Current smoking is associated with lower seminal vesicles and ejaculate volume, despite higher testosterone levels, in male subjects of infertile couples.

STUDY QUESTION: What is the impact of smoking behaviour on seminal, hormonal and male genital tract ultrasound parameters in subjects seeking medical care for couple infertility? STUDY ANSWER: In males of infertile couples, current smokers (CS), when compared with non-smokers, show lower ejaculate and ultrasound-derived seminal vesicles (SV) volume, despite higher testosterone levels. WHAT IS KNOWN ALREADY: Data on the effects of smoking on male fertility are conflicting. A correlation between smoking and reduced semen parameters has been reported, however, with a high heterogeneity among studies. An association between smoking behaviour and higher testosterone levels in men has been described in several, but not all, the previous studies. No study has systematically evaluated the impact of smoking on the male genital tract ultrasound characteristics. STUDY DESIGN, SIZE AND DURATION: Retrospective cross-sectional analysis of a consecutive series of 426 subjects seeking medical care for couple infertility from January 2010 to July 2013. PARTICIPANTS/MATERIALS, SETTING, METHODS: From the entire cohort, 394 men (age 36.0 ± 8.0 years) free of genetic abnormalities were selected. All subjects underwent a complete andrological and physical examination, biochemical and hormonal assessment, scrotal and transrectal colour-Doppler ultrasound and semen analysis (including seminal interleukin-8 levels, sIL-8) within the same day. MAIN RESULTS AND THE ROLE OF CHANCE: Among the patients evaluated, 229 were never smokers (NS), 56 past smokers (PS) and 109 CS. When CS were compared with the rest of the sample (non-smokers, NS + PS), in a multivariate model (analysis of covariance, ANCOVA) adjusted for age, lifestyle (including alcohol, cannabis and physical activity), BMI and sex hormone-binding globulin, significantly higher androgen (total testosterone, P = 0.001; calculated free testosterone, P < 0.005) and lower FSH (P < 0.05) levels were observed in CS. However, when total testosterone was also included in the multivariate model as a further covariate, the difference in FSH levels was not confirmed. In a similar model, a lower ejaculate volume (P < 0.01) and a higher prevalence of normal sperm morphology (P < 0.02) were also detected in CS in comparison with the rest of the sample. However, when total testosterone was also included in the multivariate model as a further covariate, only the difference in ejaculate volume between CS and non-smokers was confirmed (-0.61 ± 0.23 ml, P < 0.01). Finally, CS showed lower total SV volume, before and after ejaculation, even after adjusting for confounders (P = 0.02 and <0.01, respectively). Similar results were observed when the reported number of cigarettes smoked or the number of pack-years was considered separately. LIMITATIONS, REASONS FOR CAUTION: The present results are derived from patients consulting an Andrology Clinic for couple infertility, who could have different characteristics from the general male population or males consulting general practitioners for reasons other than couple infertility. In addition, we did not have a true control group composed of age-matched, apparently healthy, fertile men, and therefore true normative data of sonographic parameters cannot be inferred. Due to the cross-sectional nature of our study, neither a causality hypothesis nor mechanistic models can be drawn. Finally, this is a retrospective study, and further prospective studies are required. WIDER IMPLICATIONS OF THE FINDINGS: We report an apparent paradox in CS: lower SV volume despite higher testosterone levels. Our data suggest that smoking may negatively affect SV volume in an independent manner, as the difference between CS and non-smokers retained significance after adjusting for confounders including testosterone. This is the first study reporting such ultrasound evidence. How this new smoking-related alteration, along with low semen volume, impacts male fertility needs to be addressed by further studies. STUDY FUNDING/COMPETING INTERESTS: No funding was received for the study. None of the authors have any conflict of interest to declare.

The 17ß-hydroxysteroid dehydrogenase type 3 deficiency: a case report of an 18-year patient and review of the literature.

