Fertility maintenance in male oncological patients: current state and future perspectives.

Growing cancer incidence in reproductive age goes hand in hand with a rising survival rate of patients who underwent anticancer therapy. This trend points to the necessity of discussion regarding the fertility maintenance. The patient´s future with respect to his reproductive ability has to be addressed properly to achieve a complex approach to cancer management. The germinal epithelium of the testes is highly susceptible to deleterious effects of chemotherapy. After the administration of gonadotoxic chemotherapeutic agents, a patient can develop oligospermia, or even azoospermia. Similarly, radiation exposure can damage spermatogenesis, while higher doses lead to azoospermia. This review brings an overview of the methods of assisted reproduction, which are currently in use for fertility maintenance in oncological patients, but also in those with non-malignant indications. Also, novel, yet still experimental, methods are discussed, which represent promising technologies applicable to prepubertal oncological patients. We also discuss historical milestones in the development of assisted reproduction, summarize the options of semen analysis, and we present a practical guide through the process of sperm cryopreservation and subsequent in vivo or in vitro fertilisation. We deem that fertility maintenance should be an integral part of the health care in oncological patients in reproductive age (Tab. 1, Ref. 85). Keywords: assisted reproduction technique, sperm cryopreservation, testicular tissue cryopreservation, spermatogenesis, sperm quality in oncological patients.

Sentinel lymph node - historical background and current views on its significance in complex management of breast cancer patients.

Nowadays, breast cancer is the leading oncological diagnosis in women worldwide. On the other hand, breast cancer treatment can be considered one of the most progressive therapeutic approach in the medical field of oncology. The invasive types of breast cancer have a tendency to spread via lymphatic route, what brings in the issue of sentinel lymph node - the first node into which the lymph drains from a given anatomical location. This review paper discusses the historical background of the concept of sentinel lymph node and focuses on clinical significance of the positivity of sentinel lymph node(s) as well. Modern-day conservative therapeutic surgery of breast cancer should be in accordance with diagnostic and preventive interventions in the axilla, whose rate of invasiveness and morbidity must be also attenuated without worsening the patient´s prognosis and survival rate. Formerly, a complete axillary lymph node dissection was routinely performed for prophylactic and cancer staging purposes. The indiscriminate application of this approach was replaced by sentinel lymph node biopsy. Along with common histopathological examination, immunohistochemistry, as well as modern techniques of molecular biology are often employed. These state-of-the-art methods enabled the identification of micrometastases, or even nanometastases, though their real prognostic value is yet to be concluded (Ref. 52). Keywords: sentinel node, breast cancer, biopsy, historical background.

Childhood bone tuberculosis from Roman Pécs, Hungary.

A child from a Roman necropolis in Pécs, Hungary (4th century CE) was initially diagnosed with severe spinal osteomyelitis. The post-cranial skeleton displayed bone alterations in the lower thoracic and upper lumbar segments, including vertebral body destruction, collapse and sharp kyphosis, and additional multiple rib lesions, suggesting a most likely diagnosis of pulmonary and spinal tuberculosis. This study discusses a number of selected diagnoses in the context of our pathological findings, complementing the macroscopic examination with radiological and biomolecular analyses.

Decontamination of the digestive tract and oropharynx in ICU patients.

BACKGROUND: Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) are infection-prevention measures used in the treatment of some patients in intensive care, but reported effects on patient outcome are conflicting. METHODS: We evaluated the effectiveness of SDD and SOD in a crossover study using cluster randomization in 13 intensive care units (ICUs), all in The Netherlands. Patients with an expected duration of intubation of more than 48 hours or an expected ICU stay of more than 72 hours were eligible. In each ICU, three regimens (SDD, SOD, and standard care) were applied in random order over the course of 6 months. Mortality at day 28 was the primary end point. SDD consisted of 4 days of intravenous cefotaxime and topical application of tobramycin, colistin, and amphotericin B in the oropharynx and stomach. SOD consisted of oropharyngeal application only of the same antibiotics. Monthly point-prevalence studies were performed to analyze antibiotic resistance. RESULTS: A total of 5939 patients were enrolled in the study, with 1990 assigned to standard care, 1904 to SOD, and 2045 to SDD; crude mortality in the groups at day 28 was 27.5%, 26.6%, and 26.9%, respectively. In a random-effects logistic-regression model with age, sex, Acute Physiology and Chronic Health Evaluation (APACHE II) score, intubation status, and medical specialty used as covariates, odds ratios for death at day 28 in the SOD and SDD groups, as compared with the standard-care group, were 0.86 (95% confidence interval [CI], 0.74 to 0.99) and 0.83 (95% CI, 0.72 to 0.97), respectively. CONCLUSIONS: In an ICU population in which the mortality rate associated with standard care was 27.5% at day 28, the rate was reduced by an estimated 3.5 percentage points with SDD and by 2.9 percentage points with SOD. (Controlled Clinical Trials number, ISRCTN35176830.)

Occurrence of neoclassical facial canons in Caucasian primary school pupils and university students.

INTRODUCTION: The study concentrates on nine neoclassical facial references, canons. SAMPLE AND METHODS: These neoclassical canons are studied and compared in two groups of young Caucasian population as follows: 160 students were studied, namely 60 primary school boys at the age of seven and 100 young men at the age ranging from 22 to 25 studying at the Comenius University and Slovak Technical University in Bratislava. The following anthropometric parameters were measured: ten heights, five widths, and two angles. CONCLUSION: Some of neoclassical canons have not appeared in our measured group at all. Other canons although present, were present less frequently then their variations. Comparisons with literature are discussed (Tab. 9, Fig. 9, Ref. 7). Full Text (Free, PDF) www.bmj.sk.

