Platelet-derived exosomes induce cell proliferation and wound healing in human endometrial cells.

Aim: To investigate the regenerative effects of a platelet-derived purified exosome product (PEP) on human endometrial cells. Materials & methods: Endometrial adenocarcinoma cells (HEC-1A), endometrial stromal cells (T HESC) and menstrual blood-derived stem cells (MenSC) were assessed for exosome absorption and subsequent changes in cell proliferation and wound healing properties over 48 h. Results: Cell proliferation increased in PEP treated T HESC (p < 0.0001) and MenSC (p < 0.001) after 6 h and in HEC-1A (p < 0.01) after 12 h. PEP improved wound healing after 6 h in HEC-1A (p < 0.01) and MenSC (p < 0.0001) and in T HESC between 24 and 36 h (p < 0.05). Conclusion: PEP was absorbed by three different endometrial cell types. PEP treatment increased cell proliferation and wound healing capacity.

The uterus has a remarkable ability to heal itself. Every month the inside lining of the uterus grows in preparation for pregnancy and sheds if no pregnancy occurs. Unfortunately, this cycle of growth, shedding and repair can be injured and lead to menstrual changes, pain or even infertility. In this study, we looked how special cell messengers ­ called exosomes ­ could help uterine cells. Exosomes are special messengers that contain substances to help the body heal and regenerate injured cells and tissues. We obtained exosomes created from human transfusion-grade platelets. We studied the exosomes' effects in three different cell types that all are important inside the uterine lining. Specifically, we studied the ability of the exosomes to help cells proliferate and migrate into a wound. In this study, exosomes were recognized by the human endometrial cells and were absorbed. Once they were inside the cells, they increased cell proliferation as well as the ability of the cells to heal a scratch wound. Furthermore, the more exosomes we presented to the cells, the more the cells were able to proliferate and move into a wound for healing. These findings lay the groundwork for future studies in animal models of uterine injury.

Outcomes of embryo transfers performed by Reproductive Endocrinology and Infertility fellows vs. faculty: an 11-year retrospective review.

OBJECTIVE: To compare the clinical pregnancy rate (CPR) and live birth rate (LBR) of embryo transfer episodes (ETEs) performed by Reproductive Endocrinology and Infertility fellows vs. those of ETEs performed by faculty physicians. DESIGN: Retrospective cohort analysis. SETTING: Academic reproductive endocrinology and infertility practice. PATIENT(S): In total, 3,073 ETEs for 1,488 unique patients were performed by fellows or faculty physicians between January 2009 and January 2020. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate and LBR. RESULT(S): Fifteen fellows performed 1,225 (39.9%) of 3,073 ETEs after completing 30 mock transfers. On comparing outcomes among fellowship years (FY1, FY2, and FY3), CPR (44.1% vs. 43.2% vs. 45.7%, respectively, P = .83) and LBR (39.1% vs. 38.1% vs. 38.4%, respectively, P = .97) were not significantly different. Fellowship year 1 fellows' initial 30 ETEs vs. all the remaining FY1 ETEs had a significantly higher CPR (48.1% vs. 40.5%, respectively, P = .030) and LBR (45.4% vs. 34.3%, respectively, P = .001). There were no significant differences between faculty versus fellow ETEs in terms of CPR (43.0% vs. 45.0%, respectively, P = .30) or LBR (37.3% vs. 39.8%, respectively, P = .16), even after adjusting for patient age, body mass index, primary infertility diagnosis, autologous vs. donor oocyte, fresh vs. frozen embryo, number of embryos transferred, type of transfer catheter, and year of transfer (P = .32 for CPR, P = .22 for LBR). CONCLUSION(S): Appropriately trained FY1 fellows had success rates maintained throughout all FYs. There were no significant differences in clinical outcomes between fellow- and faculty-performed transfers. These data demonstrated that allowing fellows to perform live embryo transfers is not detrimental to clinical outcomes.

Outcomes of Frozen Oocyte Donor In Vitro Fertilization (IVF) Cycles Using Fresh Versus Frozen Sperm.

