A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment.

OBJECTIVE: To design a reproductive treatment algorithm based on the sperm DNA fragmentation (SDF) for couples with unexplained infertility following a poor intrauterine insemination (IUI) outcome. DESIGN: Couples that failed IUI with no apparent reproductive issue in both partners were allocated to diverse reproductive treatments on the basis of SDF. SETTING: Reproductive medical center in an academic setting. PATIENT(S): Over 4 years, couples with an unexpected poor IUI outcome and no apparent female or male partner reproductive issues were recruited. INTERVENTION(S): IUI, IVF, and ICSI were performed in the standard fashion following sperm SDF assays. MAIN OUTCOMES MEASURE(S): Fertilization rate, implantation rate, pregnancy characteristics, and delivery rates. RESULT(S): A total of 354 couples with unexplained infertility and normal semen parameters underwent 1133 IUI cycles. Clinical pregnancy rate (CPR) with IUI at our center in an age-matched cohort is 23.9% while the study cohort had 1.8%. Following SDF assessment, couples with failed IUI attempts but normal SDF (SCSA 9.8 ± 4.6%; TUNEL 11.8 ± 6.2%) underwent IVF with a CPR of 12.7%; those with abnormal SDF underwent ICSI with ejaculated spermatozoa, resulting in a CPR of 18.7%. This group included couples with normal SDF that had failed IVF. Couples with abnormal SDF that failed ICSI with ejaculated spermatozoa achieved a CPR of 31.0% with surgically retrieved spermatozoa. CONCLUSION(S): Couples with unexplained infertility that present with unexpectedly poor IUI outcomes can be funneled into a treatment algorithm guided by the integrity of the sperm genome for higher chances of pregnancy using an alternate method of insemination.

Intracytoplasmic sperm injection: state of the art in humans.

Among infertile couples, 25% involve both male and female factors, while male factor alone accounts for another 25% due to oligo-, astheno-, teratozoospermia, a combination of the three, or even a complete absence of sperm cells in the ejaculate and can lead to a poor prognosis even with the help of assisted reproductive technology (ART). Intracytoplasmic sperm injection (ICSI) has been with us now for a quarter of a century and in spite of the controversy generated since its inception, it remains in the forefront of the techniques utilized in ART. The development of ICSI in 1992 has drastically decreased the impact of male factor, resulting in millions of pregnancies worldwide for couples who, without ICSI, would have had little chance of having their own biological child. This review focuses on the state of the art of ICSI regarding utility of bioassays that evaluate male factor infertility beyond the standard semen analysis and describes the current application and advances in regard to ICSI, particularly the genetic and epigenetic characteristics of spermatozoa and their impact on reproductive outcome.

Efficacy and safety of tenofovir, entecavir, and telbivudine for chronic hepatitis B in heart transplant recipients.

BACKGROUND: Treatment of chronic hepatitis B (CHB) with polymerase inhibitors is key to prevent disease flares and progression toward advanced liver disease. Efficacy and tolerability of newer agents has been reported anecdotally in transplant recipients. METHODS: In this prospective, observational study, we assessed outcomes of therapy with tenofovir (TDF), entecavir (ETV), and telbivudine (LdT) in 13 heart transplant recipients (HTR) with CHB. RESULTS: Most patients were hepatitis B e antigen negative, had low baseline hepatitis B virus (HBV) DNA, and normal aminotransferases. Liver biopsy showed a median fibrosis score of 1.5 (range 0-4). Glomerular filtration rate (GFR) was <50 mL/min in 7 patients (54%). Two patients were started on de novo ETV before transplant. Eleven previously treated patients were switched to TDF (n = 9) or LdT (n = 2). Median treatment duration was 33 months (range 1-71). HBV DNA remained suppressed in 6 patients and became undetectable in 5. Aminotransferases went down to the normal range in all patients, with a single flare in 1 patient. One patient lost hepatitis B surface antigen. No cases occurred of hepatic decompensation, hepatocellular carcinoma, or liver-related death. The GFR remained largely stable, and no cases of TDF-related hyper-phosphaturia were observed. CONCLUSIONS: This study indicates that newer antivirals are effective and safe in HTR with CHB.

Antimutagenic and antigenotoxic effects of vegetable matrices on the activity of pesticides.

