ina33, ne boj se - sigurno će koristiti ...
cure zakon ste, ekipa kakvu treba tražit ...
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ina33, ne boj se - sigurno će koristiti ...
cure zakon ste, ekipa kakvu treba tražit ...
sanja
Evo malo tekstova o NK stanicama:
http://repro-med.net/tests/nkassay.php#topNatural Killer (NK) Cell Assay for the Consumer
This is a very precise and simple test that is done by a sophisticated machine called a flow cytometer. Twelve percent of women with recurrent pregnancy losses (3 or more) and 35% of women with 3 or more IVF failures have elevations in NK cells. Natural killer (NK) cells are one of the oldest lymphocytes (white blood cells) in man. They have many functions. One of these functions is to produce a cytotoxic chemical called tumor necrosis factor (TNF). This is a chemotherapy drug that kills cancer cells in our body. In some couples, the embryo is misinterpreted as a cancer cell and when pregnancy is initiated, the Natural Killer cells of the woman increase in numbers and in killing power. Subsequent pregnancies fail early because of this activation. The embryo is damaged just as a cancer cell, by the tumor necrosis factor. This activation of Natural Killer cells has adverse consequences in some women.
Five percent of women with activate NK cells may develop thyroiditis. This may result in an overactive or an underactive thyroid condition (hyper or hypothyroidism - inflammation of the thyroid gland resulting in over or under production of thyroid hormone). A blood test in these women shows that they have developed antibodies to thyroid microsomes, thyroglobulin or peroxidase and which results in a diagnosis of Hashimoto's thyroiditis. It is recommended that women with activated natural killer cells have a thyroid evaluation yearly to make certain that this condition is not developing.
The test for NK cell activity is a simple one. Natural Killer cells from the woman are separated from her blood and are cultured at different dilutions with target cells that they can kill. The target cells used are from an embryonic cancer cell line that have many similarities to placentas and embryos. These target cells are tagged with a special cytoplasmic dye so that the flow cytometer can find them when asked to see how many of the targets have been killed by the NK cells that have been placed in culture with them. After two to four hours of culturing the NK cells with the embryo-like targets, a special DNA dye called propidium iodide is added to the culture. This dye is taken up by the DNA of the cells that have been killed. The living cells do not take up the dye. The cell suspensions are then put into the flow cytometer and it precisely counts the percentage of dead to live cells at the different dilutions.
http://repro-med.net/tests/pheninfo.phpA Guide to Interpreting the Results of the Reproductive Immunophenotype
Contents
* Introduction
* CD-3 (Pan T-Cells) 63-86%
* CD-4 (T-Helper Cells) 31-53%
* CD-8 (T-Cytotoxic-Suppressors) 17-35%
* CD-19 (B Cells) Normal Range 3-8%
* CD56+ CD16+ Natural Killer Cells 3-12%
* CD 56+ Natural Killer Cells 3-12%
* Natural Killer Cell Assay
* CD3/IL-2R+ Cells Normal Range 0-5%
* CD 19+ CD 5+ (B-1 Cells) Normal Range 2-10%
* Summary
Introduction
The reproductive immunophenotype is a specialized blood test done in the flow cytometer where eight of the most important white blood cell types are counted. Everyone has 30 different types of white blood cells (lymphocytes); however, disorders in the percentages of these eight cell types predict a future pregnancy loss, whether the person is an infertility patient preparing for assisted reproductive technologies or a patient who becomes pregnant and loses her pregnancy through miscarriage or does not become pregnant at all. This test was developed by me and you will find little reference material in the literature regarding this test.
CD-3 (Pan T-Cells) 63-86%
These cells are the most important in our immune system. They are low when the immune system is weak (suppressed) and normal when the immune system is healthy. Infertile patients and patients with recurrent pregnancy losses have values in the high normal range. These individuals have immune systems that are strong - even overactive. A strong overactive immune system is associated with a 5% incidence of autoimmune diseases for example, thyroiditis, lupus, rheumatoid arthritis.
CD-4 (T-Helper Cells) 31-53%
These cells are CD-3 lymphocytes and are essential for all lymphocytes to know what to do. They cannot function without the road map provided by the CD-4 T Helper cells. CD-4 cells are killed by the HIV virus and as a result the immune system falls into disarray. In women with infertility or miscarriage these cells are also high normal because they are helping the many CD3 Pan T cells. They are rarely low in number. If they are low, the patient needs a further immunological evaluation to study the etiology of this deficiency.
CD-8 (T-Cytotoxic-Suppressors) 17-35%
These cells are the referees of the Pan T and the T Helper interactions. They coordinate how strongly or how weakly the immune system reacts. In women with miscarriage and or infertility these cells are often on the low side. "They get tired arbitrating the hyperactive Pan T cells and the T Helpers." They are rarely high.
These three cell types comprise the 'engine' of the immune system. AIDS and immunological deficiencies affect these cell populations and as a result they are low in number. In patients with infertility and recurrent pregnancy losses, the CD3 and CD4 cells are usually high with the T- cytotoxic suppressors a little low from overwork.
CD-19 (B Cells) Normal Range 3-8%
These lymphocytes are plasma cells that produce antibody of all classes. What does this mean? IgM is the first antibody produced to anything that enters our body. This antibody stays in the blood and then as the immunity progresses it produces IgG (gamma globulin G) that resides in the lymph system. One IgM molecule has the immune capacity of 5 IgG molecules. IgG (Gamma globulin G) lives and repopulates itself in the lymph gland system. IgA (Gamma globulin A) is the last antibody made in an immune response and it resides in and protects the organs, skin and GI tract. When this antibody appears, it means that the immune response is completed and cannot go any further. When IgA responses (organ immunity) are present in any test for reproductive failure it usually means that the patient has an autoimmune process such as lupus, rheumatoid arthritis or other disorders.
CD-19 B cells are almost always high normal or very elevated in women with an immune cause for their infertility or recurrent pregnancy losses. There is often a greater than 12% elevation. This is one of the most important indicators of an immune problem and that the immune system is working overtime. Endometriosis also primes this system into greater hyper-reactivity.