UNLABELLED: Deficiency of 17ß-hydroxysteroid dehydrogenase type 3 (17ßHSD3), an enzyme converting androstenedione (A) to testosterone (T), is a rare cause of autosomal recessive 46,XY disorder of sexual development (DSD). A 18-years phenotypically female patient from southern Italy presented with primary amenorrhea. She had deep voice, macrocephaly, enlarged and bulbous nasal tip, macrostomia, facial acne, breast asymmetry, hypoplasia of the first finger of right hand, proximal implant of the fifth metatarsus bilaterally as well as an increased muscle mass and hirsutism, with hair distribution on face, neck, chest, abdomen, pubic region and on upper and lower limbs. Genital exam showed thickened labra majora with absence of labra minora and a blind-ending pseudo-vagina with clitoris enlargement. Karyotype analysis showed a male genotype (46,XY). Hormonal evaluation showed decreased T (188 ng/dL-6.5 nmol/L) and increased A (10 ng/mL-34,96 nmol/L), considering male reference ranges, resulting in a decreased T/A ratio (0,186). MRI identified testicles in inguinal regions. Human Chorionic Gonadotropin test showed T/A ratio permanently under 0,8. These evidences were suggestive of a 46,XY DSD due to 17ßHSD3 deficiency. An homozygous mutation (IVS3 -1 G>C or c.326-1G>C) of the 17ßHSD3 gene was discovered. Psychologist identified a well determined female gender identity. It was decided to proceed with gonadectomy and vaginal enlargement by use of dilatators. CONCLUSION: The case described represents a new case of DSD due to 17ßHSD3 deficiency. This patient, raised as a girl, is diagnosed in a very late stage. The identified mutation, previously reported only in Dutch and Brazilian population, is one of 27 presently known mutations of 17ßHSD3 gene and is never reported in Italian population.

A novel method for DNA delivery into bacteria using cationic copolymers.

Amphiphilic copolymers have a wide variety of medical and biotechnological applications, including DNA transfection in eukaryotic cells. Still, no polymer-primed transfection of prokaryotic cells has been described. The reversible addition-fragmentation chain transfer (RAFT) polymer synthesis technique and the reversible deactivation radical polymerization variants allow the design of polymers with well-controlled molar mass, morphology, and hydrophilicity/hydrophobicity ratios. RAFT was used to synthesize two amphiphilic copolymers containing different ratios of the amphiphilic poly[2-(dimethyl-amino) ethyl methacrylate] and the hydrophobic poly [methyl methacrylate]. These copolymers bound to pUC-19 DNA and successfully transfected non-competent Escherichia coli DH5α, with transformation efficiency in the range of 103 colony-forming units per µg of plasmid DNA. These results demonstrate prokaryote transformation using polymers with controlled amphiphilic/hydrophobic ratios.

A novel method for DNA delivery into bacteria using cationic copolymers

Amphiphilic copolymers have a wide variety of medical and biotechnological applications, including DNA transfection in eukaryotic cells. Still, no polymer-primed transfection of prokaryotic cells has been described. The reversible addition-fragmentation chain transfer (RAFT) polymer synthesis technique and the reversible deactivation radical polymerization variants allow the design of polymers with well-controlled molar mass, morphology, and hydrophilicity/hydrophobicity ratios. RAFT was used to synthesize two amphiphilic copolymers containing different ratios of the amphiphilic poly[2-(dimethyl-amino) ethyl methacrylate] and the hydrophobic poly [methyl methacrylate]. These copolymers bound to pUC-19 DNA and successfully transfected non-competent Escherichia coli DH5α, with transformation efficiency in the range of 103 colony-forming units per µg of plasmid DNA. These results demonstrate prokaryote transformation using polymers with controlled amphiphilic/hydrophobic ratios.

Mechanisms of transcriptional activation of the col6a1 gene during Schwann cell differentiation.

A transgenic mouse line expressing the lacZ reporter under the control of a regulatory region of the col6a1 gene has been used to investigate differentiation of Schwann cells. The data suggest that: (1) activation of col6a1 gene transcription in the peripheral nervous system is part of the differentiation program of Schwann cells from neural crest cells stimulated by neuregulins; (2) once the Schwann cell precursors have acquired the competence of transcribing the col6a1 gene, transcriptional regulation becomes independent from neuregulins and is modulated by different mechanisms, including cell cycle; (3) activation of transgene expression after birth in sciatic nerves corresponds to the time of withdrawal of immature Schwann cells from the cell cycle and the beginning of their differentiation into myelinating Schwann cells.

Effects of photoperiod, pinealectomy and castration on body weight and daily torpor in Djungarian hamsters (Phodopus sungorus).

During the autumn and winter Djungarian hamsters (Phodopus sungorus) exhibit regression of the gonads, development of a white winter pelage, loss of body weight and daily torpor. These seasonal events are largely regulated by changes in photoperiod. The present experiments were designed to examine the role of the testes and the pineal gland in photoperiodically induced daily torpor and body weight loss. Hamsters displayed a loss of body weight and daily torpor when exposed to a short-day photoperiod in a cold environment, but these phenomena did not occur in hamsters exposed to long days and cold. Testicular regression is probably a precondition for the display of torpor, since daily torpor was almost totally inhibited in hamsters which were exposed to short days and in which testosterone was administered from subcutaneous silicone elastomer implants. Nevertheless, decreased testosterone secretion alone is not a sufficient condition for induction of daily torpor, since torpor was rarely observed in hamsters exposed to long days, even after castration. In addition to decreased testicular activity, the pineal gland is also involved in establishing conditions for torpor. Thus, pinealectomy prevented the display of torpor by castrated hamsters exposed to short days. Body weight changes were also found to be influenced by both testicular hormone and pineal activity. These observations indicate that the pineal gland is involved, as a part of the photoperiodic mechanism, in regulating a variety of physiological events and that some of these actions of the pineal are independent of its extensively described actions on the reproductive axis.