Two in vitro tests, one to detect bacterial mutagenicity (Ames test) on Salmonella typhimurium TA98, TA100, and TA1535 and the other the primary DNA damage (SOS Chromotest) on Escherichia coli PQ37, were applied to determine the overall genotoxic activity of 12 pesticides (azinphos methyl, chlorothalonil, chlorphyriphos ethyl, chlorphyriphos methyl, lambda-cyhalothrin, cypermethrin, cyprodinil, fenazaquin, fludioxonil, indoxacarb, iprodione and penconazol). These were detected by gas chromatography (GC) analysis with electron capture (ECD) and nitrogen phosphorus detection (NPD) in 18 samples of vegetables. Some extracts of vegetables, found positive for pesticides with GC, were subjected to the Ames test and SOS Chromotest to evaluate the possible antimutagenic and/or antigenotoxic effects of vegetable matrices. The same bioassays were also performed on the mixtures of pesticides found in these samples to evaluate whether interactions could occur between pesticides and be responsible for the possible antimutagenic and/or antigenotoxic effects of the contaminated matrices. Experiments were also carried out to compare the results found for contaminated vegetables with their content of antioxidant components. Significant differences in mutagenicity and genotoxicity were found among the pesticides selected for this study. Of the 12 pesticides tested, only azinphos methyl, cyprodinil, fludioxonil and iprodione were found to be positive for both S. typhimurium and E. coli. No mutagenic/genotoxic activity was found in the extracts of vegetables contaminated by pesticides. S. typhimurium TA1535 showed a strong positive mutagenic effect for the mixtures of pesticides while they were not able to induce the SOS system. The data concerning the content of polyphenols and the total reducing activity of the contaminated vegetables indicated high amounts of antioxidants that could explain the inhibitory effect on the activity of pesticides shown by vegetables.

Occurrence of salmonella and Listeria spp. on retail poultry products in south Italy and comparison of conventional and rapid methods for their detection.

Salmonella and Listeria spp. are frequently detected in poultry meats. Conventional isolation and identification methods to detect these microrganisms in food are laborious and time-consuming. In the present study the occurrence of Salmonellae and Listeriae on 362 samples of retail poultry in Caserta, South Italy was evaluated and standard microbiological and rapid methods were compared. Furthermore, the samples were collected and analyzed twice a week, on Monday and Friday to establish their possible variability from storage. Both methods showed a strong contamination of samples by Listeria spp. (about 50% for both methods) with 12% Listeria monocytogenes while the contamination of Salmonella was poorer (14-15%). The two procedures showed a good agreement for the detection of Listeriae while the sensitivity of the Rapid test for Salmonellae was poorer (75%). Data about sampling on Monday and Friday highlighted a significant increase in Listeria spp. at the end of the week.

Chemical and toxic evaluation of a biological treatment for olive-oil mill wastewater using commercial microbial formulations.

Olive-oil-mill wastewater (OMW) has significant polluting properties due to its high levels of chemical oxygen demand (COD), biochemical oxygen demand (BOD), and phenols. In the present study, different commercial bacterial formulations were used in the biological treatment of OMW. COD and toxicity testing using primary consumers of the aquatic food chain (the rotifer Brachionus calyciflorus and the crustacean Daphnia magna) were employed to evaluate abatement of the organic load and reduction of the toxic potential. In addition, the four most active formulations were tested mixed pair-wise on the basis of their unique characteristics in order to evaluate the improvement of treatment. The effect of treatment was assessed by measuring COD removal, reduction of total phenols, and decreased toxicity. The results obtained with the mixed formulations showed that the maximum removal of the organic load was about 85%, whereas phenols were reduced by about 67%. The toxicity for rotifers decreased by 43% and for crustaceans by about 83%.

[Environmental quality of Volturno river with toxic and genotoxic findings]. / Stato di qualità ambientale del fiume Volturno integrato da indagini di tossicità e genotossicità.

In order to assess the environmental quality of Volturno river in Southern Italy, the Extended Biotic Index, chemical and microbiological parameters were determined in nine sampling points as provided for D. Lgs. 152/99. Furthermore, this study reported toxicity of surface waters and pore waters from sediments and genotoxicity of pore waters to improve the definition of the ecological condition of the investigated watercourse. Results showed that toxicity and genotoxicity testing contributed to assess environmental quality and pore waters are an useful tool to combine investigations.

[Quality evaluation multiapproach of sediments in water bodies in Southern Italy]. / Approccio integrato per la valutazione della qualità dei sedimenti dei corpi idrici in provincia di Napoli.

This study reports the toxicity of sediments from rivers and canals collected at two six-month intervals from 19 sampling points of the province of Naples in Southern Italy. The toxicity of the pore-water from sediments was determined with a battery composed of different freshwater microbiotests. The toxicity varied substantially from station to station, but none of the Toxkit tests was either the most or the least sensitive for all stations. Chemical analyses were accomplished on some heavy metals. Furthermore, the in situ biological communities of macroinvertebrates were assessed. Most of tested sediments were found to be very toxic for several if not all the microbiotests as well as the biological communities (EBI). Comparison between toxicological data and heavy metals revealed a positive correlation for zinc and copper. This study confirms that only an integrated approach is suitable for the evaluation of contaminated sediments and that single parameters are not always able to define a situation of environmental deterioration.