CD56+ CD16+ Natural Killer Cells 3-12%
Natural Killer cells of this type are produced in the bone marrow and these cells produce a chemotherapy molecule called TNF (Tumor Necrosis Factor). This molecule is involved in eliminating cancer cells that may develop in normal individuals. Tumor Necrosis Factor also causes joint damage in women with rheumatoid arthritis. These Natural Killer cells are often elevated in women with infertility and recurrent miscarriage. The Tumor Necrosis Factor produced by these cells kills the rapidly dividing cells of the embryo and placenta often resulting in IVF or GIFT failure, blighted ovum or a chemical pregnancy where the BhCG elevates slightly and then quickly returns to non-pregnant levels. Normal levels for this cell population are 3-12%. The CD 56 and the CD16 molecules on the surface of these cells are special glue (adhesion) molecules that allow the Natural Killer Cells to attach to cancer, placental and embryonic cells. Once glued to the placental cell, it sprays Tumor Necrosis Factor on the cell and kills it.
CD 56+ Natural Killer Cells 3-12%
These Natural Killer (NK) Cells include CD56+/16+ Natural Killer Cells and CD56+ Natural Killer cells with lack of a CD16 molecule. Natural Killer Cells are activated by a pregnancy that fails or a fertilized embryo that degenerates. CD56+/16+ Natural Killer Cells are produced in the decidua and they are even more geared up to kill than those from the bone marrow. They produce large quantities of Tumor Necrosis Factor locally that kills the placental cells and the fetal cells. The normal range of CD56+ Natural Killer cells is 3-12%. Levels of 18% or greater correlate with poor reproductive outcome.
Natural Killer Cell Assay
The Natural Killer research test simply separates NK cells from the patient and asks them to perform their aggressive roles in the test tube. Varying concentrations of IVIg are added to the test tube to determine how much is necessary to prevent killing.
CD3/IL-2R+ Cells Normal Range 0-5%
These are pan T (CD3) cells that become aggressive in women with an autoimmunity disease. They may rarely elevate in women with miscarriage and infertility. If they elevate over 5%, then the T cell recognition process is activated. These cells are always elevated in patients rejecting a kidney or a bone marrow graft. We have found that some women who may be developing an autoimmune disease or who have an autoimmune disease show elevations in these cells.
CD 19+/5+ (B-1 Cells) Normal Range 2-10%
When this population of cells is activated, they produce polyclonal antibodies to hormones, hormone receptors and neurotransmitters. The hormones most usually attacked by these antibodies are thyroid hormones, estrogens, progesterone, gonadotropins and growth hormone. Women with elevations of these cells may be at risk for thyroiditis and the premature menopause. Patients whose levels are 80-90% often stimulate poorly with gonadotropins. Women with high levels often complain of immunological symptoms when stimulated with gonadotropins. These symptoms include joint pain, finger stiffness, headache, lethargy, malaise, fever, depression and occasionally urticaria and hives. These cells like the CD 3/IL-2R+ cells are elevated in autoimmune disorders and in situations where a person is rejecting a bone marrow transplant from a compatible donor. There is no question that they are involved in early embryonic loss or damage.
Summary
These comments about the reproductive immunophenotype test should serve as a guide for nurses and other health care professionals to educate patients about abnormal and normal results. If further reading material is desired, this material can be provided by calling my office.
Evo, ovo je isto jako bitno,
često se postavlja pitanje o NK stanicama i koje su njihove referentne vrijednosti za trudnoću.
Hm sad mi je jasno zakaj Tigy ima dobru liniju- pa da jeftinije prođe ako se terapija određuje po težini pacijentice.
Sorry Tigy nadam se da se nećeš uvrijediti jer namjera mi je bila da ti dam kompliment jer si me skroz iznenadila svojim izgledom tj. imala sam neku sasvim drugu predodžbu.
Dakle vidim da si pokrenula priču i da se dobrovoljci pomalo javljaju. Ja se javljam kao podrška jer kad bih ja to prevodila mislim da bi trebala četa prof.engleskog da to upristoje
U svakom slučaju bitno je imati na jednom mjestu takve informacije.
ajoooj, odvalila sam na ovo ...uporna prvotno napisa
Hm sad mi je jasno zakaj Tigy ima dobru liniju- pa da jeftinije prođe ako se terapija određuje po težini pacijentice.
da, upravo zbog toga održavam što manju kilažu, sad sam čak na 46 kg ... :shock: ... no s obzirom na moja 155 cm mislim da je to OK ...
P.S. uporna hvala na podršci, ne moraš prevoditi, možeš biti samo komentator, hehe ...
Inicijativa za 10!!!!!!!!! B R A V O !
Moj mali miš i ja smo preselili preko ljeta na Brač, tamo nemam niti komp, a kamo li internet
No, s obzirom da smo dva tjedna u Zgb, Tigy pošalji kaj da prevedem u tom periodu... nešto ću stići (noćna šihta
Hej Lidali ...
Ako želiš i ako stigneš možeš ovaj zadnji dio o NK stanicama,
a ako ne, nađem ti neki manji tekstić - za ovaj se još nitko nije javio, hehe ...
Zene - genijalne ste!
Dee-Dee, tebi posebno jedana velika pusa i da sto prije otvorimo jedan bezalkoholni sampanjanac
8) Može... prodano!
p.s. Tnx na pohvali avatara
Lidali ...
Evo još malo tekstova, smatram da su jako bitni:
The TH1 (T Helper 1) and TH2 (T Helper 2) Intracellular Cytokine Assay
The name of this test is nearly as complicated for patients as understanding what the test means. This short article will help you understand the importance of this assay for you as you prepare for a conception cycle.
In 1995, it became very clear to us that products of an activated immune system could damage the placenta and cause miscarriages as well as damage the embryo and cause implantation failure. The immune cells that could be counted and assayed at that time were of a family called natural killer cells with their CD56 marker (for more information, see Natural Killer (NK) Cell Assay for the Consumer). These cells produce a cytokine called tumor necrosis factor alpha (TNF alpha). When this molecule is released and becomes higher than normal in the body it enters the embryo, the placental cells and even cells of other active organs in the body and causes DNA damage in the cell, a process called apoptosis. The DNA of the rapidly dividing embryo cells is literally glued together and this stops cell division. The embryo or the baby "withers on the vine" and dies.