Reactance theory and alcohol consumption laws: further confirmation among collegiate alcohol consumers.

By the late 1980s, the United States legal drinking age had increased to 21 years. Based on psychological reactance theory, one would predict that these law changes would cause underage collegiate consumers to drink more alcohol because of the belief that their behavioral freedom was being reduced. It was hypothesized that underage collegiate alcohol consumers (UC) would drink more than their legal-age peers (LC) if psychological reactance was a contributing factor to consumption, whereas no differences would be present between the UC and LC groups' usage of illicit drugs, as these had not been affected by recent law changes. To test this hypothesis, a sample of 2,142 college students from 10 midwestern postsecondary educational facilities responded to the Alcohol and Other Drug Use Needs Assessment Survey in the spring of 1990. Mann-Whitney U analyses revealed significant differences between groups on alcohol use measures, but no differences were present on illicit substance use measures. These results are interpreted as supporting reactance theory.

Dacryoscintigraph evaluation of the repaired lacrimal drainage system.

We have used dacryoscintigraphy to study the efficiency of the lacrimal system following the repair of a divided lower canaliculus in 4 children. This test has been reliable in evaluating lacrimal function and suggests that a canaliculus can be repaired and splinted satisfactorily. Our experience with dacryoscintigraphy confirms that it is a safe comfortable, and reliable method for studying the patency of the lacrimal drainage system.

[EGG and arrhythmia in subjects with implanted dual-chamber VDD and DDD pacemakers]. / ECG e aritmie in soggetti portatori di stimolatori bicamerali VDD e DDD.

The ECGs of four patients with implanted dual chamber VDD and DDD PMKs are shown to demonstrate the difficulty of their interpretation and show some arrhythmias related to dual chamber pacing. In the first patient the DDD PMK caused a high ventricular frequency synchronizing on the atrial fibrillation "f" waves which occurred suddenly some time after PMK implantation; this problem was solved by programming the PMK in VVI. The second and third case, with implanted DDD and VDD PMK respectively, exemplify atrial sensing dysfunction due to atrial catheter displacement. In the fourth patient, with implanted VDD PMK, VDD stimulation periods and VVI ones alternated due to non-adjusted programming. Therefore, the paper re-emphasizes the need for accurate and periodic controls of patients with implanted PMK to correct dysfunction or undesirable patterns of stimulation.

[Ergometric test in the diagnostic and prognostic evaluation of arrhythmia]. / Il test ergometrico nella valutazione diagnostica e prognostica delle aritmie.

One thousand three hundred patient's stress tests were analyzed to value arrhythmia outline and its relationship with anamnesis and clinical data. The patients were divided into two groups: group A, with no arrhythmias at rest, and group B with arrhythmias at rest. All classic nosographic arrhythmias were considered. In some teenager patients with arrhythmias at rest and no organic cardiopathy, anomalies disappeared during stress, showing the benignity of the phenomenon. Supraventricular stress induced arrhythmias has 1.2% of incidence in normal subjects, but 81% in heart disease patients. Supraventricular tachycardia was induced in 6 patients. Ventricular stress induced arrhythmias are found in 4.9%. Two cases of sudden death occurred in our groups.

[Telethermography in the diagnosis of lumbo-sciatica syndromes]. / La teletermografia nella diagnostica delle sindromi lombo-sciatalgiche.

Thermal maps of the lumbo-sacral and gluteal regions and of the lower limbs were obtained with telethermography in 30 subjects suffering from painful lumbo-sciatic syndromes in order to assess whether there were differences of thermal index between painful and opposite side, and to evaluate the telethermographic patterns of the irritative and deficitary forms. Among 25 patients with lumbo-sciatalgia in the irritative or early stage, 16 showed hypothermia of the affected side; in three of the five patients in the deficitary stage, hyperthermia of the affected side was observed while two did not show changes of the thermal gradient. The authors stress the importance of telethermography and suggest that this method, which is not costly, non-invasive and easily reproducible, should be used to complete diagnosis of and to monitor lumbo-sciatalgic syndromes.