Role of diagnostic imaging in abdominal lymphadenopathy.

Abdominal lymph node chains and route of lymph drainage of various organs (stomach, duodenum, liver, gallbladder, pancreas, small intestine, appendix, blind intestine, colon rectum) are analyzed according to their location. The role of conventional radiology and diagnostic imaging is evaluated in the study of abdominal lymphatic system with particular reference to lymphangiography and the new procedures of sonography, CT and MRI. Present methods used in inflammatory abdominal lymphadenopathy with special attention to tuberculous lymphadenitis, liver cirrhosis, neoplastic abdominal lymphadenopathy, colorectal and pancreatic cancer, are illustrated. Combined modality imaging is considered in gastric cancer based on the evolution of the classification of gastric lymph nodes. The role of sonography, endoscopic ultrasonography, spiral CT and MRI is assessed in gastric cancer N staging. A retrospective study is analyzed and perspectives for the application of a new CT protocol are proposed. PET potentialities in the study of abdominal lymph nodes are examined.

[Intestinal preparation for colon enema with fleet sodium phosphate: comparative study with the conventional method]. / Preparazione intestinale per clisma del colon mediante fosfo-soda fleet: studio comparativo con il sistema tradizionale.

PURPOSE: To evaluate the possible optimization of a well-tolerated and versatile method of intestinal preparation able to adequately free the lumen and consequently improve diagnostic results with a lower risk of prolonged hospital stay for incorrectly prepared patients. MATERIAL AND METHODS: We examined 40 patients, namely 20 men (mean age 70 years, range 52-87) and 20 women (mean age 68 years, range 49-81) referred to the Institute of Radiology of the Università Cattolica del Sacro Cuore, Gastrointestinal tract Unit, to undergo double contrast colonic enema. The patients were divided into two groups by one-to-one randomization: group 1 was prepared with the conventional method and group 2 with the new protocol for intestinal preparation. On the two days before the examination a low-residue diet was administered; the day before the examination a phial of Fosfo-soda fleet was administered in two times (at 8 am and 4.30 pm), which was diluted with half a glass of water. Bread, pasta and vegetables were strictly forbidden at lunch and soup or milk at supper; the patients were fasted on the examination day. Two evaluations were performed: one to assess tolerance to the preparation and the other, a radiographic study, to assess the grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting. RESULTS: Of the 20 patients given X-prep, 3 had to discontinue it and 4 exhibited severe side-effects, but completed the treatment; tolerance was satisfactory in the remaining 13 patients. The grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting were considered satisfactory in 9, 17 and 16 patients respectively. None of the patients given Fosfo-soda fleet had to discontinue it and tolerance was satisfactory in 19 patients. The grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting were considered satisfactory in 15, 18 and 18 patients respectively. The statistical analysis of all data was performed with Wilcoxon test. DISCUSSION: Intestinal preparation with Fosfo-soda fleet appeared to be definitely better than the conventional method relative to tolerance (p = .02, a statistically significant difference), while providing similarly satisfactory data relative to the other parameters. CONCLUSIONS: Our results, coupled with the versatility of Fosfo-soda fleet (possible application in colonoscopy) and its ease of use recommend this preparation not only for inpatients but also for outpatients in whom self-administration is feasible.

Enhanced expression of glucose-6-phosphate dehydrogenase in human cells sustaining oxidative stress.

Recent reports have demonstrated that glucose-6-phosphate dehydrogenase (G6PD) activity in mammalian cells is necessary in order to ensure cell survival when damage is produced by reactive oxygen intermediates. In this paper we demonstrate that oxidative stress, caused by agents acting at different steps in the biochemical pathway controlling the intracellular redox status, determines the increase in G6PD-specific activity in human cell lines of different tissue origins. The intracellular level of G6PD-specific mRNA also increases, with kinetics compatible with the induction of new enzyme synthesis. We carried out experiments in which cells were exposed to oxidative stress in the presence of inhibitors of protein or RNA synthesis. These demonstrated that increased G6PD expression is mainly due to an increased rate of transcription, with a minor but significant contribution of regulatory mechanisms acting at post-transcriptional levels. These results provide new information on the defence systems that eukaryotic cells possess in order to prevent damage caused by potentially harmful oxygen derivatives.

Digitization of radiologic images.

Information technology is at present an integrating part of the department of radiology. The applications to radiology involve the new imaging procedures as CT and MRI as well as exams which to-date are performed with analog methods. Besides off-line digital conversion of images by video camera or scanner, on-line systems are available with which conventional images are directly converted to digital images. Digital radiography using photostimulable phosphors is based on the capability of barium fluorohaldeide plates to emit light when stimulated by a laser beam. Digital spot fluorography is a dedicated system which enables the digital acquisition of dynamic images. The diffusion and evolution of digital systems dedicated to conventional exams will permit in a near future a fully digital radiology department.