The first test to identify couples with this problem was the Reproductive Immunophenotype (for more information, see A Guide to Interpreting the Results of the Reproductive Immunophenotype). In this test we were able to identify women with too many NK cells and it was a great breakthrough for us. It soon became very clear that identifying these women and treating them was not successful in all. Simply counting the cell numbers was not specific enough.
We then developed the NK assay. This test cultures the NK cells of the patient with placental-like cells to determine how aggressively they kill the placental-like cells in 2 hours. We found that a killing power of above 15% at a ratio of 50:1 was too high and associated with infertility and pregnancy losses. We added one of the treatments given to patients, IVIG, to the NK assay. By doing this, we were able to determine if the IVIG would suppress the NK killing and also determine how much IVIG we needed to give the patient. This assay has been widely accepted and is now used worldwide.
It became clear to me over the years that there were some patients where treatment as I knew it simply did not work. Such patients entered a cycle of conception with a "green light, go ahead" from me, yet failed again and again. Certainly these patients were on an "Olympic team" of their own and required further treatment.
It was also becoming clear that the NK cells that I was evaluating are also the "bad guys" causing rheumatoid arthritis, and many of them prefer to leave the blood and live in the joints. I queried, "do women with implantation failures and recurrent losses, with optimal immune therapy as I knew it, have NK cells living as residents in the uterine lining, just as they do in the joint spaces with rheumatoid arthritis?" The answer to this question would turn out to be a definitive yes.
slikica:Natural Killer Cells in the Uterus
I began to do immune pathology on the pregnancy loss tissue and do endometrial biopsies on cycle day 26 of a normal cycle, or at the time of an implantation failure. Not surprising, 2% of my patients had NK cells surrounding the lost pregnancy and many had NK cells living in the uterus. At this time I began to explore the use of anti-rheumatoid arthritis (anti-TNF alpha) medications that direct their activity against the NK cells and TNF alpha molecules. I have studied three such medications that are FDA approved. Many women who had failed three IVF cycles before seeing me were successful during their next attempt following the anti-rheumatoid arthritis therapy. Many surprisingly became pregnant on their own. I have data on more than 200 babies born healthy in this program.
Since this time it has become clear that TNF alpha release by NK cells is really the fire alarm of the immune system. When elevated, it can indoctrinate other cells to perform aggressive roles of inflammation and even more TH1 cytokines to be released. These cells are not NK cells that are CD56+ but are CD3, and CD4 T cells that love to migrate to tissues including the uterus and the pregnancy where they can perform aggressive roles. We began to explore this possibility and thus five years later, the TH1/TH2 cytokine assay.
The immune system is balanced between a TH1 (autoimmune) and TH2 (pregnancy or suppressive response). Almost everyone is balanced in this system. Women with implantation failure or recurrent pregnancy losses are unbalanced; they are autoimmune with too much TH1. The TH1 (autoimmune "bad guys") produce TNF alpha, Interferon Gamma and Interleukin 2. Too much concentration of these cytokines kill cancer cells (a good thing) and a chronic state of too much of these can cause implantation failures, recurrent abortions and even thyroid, insulin and serotonin disturbances. (See Figure 1 below.)
slikica: Figure 1
The cells and the cytokines that balance this system and take over during pregnancy to protect it from being killed as cancer cells are the TH2 cytokine producing cells. These cytokines that protect the baby and down-regulate autoimmunity are Interleukin 4 (IL-4), IL-5, IL-6, IL-9, IL-10 and IL-13. During a normal pregnancy where the mother and baby experience no problems there are very high levels of TH2 cytokines and TH2 cytokine bearing cells in the blood and very low levels of TH1 cytokines and TH1 cytokine bearing cells in their body. Since high TH1 is also associated with the diseases Lupus and Rheumatoid Arthritis, these diseases often get much better during pregnancy and flare again following pregnancy. We have known this for years, but now understand the cellular basis for this phenomenon.
The TH1/TH2 intracellular cytokine assay simply counts the "good guys" and the "bad guys." We then give the results as two ratios:
1. the ratio of TNF alpha bearing cells to IL-10 bearing cells (TNFa/IL-10); and
2. the ratio of the Interferon Gamma bearing cells to IL-10 bearing cells (IFNg/IL-10).
The normal values are as follows:
TH1/TH2 INTRACELLULAR CYTOKINE RATIOS
TNFa/IL-10 IFNg/IL-10
Mean +/- SD (Limits) Mean +/- SD (Limits)
Non-pregnant 21.9 +/- 9.7 (12.2 -31.6) 13.1 +/- 7.4 (5.7-20.5)
Pregnant
1st Trimester 22.2 +/- 8.8 (13.9 - 31) 13.5 +/- 5.3 (8.2 - 18.8 )
2nd Trimester 18.2 +/- 9 (9.2 - 27.2) 11.9 +/- 5.2 (6.7 - 17.1)
3rd Trimester 26.5 +/- 9.5 (17 - 36) 11.7 +/- 4.6 (7.1 - 16.3)
We have found that women with the highest numbers are as follows:
1. Women with one live born child followed by secondary infertility or recurrent pregnancy losses. They are the coaches of the "Olympic team" with some of the highest values. Many of these women need the Rheumatoid arthritis drugs for 30 days before they begin a cycle of conception.
2. Second in line are women with three or more implantation failures following IVF.
3.Third in line are women with three or more pregnancy losses.
This new test is a godsend based on my experience. I feel strongly that we can use this test to find those infertile women and recurrent abortion women who will fail their next cycle without aggressive treatment. I look forward to the day when couples will stop the abuse of three or more implantation failures or recurrent losses before we get serious that there may be an immune problem that requires treatment. I strongly believe that we can find these couple before their first IVF cycle loss. Couples are waiting longer to start their families. Certainly pregnancy risk assessment is advocated in many areas of medicine. We must now add immune assessment to find these unfortunate couples that will spend a fortune in money, time and emotion and get nothing in return.
In women who find themselves on the list above, I recommend that minimal testing include:
1. Endometrial biopsy on cycle day 26.
2. Placental immune pathology of a D and C specimen done at the time of a loss.
3. Natural killer cell assay.
4. TH1/TH2 intracellular cytokine assay.
http://repro-med.net/tests/th1th2.php
Evo malo o NK stanicama u uterusu ( da naši doktori napokon shvate koliko je bitna ova pretraga ) ... :/
Immune Pathology Evaluation of the Endometrium
Introduction
Immune pathology studies of a biopsy of the endometrium (uterine lining) in women with recurrent pregnancy losses, IVF failures and implantation failures show that lymphocytes can damage the lining as well as the embryo. These lymphocytes are not seen in the uterus of fertile women. To find if a woman has this problem an endometrial biopsy is done by a gynecologist on cycle day 26 or a few days before menstruation.
