the developing retina. In this study we sought to explore potential relationship between concentration of circulating bone marrow-derived EPCs and development of ROP in prospective study. MATERIAL AND METHODS: The study groups consisted of 90 preterm (23-36 weeks of gestational age), and 52 full-term control infants. EPCs were analyzed in cord blood (CB) and subsequently in peripheral blood (PB) in second and sixth week since delivery. The incidence and stage of ROP was prospectively documented in the preterm infants. RESULTS: EPC concentration in CB was considerably higher in the preterm infants developing ROP. In the preterm infants a noticeable decrease in PB EPC concentration within six weeks of the follow up was found, whereas in full-term infants EPC concentration was maintained at invariable level. Of note, in the sixth week since delivery, EPC concentration in preterm infants with ROP was lower compared to preterm infants without ROP. CONCLUSIONS: Increase in CB EPC concentration in preterm infants, including those developing ROP, indicates that the circulating EPC cells contribute to the process of blood vessel formation, and their number in CB reflects the degree of prematurity. Impaired blood vessel formation within retina in the course of ROP may result from decrease in circulating EPC number observed at the sixth week since delivery.

Clinical outcomes of high-risk labours monitored using fetal electrocardiography.

OBJECTIVES: The aim of the study was to review clinical and laboratory outcomes of a cohort of fetuses monitored during high-risk labours, simultaneously by fetal electrocardiography (FECG) and routine cardiotocography (CTG). MATERIALS AND METHODS: Eighty-three parturients from the Department of Obstetrics and Gynecology of Medical University were included in the clinical study. Inclusive criteria to the study group were: (i) singleton pregnancy at term (between 37 and 42 weeks' gestation), (ii) longitudinal fetal lying, (iii) more than 2500 g of estimated fetal weight, (iv) meconium-stained liquor, and (v) induction of labour due to fetal indications. Fetal outcome parameters analysed included Apgar scores at 1st, 5th and 10th minute after birth, cord artery acid-base assessment and lactate concentrations analysis. FECG was performed during labour, until the neonate was born, with the use of single spiral scalp electrode connected to the STAN S21 heart monitor. Immediately after delivery, arterial cord blood gas and venous cord blood lactate's concentrations were analysed. RESULTS: The sensitivity (100%), specificity (97%), negative predictive value (NPV) (100%) and positive predictive value (33%) were higher for FECG than for CTG. Moreover, several significant correlations between episodic/baseline T/QRS ratio rises and cord artery acid-base as well as lactate concentrations were demonstrated. CONCLUSIONS: Correlations between episodic/baseline T/QRS ratio rises and fetal outcome parameters indicate that observed changes in FECG reflect neonatal metabolic lactate acidosis. The high sensitivity, specificity and especially very high NPV are proof that FECG serves as a reliable method for electronic fetal monitoring during high-risk labours.

[Vaginal and cervical bacterial colonization in patients with threatening preterm labor]. / Kolonizacja bakteryjna pochwy i kanalu szyjki macicy u pacjentek z zagrazajacym porodem przedwczesnym.

OBJECTIVES: The aim of the following work was to evaluate vaginal and cervical colonization in patients with threatening preterm labor and comparing the frequency of colonization of the term and preterm labor groups. MATERIAL AND METHODS: 532 pregnant women with threatening preterm labor were included into the clinical trial. The frequency of colonization was established and the frequency of colonization depending on the duration of pregnancy was checked. RESULTS: Positive vaginal cultures were found in 29.5% of patients. The most frequent were: Escherichia coli and Streptoccocus agalactiae. There was no relationship between the duration of pregnancy the frequency of colonization or the type of bacterial culture. CONCLUSIONS: 30% of positive vaginal and cervical cultures may indicate about the deficiency of the used method. The most frequent microorganisms remain to be Candida, Escherichia coli and GBS. However, the frequency of colonization with rare bacteria increases. Not only bacterial colonization but a group of different factors may be the reason of preterm labor.

Successful outcome of pregnancy complicated by Werner's syndrome.

Werner's syndrome is an extremely rare genetic disorder of the autosomal recessive type, characterized by features suggesting premature aging in young adulthood. Because of the concomitant hypogonadism, pregnancy among patients with Werner's syndrome occurs extremely rarely. We present a case of a successful outcome of pregnancy complicated by Werner's syndrome in a 34-year-old primigravida. The reason for early delivery by caesarean section, at 34th week of pregnancy, was exacerbation of coronary symptoms, with early signs of cardiac insufficiency. A healthy female child was born in a good condition, with birth weight of 1950 g.

[Rapid assessment of the IL-6 cervico-vaginal fluid level in threatening preterm labor]. / Szybka ocena stezenia IL-6 w wydzielinie szyjkowo-pochwowej w zagrazajacym porodzie przedwczesnym.

OBJECTIVES: The aim of the study was to check the cervico-vaginal fluid IL-6 levels using rapid, quantitive test in patients with threatening preterm labor before and after tocolytic treatment. MATERIAL AND METHODS: Sixty seven singular pregnant women, between 24 and 36 weeks of gestation, were included into the clinical trial. 35 women who were admitted to the Department due to clinical symptoms of threatened preterm labor formed the study group. 32 women between 24 and 36 gestational week, with uncomplicated pregnancy formed the control group. Levels of IL-6 were measured just after material collection, using fast, quantitative spectrofotometric test. RESULTS: The cervico-vaginal IL-6 level was higher in the study group (458 pg/mL vs 123 pg/mL; p < 0.05). A significant reduction of cervico-vaginal IL-6 level was observed after two days of tocolytic treatment. CONCLUSION: A bedside, quantitative spectrofotometric method allows for a quick and repeatable assessment of cervico-vaginal IL-6 levels to establish the risk of preterm labor as well as enables the monitoring of the effectiveness of tocolytic treatment.