[Evaluation of the exposure levels to radioactivity in the hot-spring environment of the Island of Ischia during a year]. / Valutazione dei livelli di esposizione alla radioattività negli ambienti termali dell'Isola d'Ischia nel corso di un anno.

It is known that the decay products of the U-238 are findable in nature in certain materials (such as tufa, limestone, etc.), therefore some populations are naturally exposed to radiations originated by building materials, houses and isotopes present in drinking-waters. It is evident that, for example, the residents of Campania or Lazio will be involved, on such conditions and during their whole life, in the action of natural radiations of decay products of Uranium and consequently of Radon, which is originated and, as gas, also findable in the air of those indoor areas, at a concentration inversely proportional to the relevant ventilation factors. Furthermore, it is known that this isotope is always found in thermal waters too and sometimes at levels which make them classify as radioactive and with therapeutic properties still subjects of studies and researches. Actually, presence of Radon in warm waters is particularly evident in some basins (the Baths of Badgastein in Austria) and is also findable in some italian thermal towns such as Merano Laurisia, Abano, Baths of Lucca or the island of Ischia itself. All underground waters and especially the warm ones, including, those of Ischia basins, hold radioactive isotopes, since their composition is related to the nature of the underground, which they come from, and is strongly influenced by the kind of rocks present in that area, by the granulometry of the geological strata or by existent fractures, by flow speed and finally by solubilization capacity. On such conditions it is evident that all waters, during their scouring, will be enriched by Radon 222 (a gaseous, therefore more soluble, element); just because of its physical state, it will be more present in external environment in case of warm waters such as those ones now examined. Consequently the environmental state from a radioecological point of view of the utilized waters has to be considered, as well as any other thermal resort, fundamentally due to Radon (Rn) and to the relevant decay products. As a matter of fact, whereas from the family of Uranium come Radon (Rn 222), Lead (Pb 210) and Polonium (Po 210), these last two, respectively with halving-times of 22.3 years and 138.4 days, from the family of Thorium (Th 232) originates Radon (Rn 220 in past times defined "Toron" according to its "forebear") and Lead (Pb 212 with a halving-time of 10.6 hours).(ABSTRACT TRUNCATED AT 400 WORDS)

[Research, education and environmental health related to pollution in the Gulf]. / Ricerca, didattica ed igiene ambientale nel settore inquinamento del golfo.

At Italian-Russian International Conference on "Rôle of the University on ecological education and training", was illustrate six topics of 30 years of our scientific and didactic activity on Environmental Hygiene, here below summarized: I. At first time, sludges of biological treatment plants and domestic sewage were frequently utilized under bacteriological control as economical and ecological fertilizers of land and waters. At present such a custom is very rare owing the chemical pollution of sewage continuously increasing; but in some countries it is still in use, and is our opinion and experience that organic waste material must be reused as fertilizer of land, more and more devoid of humus and subject to erosion of winds and waters. Some treatment plants are shown, and related plankton pyramid's. II. Pilot sewage treatment plants are frequently used in our experiments and training, for study and control of the biological degradation of organic matter, for evaluate the disappearance rate of bacteria and viruses, for investigate the foric action and behaviour of chemical and radioactive pollutants, for quantify their accumulation in the sludges of sewage treatment plants, and so forth. Different pilot plants are used, located both in our laboratories both in industries; in nuclear power plant are tested at the same time 3 models of 3 different plants (biodiscs, activated sludges, biofiltering channels), working with prevalent algal growth. III. Many species of microorganisms (metazoa, protozoa, algae, fungi, bacteria, viruses and new species like Bdellovibrio) are present in aerobic sewage treatment plants (activated sludge, bacterial bed, biodiscs, lagooning, etc.); in anaerobic treatment (digesters) prevail only methane-producing bacteria. Some of these organisms are very abundant and very active as consumers of organic matter; others are characteristic indicators of well balanced purification or of bad purification owing acute variation of organic load or presence of toxic substances in sewage. Many strains are antibiotic-producing, or Vit. B12 producing; others explain a strong lytic activity or are neuraminidase-formers. Production of great amount of biofloculant polysaccharides useful on sedimentation of organic matter is enhanced by adding particular organic pollutants like distillery wastes and others. Sewage treatment plants are good means for scientific research of particular biota continuously available and for food microbiological training for students and technicians on pathogens present in treated and untreated sewage and in sludges. IV. Big fecal pollution of coastal waters is clearly dangerous because of bathing beaches, shellfish farming, bacterial aerosols, damage to marine biota, eutrofication, aesthetic problems.(ABSTRACT TRUNCATED AT 400 WORDS)