These unwanted immigrant cells that take up house-keeping in the uterus are:
1. Activated macrophages that secrete IL-1 (toxic to the lining and to the embryos);
2. CD 56+ Natural Killer cells that secrete tumor necrosis factor alpha (toxic to the embryos and uterine tissue). These cells can cause stromal hemorrhages, subchorionic hemorrhages and early premenstrual spotting;
3. Mast cells (associated with hives and rashes in the skin of allergic individuals), when present in the uterus, cause stabbing pains, bad premenstrual syndrome, severe cramping and ill feelings after intrauterine insemination or embryo transfer.
Most individuals with category 5 immune problems have increased numbers of natural killer cells in the blood, and increased cytotoxicity (killing power) of these cells when tested in the NK assay. Some women, who have had category 5 immune problems for a long time, have natural killer cells that have migrated to the uterus and are living there as "tissue residents."
Background
At the time of ovulation the uterus and the endometrial lining are prepared for implantation. The glands and the endometrium are thickened to 10-14 mm, have formed three zones, blood vessels and blood flow have entered zone three and the glands are producing rich sugar-like secretions to nourish the embryo until it implants. New molecules are forming on the lining to make it receptive and sticky (integrins) for the embryo. Heparin molecules are arriving into the uterus to help cross link the embryo with the lining. Lymphocytes are arriving (TH-2) that will secrete cytokines (growth molecules) that help with implantation and growth of the embryo. All of this can be seen by immune pathology and can be seen as in good order. Immune pathology can also find the TH-1 natural killer cells that do not put the uterus and the lining in good order.
Two percent of unfortunate women that I see have a chaotic situation in the uterus. The lining development is disordered because of NK cells that have taken up residence there. NK cells live in the uterine glands, lining and in the stroma (soon to become decidua). This stroma is the tissue that nourishes the glands and the lining. It will soon nourish the placenta and we call this tissue decidua. When the embryo arrives, these NK cells are activated and secrete Tumor Necrosis Factor alpha, which causes a breakdown in the lining of the uterus, the glands and the stroma. When the stroma breaks down, hemorrhages and blood cysts appear. This can cause severe cramping and some bleeding. This results in the uterus becoming a hostile environment for the embryo. Pregnancies fail very early or do not occur at all.
Women at Risk for NK Cells in Uterine Tissue
Women who are at risk for having NK cells in the uterine tissue are:
1. Women with a known autoimmune disorder such as fibromyalgia, lupus, rheumatoid arthritis, Crohn's Disease, thyroiditis, chronic fatigue syndrome, Raynaud's disease, mixed connective tissue disorder and ulcerative colitis;
2. Women with a history of dysplasia of the cervix, carcinoma in situ of the cervix or papilloma virus infections (HPV);
3. Infertile women with endometriosis prior to their first assisted reproductive technology (ART) or IVF cycle;
4. Women with recurrent spontaneous abortions who lose their pregnancies earlier and earlier or who have secondary infertility;
5. Women with two IVF failures;
6. Women with repeated implantation failures;
7. Women who experience flu like symptoms with implantation, transfer or implantation failure;
8. Women who experience stabbing pelvic pains or intense cramping with inseminations or embryo transfers;
9. Women who experience strange symptoms in abdomen, pelvis and legs of cramping, jitteriness, jerking or strange traveling sensations in the skin post intrauterine insemination or post transfer.
In many women, all of these situations and complaints are discounted and minimized by most reproductive endocrinology or OB/GYN doctors. These symptoms are not in your head as figments of your imagination. They are real and demand attention and workup.
What can Diagnose this Problem?
1. An endometrial biopsy done two or three days before expected menses or, at the latest, on the first day of menstruation of a normal non-conception cycle.
2. An endometrial biopsy done 10-14 days post transfer when the pregnancy test is negative and before menstruation begins.
How is the Biopsy Done?
The information on how the biopsy is done is intended for registered patients of our program.
1. The instruments used by the doctor is a disposable Endometrial Suction Curette or a Novak curette. The biopsy is done in the doctor's office or at the hospital.
2. The doctor places the tissue in 10% formalin. He/she can send the tissue directly to my laboratory, or it can be sent to his/her pathologist to be embedded in paraffin blocks and the paraffin blocks can be sent. The tissue should be sent by overnight mail to
Alan E. Beer, M.D.
Medical Associates Infusion Center
15151 National Ave. #2
Los Gatos, CA 95032
Prior to s(kršitelj koda)ing a pathology specimen, you should contact us and register your information. If a specimen arrives without a completed patient registration packet, then the specimen will not be submitted for a pathology evaluation.
3. When the test results are available, someone from our office will contact you. However, it is a good practice to contact us at (408) 356-9500 if you do not hear from us more than three weeks from your specimen ship date.
4. A consultation will be set up with one of our physicians to discuss the results (please note, there will be a charge for both phone and e-mail consultations).
Costs
If you are a registered patient with our program
1. Please contact info@repro-med.net for the most current price.
2. There is an additional fee for reviewing the registration packet and medical records. This review allows the physician to make recommendations for testing that will need to be completed prior to initiation of treatment.
http://repro-med.net/tests/endomet.php ... evo i link ...
The Importance of Pathological Evaluation of Pregnancies
that Terminated in Spontaneous Miscarriage
http://repro-med.net/tests/patho.php ( evo link, da ne copy-pastam )
zlato si, da sam barem bila pristojnija i više slušala na engleskom pa bi sad bila od koristi....mislila sam da ajde znam dosta, a sad vidim :shock:
Tigy, prikoci malo... Mislim da cu svisnuti od toooolikih tekstova.
Salim se, jos nisam nista pocelajer sam imala neodloznih obaveza... Ali hocu i to vec od petka... A u subotu idem na svadbu, itd.
Salim se, obecanje stoji. Samo polako, zeno, ionako PMS-iram i tucem se s MM za mjesto ispred kompjutera...JA barem radim nesto korisno a on bi samo igrao igrice...