Heritable variation for aggression as a reflection of individual coping strategies.

Evidence is presented in rodents, that individual differences in aggression reflect heritable, fundamentally different, but equally valuable alternative strategies to cope with environmental demands. Generally, aggressive individuals show an active response to aversive situations. In a social setting, they react with flight or escape when defeated; in non-social situations, they react with active avoidance of controllable shocks and with sustained activity during an uncontrollable task. In contrast, non-aggressive individuals generally adopt a passive strategy. In social and non-social aversive situations, they react with immobility and withdrawal. A main aspect of these two alternative strategies is that individuals with an active strategy easily develop routines (intrinsically determined behaviour), and consequently do not react (properly) to 'minor' changes in their environment, whereas in passively reacting animals it is just the other way around (extrinsically determined behaviour). It has become clear that active and passive behavioural strategies represent two different, but equivalent, coping styles. The coping style of the aggressive males is aimed at the removal of themselves from the source of stress or at removal of the stress source itself (i.e. active manipulation). Non-aggressive individuals seem to aim at the reduction of the emotional impact of the stress (i.e. passive confrontation). The success of both coping styles depends upon the variability or stability of the environment. The fact that aggressive males develop routines may contribute to a fast execution of their anticipatory responses, which is necessary for an effective manipulation of events. However, this is only of advantage in predictable (stable) situations, but is maladaptive (e.g. expressed by the development of stress pathologies) when the animal is confronted with the unexpected (variable situations). The flexible behaviour of non-aggressive individuals, depending strongly upon external stimuli, will be of advantage under changing conditions. Studies on wild house mice living under natural conditions show how active and passive coping functions in nature, and how the two types have been brought about by natural selection.

Behavioural differences between artificially selected aggressive and non-aggressive mice: response to apomorphine.

The present study reports a first attempt to unravel the neurochemical background that underlies the difference in behavioural profiles between aggressive and non-aggressive male mice. For this purpose two bidirectionally selected lines for attack latency (SAL and LAL) were used. In pursuit of Cools'9 approach, the susceptibility of individuals of both selection lines to the dopamine agonist apomorphine was measured. The apomorphine was injected subcutaneously at dose levels of 2.5 and 5.0 mg/kg. Apomorphine is considered to stimulate the dopamine receptors in the telencephalon and induces stereotyped behaviour. The responsivity to apomorphine can be rated as a total stereotypy-score. SAL (aggressive) mice showed a significantly greater enhancement of stereotyped behaviour in response to apomorphine than LAL (non-aggressive) mice. In addition, it was demonstrated that this difference is of a quantitative rather than qualitative character. Pharmacokinetic variation between the two lines could be ruled out as cause of the difference. Hence, it was concluded that SAL mice are more sensitive to apomorphine than LAL males, which provides evidence for a difference in the dopaminergic system between the two selection lines. It was suggested that this difference underlies the difference in flexibility in behaviour between aggressive and non-aggressive male mice.

Behavioural strategies of aggressive and non-aggressive male mice in response to inescapable shock.

The effect of exposure to inescapable long-duration shocks of moderate intensity on intershock activity and on subsequent escape or avoidance performance was studied in aggressive and non-aggressive male mice. The activity of the non-aggressive mice was severely suppressed during the inescapable shock session, while that of the aggressive males was hardly influenced. The decremental effect of prior shock exposure on subsequent response latency and activity in an active two-way escape or avoidance task was greater in the non-aggressive than in the aggressive mice. There was no evidence that learned inactivity or learned helplessness (an associative deficit) could explain the results. Instead, individual differences in behavioural strategy in response to threatening situations appeared to account for the effects of inescapable shock. Aggressive male mice predominantly adopted an active behavioural strategy in challenging situations, which resulted in persistent attempts to exercise control over the external situation and hence in a sustained tendency to initiate responses. Non-aggressive mice primarily assumed a passive strategy; their tendency to exercise control was low, which readily resulted in a reduced tendency to initiate responses.

Behavioural strategies of aggressive and non-aggressive male mice in active shock avoidance.

The hypothesis, partly based on findings in social interactions, that aggressive mice generally adopt an active behavioural strategy (cf. fight-flight) in threatening situations, while non-aggressive ones generally assume a passive strategy (cf. conservation-withdrawal) was tested using a two-way active shock avoidance paradigm. Overall, aggressive mice were found to be better active shock avoiders than non-aggressive animals; a finding that is consistent with our hypothesis. However, within the non-aggressive mice a clear dichotomy in high and low avoidance individuals was found. The high intertrial activity in the superior avoidance groups and the low activity in the poor avoidance group was interpreted as another indication of an active versus passive strategy respectively. Accordingly, it was concluded that not all non-aggressive mice assume a passive strategy, but that some mice adopt an active strategy, like all aggressive males.

Aggression and adaptation to the light-dark cycle: role of intrinsic and extrinsic control.

In wild house mice, the hypothesis that in the organization of behavior the relative contribution of intrinsic factors is more important in aggressive males, while that of extrinsic factors is more important in nonaggressive individuals was confirmed using the circadian rhythmicity of activity. The faster rate of reentrainment and the suppression of activity during a subjective night and during adaptation to the new LD cycle in the nonaggressive males indicate that their circadian rhythmicity of activity is to a large extent determined by the Zeitgeber, an extrinsic factor. The slower reentrainment rate, the lack of response to a subjective night and the normal activity level seen during reentrainment in the aggressive mice suggest strong control by the pacemaker, an intrinsic factor. Tau differences between the aggressive and nonaggressive mice provide some evidence that the pacemaker of nonaggressive males is fairly labile and is easily influenced by external factors, whereas the pacemaker of aggressive animals is rather stable.