Mechanisms and clinical correlates of sperm D damage

Among the different DNA anomalies that can be present in the male gamete, DNA fragmentation is the most frequent, particularly in infertile subjects. There is now consistent evidence that a sperm containing fragmented DNA can be alive, motile, morphologically normal and able to fertilize an oocyte. There is also evidence that the oocyte is able to repair DNA damage; however, the extent of this repair depends on the type of DNA damage present in the sperm, as well as on the quality of the oocyte. Thus, it is important to understand the possible consequences of sperm DNA fragmentation （SDF） for embryo development, implantation, pregnancy outcome and the health of progeny conceived, both naturally and by assisted reproductive technology （ART）. At present, data on the consequences of SDF for reproduction are scarce and, in many ways, inconsistent. The differences in study conclusions might result from the different methods used to detect SDF, the study design and the inclusion criteria. Consequently, it is difficult to decide whether SDF testing should be carried out in fertility assessment and ART. It is clear that there is an urgent need for the standardisation of the methods and for additional clinical studies on the impact of SDF on ART outcomes.

Clinical correlates of enlarged prostate size in subjects with sexual dysfunction

Digito-rectal examination （DRE） of the prostate provides useful information on the state of prostate growth and on the presence of suspected peripheral nodules. The aim of this study is to describe the clinical and biochemical correlates of finding an enlarged prostate size at DRE in subjects with sexual dysfunction （SD）. A consecutive series of 2379 patients was retrospectively studied. The analysis was focused on a subset of subjects （n = 1823; mean age 54.7± 11.4） selected for being free from overt prostatic diseases. Several parameters were investigated. After adjusting for confounders, the presence of an enlarged prostate size at DRE was associated with a higher risk of metabolic syndrome （HR = 1.346 （1,129-1.759）; P = 0.030）, type 2 diabetes mellitus （HR = 1.489 （1.120-1.980）; P = 0.006）, increased LDL cholesterol （〉100mgdl^-1; HR = 1.354 （1.018-1.801）; P = 0.037） and increased mean blood pressure （BP） values （HR = 1.017 （1.007-1.027） for each mmHg increment; P = 0.001）. Accordingly, enlarged prostate size was also associated with a higher risk of arteriogenic erectile dysfunction （ED）, as well as with other andrological conditions, such as varicocele and premature ejaculation （PE）. PSA levels were significantly higher in subjects with enlarged prostate size when compared to the rest of the sample （HR = 3.318 （2.304; 4.799） for each log unit increment in PSA levels; P 〈 0.0001）. Arteriogenic ED, according to different criteria, was also associated with increased PSA levels. In conclusion, our data support the need to examine prostate size either by clinical （DRE） or biochemical （PSA） inspection in subjects with SD, in order to have insights into the nature of the SD and the metabolic and cardiovascular （CV） background of the patient.

Clinical evaluation of the infertile male： new options, new challenges

Male reproductive dysfunction is the sole or contributory cause of infertility in half of couples making the systematic clinicaland laboratory evaluation of the male, and the application of cost- effective management strategies tailored to the individual patient＇s need, vital parts of fertility practice. Male infertility has a wide range of etiologies and effective approaches to initiate, restore or preserve natural fertility are available in some settings. But the most striking development in the past 20 years has been in the area of assisted reproductive technologies （ART）, especially intracytoplasmic sperm injection （ICSI）; the latter provides an extraordinarily effective bypass of the natural processes involved such that a single viable sperm,

Genomic and genetic alterations influence the progression of gastric cancer

Gastric cancer is one of the leading causes of cancerrelated deaths worldwide, although the incidence has gradually decreased in many Western countries. Two main gastric cancer histotypes, intestinal and diffuse, are recognised. Although most of the described genetic alterations have been observed in both types, different genetic pathways have been hypothesized. Genetic and epigenetic events, including 1q loss of heterozygosity (LOH), microsatellite instability and hypermethylation, have mostly been reported in intestinal-type gastric carcinoma and its precursor lesions, whereas 17p LOH, mutation or loss of E-cadherin are more often implicated in the development of diffuse-type gastric cancer.In this review, we summarize the sometimes contradictory findings regarding those markers which influence the progression of gastric adenocarcinoma.