Hehe, evo stopiram ...
Ja sam vam sada okačila malo više da se ufurate,
jer ni mene nema često online, pa kad stignem, zakačim još ...
Prijevod ovih tekstova zaista će puno značiti, jer su te informacije u zadnjih nekoliko godina jako aktualne u svijetu,
tako da ćemo uskoro imati cijelu bazu podataka što se tiče reproduktivne imunologije i mislim da ćemo na taj način pomoći mnogima koji žive u nedoumici ponavljanih neuspješnih IVF-ova, te spontanih pobačaja i idiopatske neplodnosti.
Također ćemo na ovaj način ukazati našim klinikama na propuste koji se događaju pri određenim testovima,
osobito tu mislim istaknuti NK stanice ( jer na Rebru rade samo CD56 ) i to u perifernoj krvi protočnom citometrijom. (itd itd ... )
Istodobno vidjet ćete koja je razlika između imunoloških testova kod nas i u svijetu.
Drago bi mi bilo kad bi nam se javio i netko od doktora za komentar,
pogotovo u vezi šta možemo učiniti kako bi popravili stanje na ovom području,
da li nam trebaju stručnjaci, koja dodatna oprema, koji aparati su točno u pitanju ... :?
Mislim da snagom ljudske volje puno toga možemo učiniti i promijeniti,
a informacija je najbitnija od svega i mora nam biti polazna točka u svemu... 8)
Cure, vjerujte mi, nisu Ameri baš tako ludi i ne bi oni "bacali lovu" samo tako u vjetar, da je to nešto SF,
već je to dokazano na puno parova koji su uzaludno pokušavali na svim mogućim klinikama ( ali bez imuno-terapije ).
Mislim da svaki čovjek ima pravo na ovakav vid informacije,
a njegova je odluka hoće li se odlučiti na takav korak ili ne.
Jer, rekla je ina33, nada se da ovakve info neće "ukomirat" pacijente već pomoći im, s obzirom na općepoznatu lošu financijsku situaciju u državi, ali ljudi moji, ako netko zaista ima ovaj problem i vuče ga dugi niz godina, a diže kredite za raznorazne potrebe npr. za novi auto, mislim da će ipak izabrati ovu opciju i uplatit si za imuno-pretrage i imuno-terapiju, te rješit svoje osnovno reprodukcijsko pitanje ( naravno, ukoliko se dokaže da par ima imuno-problem ).
Također, smatram da budući se radi o jako skupim pretragama,
a HZZO ne može snositi sam sve troškove, da se omogući pacijentima šansa za vlastito financiranje
u smislu da sve svoje nalaze dobiju potpune i u što kraćem roku.
To pišem iz tog razloga što u našem zdravstvu uvijek nešto i negdje nažalost šteka, pa se stalno stvara neki problem ni iz čega, a kad bi svi uplatili bar polovicu iznosa, olakšali bi HZZO ( nešto poput dopunskog zdravstvenog ) i omogućili kvalitetniji i brži pristup našem problemu, te rješavanju istoga.
Zapravo, svatko misli na ovaj način - " tko sam ja da kao pojedinac promijenim nešto u cijelom tom sustavu,"
ali vjerujte mi da je svaki glas i svaka riječ bitna i da se mnogo toga može promijeniti samo ako mi to doista želimo.
Eto, drage moje rodice, opet ja oduljila ...
pa neka to onda bude za početak " iz riječi u djela" ...
Tako je Tigac, svaki glas se racuna i od malog kamencica krece odron
Mogu samo reci, hvala Bogu da Dr Beer nije tako mislio, inace mi ne bi imali nadu ni sansu ostvariti rodeiteljstvo
Slažem se, slažem - ja ću prevest svoj dio pa nek' ljudi čitaju i odluče za sebe, imam ja malo tu defetističku crtu, nemojte kaj zameriti. Još jedna zamolba - najzanimljije su svima uvijek "žive priče" tj. put kojim su curke forumašice uspjele sebi organizirat imunoterapiju i kako je to teklo u praksi, koji su bili troškovi, kako je to u Hrvatskoj ili u europskom susjedstvu izvedivo - tj. "kuharica"
Ina33, nadam se da će se javiti i cure sa iskustvima ...
A za sada, na nama je barem da prevedemo ove informacije da bi napokon imali sve na jednom mjestu.
Ma, Tigica, imaju doktori sve na jednom mjestu - imaju pristup knjizi, imaju internet, znaju naručit preko neta, valjda govore engleski itd. Ovo je više patient manual za nas s "druge strane bijele kute", a ova teorija bez ključeva za praktičnu primjenu je super, ali... bilo bi super čuti sve to in vivo, ali ne preko Beerovih caseova u knjizi, nego kao iskustvo forumaša - dojmljivije je, rekla bih.
ok, prevest ćete ovo, ali ja mislim da će nam tek onda trebati rječnik !!
Većina od nas nema veze s medicinom i ja se već polako gubim u svim ovim tekstovima, tj. razumijem problematiku i njenu važnost, ali kako ćemo pobuditi interes nekog imunologa i MPO doktora ?
znam, obuzima me ponekad malodušnost....ali tigy, kako si to zamislila konkretno,tj.kako da mi tome pripomognemo ( jer kao što je ina napisala,imaju oni knjige, internet...)
U svakom slučaju podržavm inicijativu po tom pitanju jer sam i sama u tome !!
