Appraisal of Experimental Methods to Manage Menopause and Infertility: Intraovarian Platelet-Rich Plasma vs. Condensed Platelet-Derived Cytokines

The first published description of intraovarian platelet-rich plasma (PRP) appeared in mid-2016, when a new experimental technique was successfully used in adult human ovaries to correct the reduced fertility potential accompanying advanced maternal age. Considering the potential therapeutic scope of intraovarian PRP would likely cover both menopause and infertility, the mainstream response has ranged from skeptical disbelief to welcome astonishment. Indeed, reports of intraovarian PRP leading to restored menses in menopause (as an alternative to conventional hormone replacement therapy) and healthy term livebirths for infertility patients (from IVF or as unassisted conceptions) continue to draw notice. Yet, any proper criticism of ovarian PRP applications will be difficult to rebut given the heterogenous patient screening, varied sample preparations, wide differences in platelet incubation and activation protocols, surgical/anesthesia techniques, and delivery methods. Notwithstanding these aspects, no adverse events have thus far been reported and ovarian PRP appears well tolerated by patients. Here, early studies guiding the transition of ‘ovarian rejuvenation’ from experimental to clinical are outlined, with mechanisms to explain results observed in both veterinary and human ovarian PRP research. Current and future challenges for intraovarian cytokine treatment are also discussed.

Appraisal of Experimental Methods to Manage Menopause and Infertility: Intraovarian Platelet-Rich Plasma vs. Condensed Platelet-Derived Cytokines

The first published description of intraovarian platelet-rich plasma (PRP) appeared in mid-2016, when a new experimental technique was successfully used in adult human ovaries to correct the reduced fertility potential accompanying advanced maternal age. Considering the potential therapeutic scope of intraovarian activated PRP and/or condensed platelet cytokines would likely cover both menopause treatment and infertility, the mainstream response has ranged from skeptical disbelief to welcome astonishment. Indeed, reports of restored menses in menopause (as an alternative to conventional hormone replacement therapy) and healthy term livebirths for infertility patients (either with IVF or as unassisted conceptions) after intraovarian PRP injection continue to draw notice. Yet any proper criticism of ovarian PRP applications will be difficult to rebut given the heterogenous patient screening, varied sample preparations, wide differences in platelet incubation and activation protocols, surgical/anesthesia techniques, and delivery methods. Notwithstanding these features, no adverse events have been reported thus far and ovarian PRP appears well tolerated by patients. Here, early research guiding the transition of ‘ovarian rejuvenation’ from experimental to clinical is outlined. Likely mechanisms are presented to explain results observed in both veterinary and human ovarian PRP research. Current and future challenges for intraovarian cytokine treatment are also discussed.

Resuming Elective Ophthalmic Surgery during COVID-19 Pandemic

Background: The Coronavirus (COVID-19) pandemic has become a global health problem. Purpose: This paper aims to describe the practical experience of resuming elective ophthalmic surgery during the COVID-19 pandemic in a specialized eye hospital. Methods: A descriptive design was conducted in Middle East Eye Hospital, Ammann, Jordan. The current practices were observed to be conducted according to many evidence-based measures, including mainly the American Academy of Ophthalmology guidelines to safely resume ophthalmology service during the COVID-19 pandemic. Results: The main strategies that were adopted were related to patient and employee awareness and education, infection control measures, medical instruments, clinical environment, administrative control, patient screening and workflow, and quality control. Conclusion: We expect that these strategies could help ophthalmologists globally to resume elective ophthalmic surgery.

Neutrophils as Regulators and Biomarkers of Cardiovascular Inflammation in the Context of Abdominal Aortic Aneurysms

Neutrophils represent up to 70% of circulating leukocytes in healthy humans and combat infection mostly by phagocytosis, degranulation and NETosis. It has been reported that neutrophils are centrally involved in abdominal aortic aneurysm (AAA) pathogenesis. The natural course of AAA is growth and rupture, if left undiagnosed or untreated. The rupture of AAA has a very high mortality and is currently among the leading causes of death worldwide. The use of noninvasive cardiovascular imaging techniques for patient screening, surveillance and postoperative follow-up is well established and recommended by the current guidelines. Neutrophil-derived biomarkers may offer clinical value to the monitoring and prognosis of AAA patients, allowing for potential early therapeutic intervention. Numerous promising biomarkers have been studied. In this review, we discuss neutrophils and neutrophil-derived molecules as regulators and biomarkers of AAA, and our aim was to specifically highlight diagnostic and prognostic markers. Neutrophil-derived biomarkers may potentially, in the future, assist in determining AAA presence, predict size, expansion rate, rupture risk, and postoperative outcome once validated in highly warranted future prospective clinical studies.

A patient screening tool for clinical research based on Electronic Health Records Using openEHR (Preprint)

BACKGROUND The widespread adoption of electronic health records (EHRs) has facilitated the secondary use of EHR data for clinical research. However, screening eligible patients from EHR is a challenging task. The concepts in eligibility criteria are not completely matched with EHR, especially for “derived concepts”. The lack of high-level expression of SQL makes it difficult and time-consuming to express them. The openEHR Expression language (openEHR EL) as a domain-specific language based on clinical information models shows promise to represent complex eligibility criteria. OBJECTIVE The study aims to develop a patient screening tool based on EHR for clinical research using openEHR to solve concepts mismatch and improve query performance. METHODS A patient screening tool based on EHRs using openEHR is proposed. It utilizes the advantages of information models and expression language in openEHR to provide high-level expressions and improve query performance. Firstly, openEHR archetypes and templates were chosen to define concepts called “simple concepts” from EHR directly. After, openEHR EL was utilized to generate “derived concepts” by combining simple concepts and constraints. Third, a hierarchical index corresponding to archetypes in Elasticsearch was generated to improve query performance for subqueries and join queries related to “derived concepts”. Finally, on top of these works, we realized a patient screening tool for clinical research. RESULTS 500 sentences randomly selected from 4691 eligibility criteria in total 389 clinical trials about stroke from the Chinese Clinical Trial Registry (ChiCTR) were evaluated. An openEHR-based clinical data repository (CDR) in a Grade A tertiary hospital in China was considered as an experimental environment. Based on them, 589 medical concepts were found in these sentences. Among all of them, 513(87.1%) concepts can be represented, and the others cannot be represented because of a lack of information models and coarse-grained requirements. Also, our case study on 6 queries demonstrates our tool shows better query performance among 4 cases (66.67%). CONCLUSIONS We develop a patient screening tool using openEHR. It not only helps solve concepts mismatch but also improves the query performance to reduce the burden on researchers. Also, we demonstrate the promising solution for secondary use of EHR data using openEHR which can be referenced by other researchers.