A cohort of 123 infertile couples was studied by life tables over a 30-month follow-up period to determine the influence on reproductive prognosis of clinical features, namely the women's age, previous gestational events, evolution time, and a number of conditioning infertility factors. The cumulative pregnancy rate (CPR) was 60% at 30 months. Women aged 32 years or less had a CPR of 65% and those over 32 years had a CPR of 31%. Couples with previous pregnancy had a CPR of 88%, while those with primary infertility had a CPR of 45% (marginal statistical difference). The group with infertility evolution of 36 months or less had a CPR of 75% and those with greater than 36 months infertility evolution had a CPR of 43% (p < .05). With one conditioning infertility factor a CPR of 75% was found, and with multiple factors a CPR of 47% (p < .05) was found. With these results a grading chart was created using all the analyzed criteria, determining the proportion of pregnancies per number of negative points obtained; at greater grades the proportion of pregnancy was reduced (p < .01). This report establishes the prognostic value of different variables observed in the evaluation of infertile men and women, and a simple procedure to calculate the probability to achieve pregnancy is proposed.
Natural Killer (NK) cells are the most abundant lymphocytes in the decidua during early gestation. The interactions of NK cells with the extravillous cytotrophoblast have been associated with a normal spiral artery remodeling process, an essential event for a successful pregnancy. Recent data indicate that alterations in the amount of decidual NK (dNK) cells contribute to the development of preeclampsia (PE). Moreover, genetic studies suggest that Killer Immunoglobulin-like Receptors (KIR) expressed in dNK cells influence the susceptibility to PE. Although dNK cells have been well characterized during early pregnancy, they have been scarcely studied in the third trimester of gestation. The aim of this work was to characterize dNK cells at the last trimester of gestation and to analyze the KIR genotype of healthy and PE women. Decidual samples were obtained during Caesarean section from control (n = 10) and PE (n = 9) women. Flow cytometric analysis of CD3, CD56, CD16 and CD9 was used to characterize and quantify dNK cells in both groups. Cell surface markers from decidual leukocytes were compared with PBMC from healthy donors. KIR genotyping was performed in genomic DNA (control, n = 86; PE, n = 90) using PCR-SSP. The results indicate that dNK cells persist throughout pregnancy. They represented 20% of total leukocytes in control and PE groups, and they expressed the same cell surface markers (CD3-, CD56+, CD16- and CD9+) as dNK in the first trimester of gestation. There were no significant differences in the percentage of dNK cells between control and PE groups. The analysis of KIR gene frequencies and genotypes was not statistically different between control and PE groups. The ratio of activating to inhibitory genes indicated that the overall inhibitory balance (0.2-0.5) was more frequent in the PE group (control, 31.3% vs PE, 45.5%), and the activating balance (0.6-1.1) was more frequent in the control group (control, 68.6% vs PE, 54.4%). However this difference was not significant. We demonstrated the persistence of dNK cells in PE and control women at the third trimester of pregnancy; these dNK cells had a similar phenotype to those found during early pregnancy. The predominance of a KIR inhibitory balance in the PE group could be associated to the physiopathology of PE.
Preeclampsia (PE) is one of the most severe complications of pregnancy. PE is responsible for the highest rates of morbidity and mortality for both pregnant women and the neonate. In this review, we first address general aspects of PE and its diagnosis, along with some epidemiological aspects of this disease in the mexican population, in particular the experience from the Instituto Mexicano del Seguro Social. Even though over the last 20 years a great deal of evidence has accumulated regarding PE's pathophysiology, an exact mechanism to explain its etiology has not been established. This review aims to cover the status of two of the most important hypotheses in the etiology of PE: the immunological and the placental ischemia hypotheses. Recent data suggest that Natural Killer cells (NK) play a major role in the decidual spiral arteriole remodeling and in normal placental development. In genetic studies, KIR receptors present in NK cells have been involved in the susceptibility for the disease. In this review, we discuss data of our group regarding the presence of NK cells in the decidua, at the end of pregnancy and the genotypes of KIR receptors in normal and preeclamptic Mexican population. PE is characterized by abnormal placentation and hypoxia with an increase of anti-angiogenic factors; the Hypoxia-inducible factor 1-alfa (HIF1-alfa) is over expressed in PE. In this review, we also included some of our results concerning the polymorphisms and regulation of HIF in preeclamptic women.
The sheer complexity of Web applications and inadequate approaches to analyze, design or update such projects generate incorrect environments, which are the source of potential risks.Poor applications reflect low availability, maintenance difficult and questionable efficiency in the services they provide.At present the quality assurances schemes still performed manually.A group of evaluators are based on a test matrix to run tests, and thus according to the degree of experience is that the results are interpreted by each evaluator.This process requires much time and effort, since the goal is to test the system thoroughly to identify as many potential errors in the system.This proposal focuses on the development of an assessment tool with the ability to emulate a group of virtual testers in real contexts of tests for applications on the Internet.This system generates controlled testing using virtual evaluators that emulate the activity of people atmosphere.The results have been satisfactory, currently we worked on the proposal to create a factory abstract of test cases to extend the functionality tool.