Vjerojatno je Tigy zamislila da svaka od nas svog MPO-ovca za ovo pita ili... Samo, onda bi trebao nekakav "hint" kakvo je njihovo načelno mišljenje o tome, što ne znači da se neće promijeniti. Tigy je već to i sama odgovorila naznačivši osobe koje su joj u Hrv. pomogle, čisto da se netko mlad i zelen ne nađe u situaciji da dođe kod svog doka s ovim pa ga odmah u startu antagonizira (mislim, ja otprilike znam kako ko "diše" od postojeće MPO "garniture" jer sam se isto malo "spržila" u direktnom kontaktu na temu imunologije s doktorima), jer će neki tako regirat na sva istraživanja sa strane, a neki baš na imunološka i protiv su toga, treba bit realan, a svi mi, uz želju da otvorimo neke nove svjetove drugima, ipak primarno liječimo sebe i pokušavamo napravit našu bebicu, pa treba i doza takta itd. A, to be fair, trebalo bi onda prevest i one tvoje linkove koje si ti linkala vezano za neka drugačija mišljenja u Engleskoj a propos NK u uterusu itd. Mislim, trebalo bi ljudima biti jasno je li vani postoji ili ne postoji konsenzus o tome (meni se čini da ne postoji u ovome trenutku, ali što ja znam - ja to ipak čitam iz Hrvatske i nikad nigdje nisam bila, nego u Hrv. i Slo). Moguće da u ovim terapijama možda baš nešto ima što pomaže idiopatima. I zbog toga ja mislim da bi na sasvim drugi način bilo poticajno da se napišu stvarna iskustva (do američkih ćemo lakše jer su opisana u Beerovim knjigama), ma koliko god je to teško, pa i meni dijelom, na ovako otvorenom javnom forumu. Mislim, znam i ja nekoliko uživo - i hvala vam svima, drage cure, na tome
Cure ...
istina je da doktori imaju knjige, internet, rječnike itd ...
ali o ovome nitko ne piše, ne govori, kod nas je to još uvijek "tabu tema" (nažalost).
Svi polaze od točke da je to SF i da mi financijski ne možemo pratiti Ameriku itd ...
Naravno da su u pravu ( budimo realne ).
Ali, informacija je jedno, a praksa drugo.
Svatko ima pravo izbora.
Zašto onda ( ako si liječnik ) ne ukazati pacijentu i na ovakav vid terapije.
Mislim da je to dovoljno moralno i etički.
Ili, kao doktor, kako obrazložiti da tvoja metoda uzastopnih IVF pokušaja sa dobrim embrijima ipak nije imala uspjeha ?! :?
I još nešto, nisam zamislila da svaka gnjavi svog doca u vezi ovoga. :/
Samo ljudima želim probuditi svijest da i ovo postoji i da ponekad možda ipak nisu isprobali sve što im je u mogućnosti.
Hvala ti na tome, jer sam upravo na tvom blogu uopće saznala da ima ovakvih stvari i puno si mi pomogla sa nekim pitanjima u glavi. E sad da li će svaka od nas uspjeti istražiti što želi i da li će koji dr što raditi po tom pitanju to je već nešto drugo... moramo biti uporneSamo ljudima želim probuditi svijest da i ovo postoji i da ponekad možda ipak nisu isprobali sve što im je u mogućnosti.
ja imam problem s HLA tipizacijom , poklapamo se u DQ lokusu pa svi mašu rukom na to... ne znam, vidjet ćemo što će biti....
ZO, a kakav ti je Cross-Match test ?
To ti piše na HLA tipizaciji u dnu , pa škicni ...
Eto, ja škicnuh,
piše neg. (-),
a u annotation piše testom miješane kulture limfocita dobivena niža reaktivnost,
mislim da to piše skoro svim curama koje su iznijele rezultate...
ZO, ako je Cross-Match tj. LAD test bio negativan,
postoji mogućnost da imaš nisku razinu antitijela leukocita, a to nije dobro za trudnoću.
No, budući ga na Rebru rade starom metodom( microcytotoxicity ), nisi sigurna dok ga ne ponoviš protočnom citometrijom.
U HR to nažalost nitko ne radi (LAD in flow cytometry ), ali ću pokušat objasniti na ovom tekstu koliko je taj test važan ... :/ :
http://www.sharedjourney.com/define/lad.html
Leukocyte Antibody detection (LAD)
Mnogi parovi su iskusili opetovane pobačaje ili neobjašnjive gubitke trudnoće. Ako vi i vaš partner imate teškoća oko zatrudnjivanja, moglo bi biti važno da učinite razne testove fertiliteta. LAD (Detekcija antitijela leukocita) ponekad može ponuditi informaciju zašto imate probleme vezane uz fertilitet.
Što su to Antitijela leukocita?
Antitijela leukocita se stanice koje se nalaze u vašem tijelu i napadaju leukocite. Leukociti se uobičajeno nazivaju bijela krvna zrnca. Nalaze se u vašoj krvi, koštanoj srži i limfnom tkivu, odgovorni su za napadanje stranih bakterija i drugih uljeza koji ulaze u vaše tijelo. Tijekom trudnoće, leukociti ponekad mogu napasti stanice vašeg
Fetusa. Da bi zaštitilo vašu bebu i održalo trudnoću, vaše tijelo stvara antitijela na te leukocite. Svaka trudna žena bi trebala imati pozitivan nalaz na određenu razinu antitijela leukocita.
Tko ima antitijela leukocita?
Antitijela leukocita se mogu razviti i kod muškaraca i kod žena. Ona su tipično nalaze kod ljudi koji su:
- trudni
- primaju transfuzije krvi
- primaju donirane organe
Antitijela leukocita i neplodnost
Niska razina antitijela leukocita povezana su sa problemima plodnosti. Žene sa razinom nižom od normalene vjerojatno su:
- doživjele pobačaj
- rodile mrtvorođenče
- imaju opetovane spontane pobačaje
LAD test
LAD test je jednostavno vađenje krvi iz vene na ruci koje se šalje u laboratorij na testiranje.
Tko može imati koristi od LAD testa?
LAD test se obično rabi za detekciju razine antitijela kod trudnica ili ljudi koji idu na transfuziju krvi i operaciju transplantacije organa. Žene koje se bore sa neplodnošću također mogu imati koristi od tog testa.
Možda ste pogodni za LAD test ako imate:
- neobjašnjenu neplodnost
- više pobačaja
- kontinuirane IVF neuspjehe
Nalazi
Nalazi vašeg LAD testa bi trebali biti dostupni kroz tjedan dana ili sl. Vaš reproduktivni endokrinolog će vam pomoći razjasniti nalaz.
Normalni nalaz: normalni nalaz pokazuje da ste pozitivni na antitijela leukocita u vašem krvotoku. Normalna razina LAD je iznad 50%.
Granični nalaz: granični nalaz znači da imate antitijela leukocita u krvotoku, ali niže od tipičnih vrijednosti. Graničnom vrijednosti smatra se nalaz između 30% i 50%.
Nenormalan nalaz: nenormalan nalaz označava vrlo nisku razinu antitijela leukocita u krvotoku. Razine niže od 30% smatraju se nenormalnima.