The ability to use frozen sperm for insemination during in vitro fertilization (IVF) is crucial for patients and for reproductive endocrinologists. However, concerns exist regarding the effects of cryopreservation on sperm quality and IVF outcomes. This study compares outcomes of frozen donor oocyte IVF cycles with intracytoplasmic sperm injection (ICSI) of good quality fresh versus frozen ejaculated sperm. Patients who underwent their first frozen donor oocyte IVF cycle between 2013 and 2019 at Mayo Clinic were identified. The primary outcome was live birth rate (LBR). Secondary outcomes included fertilization rate (FR), blastocyst development rate (BR), and clinical pregnancy rate (CPR). Twenty-six patients used fresh sperm and 19 patients utilized frozen sperm; there were no significant demographic differences between the groups. There were no significant differences noted in CPR, FR, and BR. Although the LBR was not statistically different when frozen versus fresh sperm was utilized (52.6% vs. 61.5%, p = 0.55), there was a distinct trend towards improved outcomes with fresh sperm that may be clinically significant. This data suggests that frozen sperm may be an alternative to a fresh sample, however fresh sperm may ultimately be a better option. This finding should be further explored with studies utilizing a larger sample size.

Three degrees of separation: complete uterine and cervical septa.

OBJECTIVE: To review the diagnosis and management of 3 variations of incomplete müllerian duct fusion and reabsorption. DESIGN: Narrated video delineating the surgical management of 3 müllerian anomalies; this video was deemed exempt from review by the institutional review board of the Mayo Clinic. SETTING: Tertiary care academic medical center. PATIENT(S): This video focuses on 3 müllerian anomalies: complete septate uterus with a single septate cervix (septate uterus unicollis); complete septate uterus with duplicated cervix (septate uterus bicollis); and complete duplication of the uterus and cervix (uterine didelphys). INTERVENTION(S): Magnetic resonance imaging (MRI), cervical septoplasty, operative hysteroscopy, and uterine septoplasty. MAIN OUTCOME MEASURE(S): Several variations of uterine malformations exist. In our practice, we differentiate complete septate uteri as either unicollis or bicollis via MRI and vaginal examination. The bicollis presentation can be identified on MRI by the "lambda sign," which is seen as the 2 cervices that diverge as they enter the vagina. This is in comparison with the unicollis presentation when the single septate cervix can be traced with parallel lines as it enters the vagina. The circle method is described in this video to help distinguish between a single and duplicated cervix on examination. RESULT(S): The cervical and uterine septa were resected completely in the patient with a complete septate uterus unicollis. In contrast, the uterine septum was resected completely and the 2 cervical canals were not incised in the case of the complete septate uterus bicollis. Although uterine and cervical septa resection is controversial, our practice is to avoid the incision of the 2 cervical canals in cases that are more clearly consistent with a bicollis classification. CONCLUSION(S): Müllerian anomalies represent a continuum of disorders caused by different degrees of disruption in embryogenesis. MRI with vaginal gel and vaginal examination are tools to help classify the anomaly and guide surgical management.

Chronic conditions and outcomes of pediatric trauma patients.

BACKGROUND: Chronic conditions influence the outcomes of adult trauma patients, but no study has investigated the impact of chronic conditions among pediatric trauma patients. METHODS: We performed a retrospective study using the 2009 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) to determine the prevalence of chronic conditions among pediatric trauma patients (ages 1-15 years) and to assess the impact of chronic conditions on care resource use and patient mortality. RESULTS: According to the 2009 KID, an estimated 22,965 or 24.6% of US pediatric trauma patients had preexisting chronic conditions. The most common chronic conditions were mental disorders (7.8%), diseases of the respiratory system (7.7%), and diseases of the nervous system and sensory organs (6.3%). Compared with pediatric trauma patients without chronic conditions, patients with chronic conditions had a longer average stay in the hospital of 5.2 days (95% confidence interval [CI], 4.8-5.5) versus 2.5 days (95% CI, 2.4-2.6). They also had higher hospital charges of $50,815 (95% CI, $47,126-$54,503) versus $23,655 (95% CI, $22,242-$25,067) and a higher mortality rate of 2.6% (95% CI, 2.3-2.9%) versus 0.1% (95% CI, 0.1-0.1%). CONCLUSION: Nearly one fourth of pediatric trauma patients had preexisting chronic conditions, and their mortality risk was significantly higher. Treatment guidelines and more research in this special group of trauma patients are warranted.