Isoprostanes 8-iPF2alpha-III: risk markers of premature rupture of fetal membranes?

AIMS: Isoprostanes may serve as sensitive and specific markers of in vivo oxidative stress intensity. We wanted to determine, whether or not isoprostane concentration may be considered as a risk marker of premature rupture of fetal membranes (PROM). METHODS: On the basis of the presence of PROM and gestational maturity, a total of 128 patients were divided into: (1) preterm PROM (pPROM) group; (2) PROM at term group; (3) control preterm (C1) group and (4) control at term (C2) group. The concentrations of 8-iPF(2alpha)-III were determined using the enzyme-linked immunosorbent assay method. RESULTS: The mean free isoprostane concentrations, examined in amniotic fluid and maternal plasma in the PROM at term patients were significantly higher than in C2 individuals (p < 0.01). The mean concentrations of free 8-iPF(2alpha)-III measured in blood plasma from women in the C1 group were significantly lower than in patients from the pPROM, PROM at term and C2 groups (p < 0.001, p < 0.00001 and p < 0.00001, respectively). CONCLUSION: The measurement of free isoprostane concentration in maternal plasma and amniotic fluid may be considered as a laboratory marker of a PROM-risk pregnancy.

[The assessment of neutrophil elastase measurements usefulness in pregnant women with premature rupture of fetal membranes and chorioamnionitis suspicion]. / Ocena przydatnosci oznaczania elastazy neutrofilowej u ciezarnych z przedwczesnym peknieciem blon plodowych w przypadkach podejrzanych o subkliniczna infekcje wewnatrzowodniowa.

OBJECTIVES: The evaluation of neutrophil elastase (NE) levels and its usefulness in pregnant women with premature rupture of foetal membranes (PROM) and chorioamnionitis suspicion. MATERIAL AND METHODS: We evaluated the relationship between maternal plasma and amniotic fluid NE levels with the presence of chorioamnion infection in sixty pregnant women, divided into two groups--with and without PROM. The diagnostic performance of NE evaluations in discrimination of suspected intraamniotic infection was calculated. RESULTS: NE levels in PROM patients are significantly higher than in the control group (p < 0.000001). Significantly higher NE concentrations are also observed in the case of chorioamnionitis. Moreover, if at least two clinical markers of infection were present, the diagnostic value of amniotic fluid NE levels proved to be 100% sensitive and of 100% negative predictive value. CONCLUSIONS: NE levels may be used as clinical markers which enable the obstetricians to exclude chorioamnionitis.

[Physiological and pathological consequences of a presence of germ line stem cells in adult tissues]. / Konsekwencje fizjologiczne i patologiczne wystepowania komórek linii zarodkowych w doroslych tkankach.

Various therapheutic strategies employing stem cells have been proposed as the alternative, effective methods for therapy of multitude diseases, difficult to treat using standard, well-established methods. Advancing regenerative medicine, which is becoming a novel branch of clinical medicine, has high hopes of stem cells which could be used in treatment of injuried organs such as myocardium after heart infarction, brain after stroke, spinal cord after mechanical injury as well as in treatment of diabetes and Parkinson disease. Application of embryonic stem cells, harvested from developing embryos, is highly controversial. Hence, the stem/primitive cells isolated from adult tissuses are considered to be an optimal source of cells for therapy. Recently our research team has isolated a population of very primitive stem cells from adult tissues (very small embryonic-like stem cells - VSELs) that show several embryonic-like features. These cells can become an alternative and more ethical source of the stem cells for therapy when compared to those isolated from the developing embryos.

[Evaluation of neutrophile elastase and isoprostane 8epiPGF2alpha concentrations in maternal and umbilical cord blood serum and in amniotic fluid in pregnancies complicated by premature rupture of membranes]. / Ocena stezen elastazy neutrofilowej i izoprostanu 8epiPGF2alpha w osoczu krwi matczynej i pepowinowej oraz w plynie owodniowym w ciazy powiklanej przedwczesnym peknieciem blon plodowych.

OBJECTIVES: To evaluate the total isoprostane 8-epi-PGF2alpha and neutrophil elastase (NE) concentrations in pregnancies complicated by premature rupture of membranes (PROM). MATERIAL AND METHODS: 128 pregnant women were divided into four groups: pregnancies complicated by PROM between 24.-36.(PPBP-N) and between 38 a 41 weeks of gestation (PPBP-D), uncomplicated pregnancies between 24-36 gestation weeks (K1) and pregnancies delivered by cesarean section (before uterine contractions had started) after 38 weeks (K2). The concentrations of NE and isoprostane 8-epi-PGF2alpha were measured in maternal serum, cord blood serum and in the amniotic fluid. RESULTS: The following study revealed higher concentrations of NE in maternal serum and in the amniotic fluid than in the umbilical cord blood in PROM cases, and lower amniotic fluid than maternal serum concentrations in the control groups. Also, the levels of isoprostane differentiated between compartments in particular groups. In both groups complicated with PROM, higher maternal serum and amniotic fluid NE concentrations than in controls were found. There were no differences in isoprostane levels between the groups. CONCLUSIONS: 1. Higher concentrations of NE in maternal blood serum and in the amniotic fluid than in the umbilical cord blood in PROM cases, as well as lower amniotic fluid than maternal serum concentrations in the controls, may be connected with pathogenesis of PROM. 2. Differentiated maternal serum, cord serum and amniotic fluid isoprostane concentrations may suggest various intensity of oxidative stress in particular compartments. 3. Lack of differences in maternal serum, cord serum and amniotic fluid isoprostane concentrations may suggest similar intensity of oxidative stress in cases with PROM and intact membranes.