Nakon LAD testa
Nakon primanja nalaza LAD testa, vi i vaš partner bi trebali razmotriti moguće alternative tretiranja plodnosti. Ako imate negativan LAD test, to bi mogao biti faktor koji doprinosi vašim problemima fertiliteta.
Tretman za ovo stanje je moguć.
LIT (Terapija leukocitnom imunizacijom) pomaže povisiti razinu antitijela leukocita u vašoj krvi. Injiciraju vam se leukociti vašeg partnera (ili donora), što pomaže vašem tijielu da poveća svoj broj antitijela. To bi vam trebalo pomoći ostvariti (održati) trudnoću.Eto, meni je također Cross-Match (LAD test ) negativan, uz povišene NK stanice,What is LIT (Lymphocyte Immune Therapy)?
(Taken from Dr Beer’s old LIT document )
Lymphocytes (white blood cells) of two classes are isolated from the male spouse. The two classes isolated from whole blood are the T cells (CD-3) and the B cells (CD-19). The Consumer’s Guide to the Reproductive Immunophenotype further defines how these white blood cells differ from others. Forty million lymphocytes are washed three times and then concentrated into an immunization that is less than 0.6 cc. This concentrate of lymphocytes is then injected in the skin of the woman (intradermally) just like an allergy skin test. It usually requires 4 injections, two on each forearm. The injected areas then become red, slightly swollen and itch just like a positive skin test. One month later the process and the injections are repeated. The second injection sites usually become less red, swollen and itch less than the first ones. One month later blood is drawn from the woman (serum) and blood is drawn from the man (lymphocytes). A test called the lymphocyte antibody detection assay (or Crossmatch) is done to determine if the immunizations have worked and the woman has made blocking antibody to her spouse’s T and B cells.
This test has two parts, 1) a microcytotoxicity assay and 2) a flow cytometry assay. The first test (microcytotoxicity) becomes positive in only 30% of women. If it does not become positive, this is not a bad result. Women who remain negative in this assay become mothers with the same frequency as women who become positive in this microcytotoxicity assay. The proper response is for the woman to become positive in the flow cytometry test. If the second part of the test does not become positive, then booster immunizations are given or donor lymphocytes are mixed with the husband’s lymphocytes and the immunizations are done again with donor plus paternal. It should be noted here that there are two types of donors, and both types are screened. Type I uses blood that has been frozen for a minimum of six months. Type II uses fresh blood from the donor. Testing for the leukocyte antibody detection assay (Crossmatch) is done one month later.
Why is LIT used?
LIT is used to treat:
Category 1 Immune problems
Lack of blocking antibody to pregnancy. More specifically:
1. Low blocking antibodies (LAD test IgG T cells or IgG B cells are below 30%)
2. Elevated NK cytotoxicity (NK Assay 50:1 is above 15%)
3. Often used in combination with IVIG in patients who show poor suppression on the NK Assay with IVIG in the test tube (50:1 over 15% at 6.25mg/ml or 12.5 mg/ml)
te visok titar antitijela štitnjače i neistražene DR i DQ lokuse - ne idem u postupak bez prave terapije ...
Tigač sada je Tvoje vrijeme
Šaljem ti pusu prijateljice!
Tnx navi ...
opet zahvaljujući tebi znam da je ovo sve što si navela mogući problem otkad sam ti proučila blog. Gdje ti namjeravaš napraviti LAD test..? još nešto, a ne znam dal sam u pravu, malo mi sve to zvoni po glavi - dal je rezultat tog testa " nastao " takav baš zbog preklapanja ili je to neovisno jedno o drugom :?
Beer smatra da je o.k. ako je rezultat preko 30%.Normalna razina LAD je iznad 50%.
Tigy, jesi li ti pitaala koliko kosta LIT u Njemackoj?
ZO, neovisno jedno o drugom, nema veze sa preklapanjem u lokusima ...
Dee-dee, meni u Njemačkoj žele ponoviti kompletne pretrage cca. 4000 €,
a u Italiji je cijena 350 € LIT, a 150 € konzultacije, samo mi iz HR moramo još ponoviti i LAD test ( ne znam točno cijenu ).
Drage devojke, da li se u Hrvatskoj rade pretrage koje ste navele. Ako se rade da li mozda znate kakva je procedura da i mi s ove strane to odradimo kod vas. Moram da priznam da se kod nas ni HLA tipizacija ne radi.
Sve mi mirise da je kod mene neki imunoloski problem, cak je i endokrinolog nesto spomenula u vezi mogucih endometrioticnih zarista koji izazivaju imunolosku reakciju na plod buduci da sam imala dve spontane trudnoce koje su se obe zavrsile u petoj nedelji. Eto, sumnjivo mi je bas to sto su obe u isto vreme otisle.
Pozdrav
a joj, sad razumijem zašto radiš, radiš, radiš.... što ti smatraju pod kompletnim pretragama da toliko košta jel to opet nešto novo ili... u Njemačkoj ne daju LIT terapiju koliko sam shvatila, a LAD test jel rade? Jesam pokopčala... kada napraviš LIT terapiju jel to onda OK za stalno ako ti i LAD test dokaže ovo što je djelomično utvrđeno kod nas Cross- match testom?ZO, neovisno jedno o drugom, nema veze sa preklapanjem u lokusima ...
Dee-dee, meni u Njemačkoj žele ponoviti kompletne pretrage cca. 4000 €,
a u Italiji je cijena 350 € LIT, a 150 € konzultacije, samo mi iz HR moramo još ponoviti i LAD test ( ne znam točno cijenu ).
Radim, radim draga ZO
U Stuttgartu ima jedan lab koji radi te pretrage i LAD, te po potrebi LIT ...
evo link: http://www.immu-baby.de/dsr/impressum.htm ( Dr.med.Sylke Reichel-Fentz )
ali oni žele radit sve pretrage iznova, a ne samo LAD posebno, pa me to toliko izađe,
znači treba mi jedno 4.000 € za pretrage, 2.000 € za terapiju (LIT) jer on se radi cca. 2 x u životu,
3.500 € za ICSI i jedno 5-6.000 € za IVIG ... i na kraju mi nitko ne garantira uspjeh, mislim koma ...
