Association of early cleavage, morula compaction and blastocysts ploidy of IVF embryos cultured in a time-lapse system and biopsied for genetic test for aneuploidy.

IVF embryos have historically been evaluated by morphological characteristics. The time-lapse system (TLS) has become a promising tool, providing an uninterrupted evaluation of morphological and dynamic parameters of embryo development. Furthermore, TLS sheds light on unknown phenomena such as direct cleavage and incomplete morula compaction. We retrospectively analyzed the morphology (Gardner Score) and morphokinetics (KIDScore) of 835 blastocysts grown in a TLS incubator (Embryoscope+), which were biopsied for preimplantation genetic testing for aneuploidy (PGT-A). Only the embryos that reached the blastocyst stage were included in this study and time-lapse videos were retrospectively reanalysed. According to the pattern of initial cleavages and morula compaction, the embryos were classified as: normal (NC) or abnormal (AC) cleavage, and fully (FCM) or partially compacted (PCM) morulae. No difference was found in early cleavage types or morula compaction patterns between female age groups (< 38, 38-40 and > 40 yo). Most of NC embryos resulted in FCM (≅ 60%), while no embryos with AC resulted in FCM. Aneuploidy rate of AC-PCM group did not differ from that of NC-FCM group in women < 38 yo, but aneuploidy was significantly higher in AC-PCM compared to NC-FCM of women > 40 yo. However, the quality of embryos was lower in AC-PCM blastocysts in women of all age ranges. Morphological and morphokinetic scores declined with increasing age, in the NC-PCM and AC-PCM groups, compared to the NC-FCM. Similar aneuploidy rates among NC-FCM and AC-PCM groups support the hypothesis that PCM in anomalous-cleaved embryos can represent a potential correction mechanism, even though lower morphological/morphokinetic scores are seen on AC-PCM. Therefore, both morphological and morphokinetic assessment should consider these embryonic development phenomena.

[Cardiac herniation and torsion after transpericardial pneumonectomy]. / Herzluxation und Torsion nach erweiterter Pneumonektomie.

This article presents the case of a 43 year old woman with right-sided lung cancer. She underwent transpericardial pneumonectomy. After an uneventfull surgery, the patient was transferred to the intensive care unit for postoperative monitoring. She was hemodynamically stable and had already been extubated in the OR.On postoperative chest X­ray a mediastinal shift to the operated side as well as a herniation of the heart into the right chest cavity was detected. While the patient remained hemodynamically stable a computed tomography of the chest was performed which confirmed the diagnosis of cardiac herniation and torsion. The lady underwent rethoracotomy the following day where the heart was repositioned and the pericardial defect was closed. She made an uneventfull recovery.Five years after the pneumonectomy she remains well and is without relapse of lung cancer.Mechanism for cardiac herniation and torsion, the clinical presentation and the typical radiologic signs are discussed. However, the clue to early diagnosis is a high index of clinical suspicion.It is highlighted that a hemodynamically unstable patient under these circumstances demands urgent rethoracotomy.

[Effect of short-term aerogenic hypoxia on the behavior of heart rate and blood pressure in newborn swine]. / Untersuchungen zum Einfluss einer kurzzeitigen aerogenen Hypoxie auf das Verhalten von Herzfrequenz und Blutdruck bei neugeborenen Ferkeln.

The adaption of the cardiovascular system to hypoxia has been examined in piglets aged 3 to 81 hour. The reaction of the piglets to a shorttime normobaric hypoxia was very different: In 50% there was an inadequate reaction with decrease of blood pressure, heart rate, pulse pressure and therefore of stroke volume, in 30% there was in compliance with the adult mechanism a compensatory increase of blood pressure, heart rate, pulse pressure and stroke volume. Only in 2 cases a compensatory increase of blood pressure could be observed in combination with a simultaneous decrease of heart rate. The results refer once more to the fact, that the reactions of the cardiovascular system of the neonate to hypoxia can be very variable and require an individual therapeutic regime provided that they are transferable to the human newborn and premature baby.