Estudio de riesgo de recurrencia de trastorno del espectro autista (TEA) en hermanos de niños con diagnóstico TEA / Study on recurrence risk of autism spectrum disorders (ASD) in siblings of children diagnosed with ASD

El trastorno del espectro autista (TEA) es un trastorno del desarrollo, común de la niñez, con una fuerte predisposición genética y alta heredabilidad. El riesgo de recurrencia en hermanos oscila entre 10-20% y en caso de familias con dos o más niños afectados el riesgo de recurrencia aumenta hasta un 35%. Dentro de las pruebas complementarias para el diagnóstico, el gold standard es la escala ADOS, existe además una prueba de pesquisa, el M-CHAT. Objetivo: evaluar riesgo de recurrencia de TEA en hermanos menores de niños con diagnóstico de TEA. Materiales y Métodos: se realizó un estudio de tipo transversal, observacional y descriptivo. Fueron estudiados niños entre 18-36 meses, hermanos de pacientes con diagnóstico de TEA. La evaluación del desarrollo se realizó utilizando: Escalas CAT/CLAMS, M-CHAT y ADOS 2. Resultados: se estudiaron 39 hermanos. 25 fueron varones y 14 fueron mujeres. Se identificaron 5 niños con diagnóstico de TEA, por lo que el riesgo de recurrencia en la población estudiada fue de 13%, con una relación varón/mujer de 4/1. Del resto de la población estudiada, 13% reunieron criterios para fenotipo ampliado del autismo (Broader Autism Phenotype ­BAP­ en su sigla en inglés), 31% presentaron retraso del lenguaje(RL) y 7%retraso global del desarrollo (RGD). Solo el 36% presentó desarrollo típico. Conclusión: Los hermanos de niños afectados representan un grupo de riesgo para problemas del desarrollo, que debe ser tenido en cuenta por los profesionales de la salud que siguen longitudinalmente a niños con diagnóstico confirmado de TEA (AU)

Autism spectrum disorder (ASD) is a developmental disorder that is common in childhood with a strong genetic predisposition and high heritability. The risk of recurrence in siblings is found to be between 10-20% and in families with two or more affected children recurrence risk is as high as 35%. Among the complementary diagnostic tests, the gold standard is the ADOS scale, and additionally the M-CHAT screening test. Objective: To evaluate the recurrence risk of ASD in younger siblings of children diagnosed with ASD. Material and Methods: A cross-sectional, observational, descriptive study was conducted. Children between 18- 36 months of age, siblings of children diagnosed with ASD were studied. Development was assessed using the CAT/CLAMS, MCHAT, and ADOS 2 scales. Results: 39 siblings were studied; 25 were male and 14 female. Five children with ASD were identified, accounting for a recurrence risk of 13% in the study population and a male/female ratio of 4/1. Of the remaining children, 13% met the criteria for the broader autism phenotype (BAP), 31% had language delay (LD), and 7% global developmental delay (GDD). Only 36% had normal development. Conclusion: Siblings of affected children are at risk for developmental disorders that should be taken into account by health professionals that ongitudinally follow children with a confirmed diagnosis of ASD (AU)

Selective COX-1 inhibition: A therapeutic target to be reconsidered.

Since cyclooxygenase (COX) isozymes discovery, many papers and reviews have been published to describe the structural bases of COX inhibition, and to debate on the therapeutic and adverse effects of worldwide clinically used nonsteroidal anti-inflammatory drugs (NSAIDs), included COX-2 selective inhibitors (well known as Coxibs). COX-2 inhibition has been widely investigated, whereas the role of COX-1 in human pathophysiology is mostly not yet well ascertained. As time goes on, the cliché that the constitutively expressed isoform COX-1 is only involved in normal physiological functions, such as platelet aggregation, gastric mucosa protection and renal electrolyte homeostasis is going to be shattered. Low-dose aspirin, behaving as a preferential inhibitor of platelet COX-1, allowed to enlighten the role exerted by this isoenzyme in many mammalian cell types. This review would elucidate the most recent findings on selective COX-1 inhibition and their relevance to human pathology such as cancer, neuro-inflammation, cardioprotection, fever and pain. It would also focus on the design and development of new highly selective COX-1 inhibitors, useful tools in pharmacological studies aimed at gaining a deeper insight of the role of COX-1 in human health and disease. Among the traditional NSAIDs, other then aspirin and indomethacin, only few examples of selective COX-1 inhibitors (SC-560, FR122047, mofezolac, P6 and TFAP) have been so far identified. This review has also the scope to stimulate the development of novel drugs, which activity is COX-1 mediated.