Draga nabla, u HR se HLA tipizacija radi na Rebru ... uzastopni spontani pobačaji mogu imati imunološki uzrok. :/
uz sve navedeno odi ti nama Tigač u Ameriku, a evo i mene s tobom po drugo!Radim, radim draga ZO
U Stuttgartu ima jedan lab koji radi te pretrage i LAD, te po potrebi LIT ...
evo link: http://www.immu-baby.de/dsr/impressum.htm ( Dr.med.Sylke Reichel-Fentz )
ali oni žele radit sve pretrage iznova, a ne samo LAD posebno, pa me to toliko izađe,
znači treba mi jedno 4.000 € za pretrage, 2.000 € za terapiju (LIT) jer on se radi cca. 2 x u životu,
3.500 € za ICSI i jedno 5-6.000 € za IVIG ... i na kraju mi nitko ne garantira uspjeh, mislim koma ...
He,he ... preko velike bare po baby-zamotuljak, dogovoreno ...
uz sve navedeno odi ti nama Tigač u Ameriku, a evo i mene s tobom po drugo!
Uh draga moja ove cifre zvuče :shock: , a pogotovo zato jer kao što sama kažeš - nitko ti ne garantira uspjeh - koliko si još daleko od toga ? mislim 1-2 mjeseca ili 10 mjeseci ?Radim, radim draga ZO
U Stuttgartu ima jedan lab koji radi te pretrage i LAD, te po potrebi LIT ...
evo link: http://www.immu-baby.de/dsr/impressum.htm ( Dr.med.Sylke Reichel-Fentz )
ali oni žele radit sve pretrage iznova, a ne samo LAD posebno, pa me to toliko izađe,
znači treba mi jedno 4.000 € za pretrage, 2.000 € za terapiju (LIT) jer on se radi cca. 2 x u životu,
3.500 € za ICSI i jedno 5-6.000 € za IVIG ... i na kraju mi nitko ne garantira uspjeh, mislim koma ... :roll
Ja imam u svemu ogromnu sreću da mi je spermiogram od muža u redu, štitnjača odnosno njezini hormoni su OK pa je valjda i to u redu, a također i NK stanice su bile 8,5 ( radila sam to na rebru iako je tamo referentna vrijednost od 10-31, znam da trebaju biti 2-12% ) No ipak sam danas vidjela da imam minimalno 2 problema- preklapanje ( možda bih to mogla riješiti kod nas dexom kad bi mi netko prepisao ) i još Cross - match test koji (ne)valja pa ne znam što ću...draga moja napraviti ćemo najveći tulum na svijetu kad ti objaviš da nosiš
a joj, ne znam beknut njemački, sad sam pogledala, svaka ti čast što si uspjela doći do svega toga...
Daleko sam još, računam tek iduću godinu ...
Ali bit će, kockar sam u duši, zariskirat ću pa šta bude ...
prije nego predam molbu za posvojenje, jer ako ne ide na ovaj način, uvijek postoji i drugi ...
P.S. preklapanja u lokusima uopće nisu velik problem, ako imate dobre embrije,
ta preklapanja ima oko 50 % populacije, a da ni ne znaju da imaju ... znači nije nikakav problem.
Cross-Match test je isto tako rađen starom metodom, pa nije pouzdan,
zato ni to možda ne bi trebao biti problem, znači samo i dalje pokušavajte, sretno draga moja ZO !!!
ma ti si jedno velikoi raditi na
ja sam sigurna da ćeš ti na kraju imati puno dječice jer ovakva želja i borba kao što je slučaj kod tebe ne može ostati nenagrađena, uz tebe sam i pratim te...
bebomanka
TIGY i tim
Ne znam sto bi vam rekla za ovu akciju..
Ja sam u Austriji i kad sam svojoj gin. postavila pitanje imunologije isto mi je odgovorila da ne misli da je kod nas taj problem i da su to jako skupe pretrage i tako je na tome i ostalo...ne znam niti gdje se rade niti koliko kostaju..
25.06.imamo termin u jednoj od najnovijih IVF klinika u Salzburgu za konzultacije i oni se bave geneticim ispitivanjem spermija,JS i embrija....pa cu se malo raspitati i o imunologiji...
Ako ste zainteresirane procitajte si malo o toj klinici..
http://www.ivf.at
Nesto je napisano cak i na hrvatskom jeziku ali ne najvaznije pa idite ipak na njemacki jer tamo postoje slike po kojima se vidi razlika u tome sto ispituju...
Cure ...
P.S. samo da priupitam, kako idu prijevodi ?!
Cca pola prevedeno, ali svaku drugu riječ ću morat provjeravat ono doslovno ko' da vezem golben - svaka druga - ajde listaj rječnik - jer ti je stručno prevođenje uvijek teže sa stranog na domaći (moraš poznavat stručnu terminologiju domaćeg). Dako si ti verzirana vezano za sve te cakice - fosfolipidi, molekula ova - ona - da ti pošaljem mailom terminološki upit? Ostaje mi samo da tražim po med. rječnicima ili guglam, ne mogu sestru mol. biologicu pitat, ona ima dvoje klinaca, s jednom mora vježbati i nema vremena ni pričat kako si - dobro...
Ako budem znala rado ću pomoći, šalji na pp ...
OK. Moja metodologija zasad je - pišem sve što nisu stručne riječi, stručne riječi označavam žutim highlighteom bez kopanja po riječnicima i tako mislim "dovest" do kraja teksta. Nakon toga ću izdvojit terminologiju i sve što ne znam (a to je 99% stručne terminologije) šaljem tebi na mail i onda ću samo sve te riječi u tekstu "riplejsat" sa riječima koje mi ti daš, a prije ili nakon toga ću još pogledat doma ako slučajno imam kakav stručni riječnik. Znači - prvo bih slala tebi riječi na eng. jer ih tako sad u tekstu ostavljam, i ti ćeš to brže ako si u tome nego da ja guglam i mislim dal' ovako, dal' onako, ispitujem okolo itd.
samo da vam kažem da mi je lidali poslala dio prijevoda, a vi sad polako, bez žurbe-ja ovaj njezin dio moram poslati na lekturu.
Hvala, vučice! Bliži se "spajanje" i svakakvi planovi se rade, ali ne uključuju laptop i riječnike
Cure, najbolje ste ...
Potpisujem inu
Saljem cim zavrsim...
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