Is lymphatic status related to regression of inflammation in Crohn's disease?

AIM:To investigate the status of the lymphatic vessels in the small bowel affected by Crohn's disease(CD) at the moment of surgery.METHODS:During the period January 2011-June 2011,25 consecutive patients affected by CD were operated on in our Institution.During surgery,Patent Blue Ⅴ was injected subserosally and the way it spread along the subserosa of the intestinal wall,through the mesenterial layers towards the main lymphatic collectors and eventually to the lymph nodes was observed and recorded.Since some patients had been undergone strictureplasty at previous surgery,we also examined the status of intestinal lymph vessels after previous strictureplasties.The same procedure was performed in a control group of 5 patients affected by colorectal cancer.Length of lesions,caliber,maximal thickness of the diseased intestinal wall,thickness of the wall at injection site and thickness of the mesentery were evaluated at surgery.RESULTS:We observed three features after the injection of Patent Blue Ⅴ in the intestinal loops:(1) Macroscopically healthy terminal ileum of patients with CD or colon cancer showed thin lymphatic vessels linearly directed toward the mesentery;(2) In mild lesions in which the intestinal wall did not reach 8 mm of thickness,we observed short,wide and tortuous lymphatic vessels directed longitudinally along the intestinal axis toward disease-free areas and then transversally toward the mesentery;and(3) Injection in the severely affected lesions,that had a thickness of the intestinal wall over 10 mm,did not show any feature of lymphatic vessels at least on the subserosal surface.There was a correlation between the thickness of the parietal wall and the severity of the lymphatic alterations.Normal lymphatic vessels were observed at previous strictureplasties in the presence of complete regression of the inflammation.CONCLUSION:Injection of Patent Blue Ⅴ in the intestinal wall could help distinguish healthy tracts of the small bowel from those macroscopically borderline.

Action of induced hypertension and apoptosis: an experimental study in rat

Objective To study the retinal tissue degeneration of intraocular hypertension experimentally induced in acute and chronic way. Methods In the acute model, pressure elevation was quickly induced by a needle in the anterior chamber and the retinal reaction was studied at 1,2,4,5,7,10 days after treatment. The tissue damage with chronic hypertension,induced by the cauterization of two episcleral veins,was studied at 1 and 2 month after the treatment. The TUNEL method and Caspade 3a immunochemical study evidenced the apoptosis mechanism. The NADPH-diaphorase reaction identified the Nitric Oxide, ( NO) producing cells. Results In the acute model,the immunohistochemical study evidenced that the apoptosis was an early death mechanism for ganglionar cells. The activity of Nitric Oxide Synthase ( NOS) didn' t show a significant activation toward the retinal tissue of control. The chronic hypertension model indicated an increase in the NOS signal, meaning an activation of this enzyme in particular bear the vascular vessels, showing the neuroprotective and not only cytotoxic effect of the NO. The TUNEL and Caspase 3a studies indicated that the apoptosic mechanism started in different times, the immunohistochemical reaction showed its immediately beginning or its later activation caused by the chronic damage. Conclusions The opportunity to have a clear vision of the beginning and causing factors of cell degeneration in hypertension damage could permit the study on different substances that act on apoptosis , on NOS mechanism and on synaptic transmission inhibiting or deviating the retinal tissue degeneration and particularly the ganglionar cells death in glaucoma.

Region of Treatment in Radiotherapy and Second Malignancies in Breast Cancer Patients

A cohort study was conducted based on clinical records for 5248 women treated for breast cancer in Florence (Italy), with continuous follow up from 1965 to 1994. The subjects were categorised into groups such as no radiation treatment;breast dose only;and radiation doses in one, two, three or four of the following fields: namely internal mammary chain, supraclavicular nodes, axillary lymph nodes and chest wall. The Cox proportional hazards model for ungrouped survival data was used to estimate the relative risk for second cancer after radiotherapy delivered to different regions. The relative risk for all second cancers combined was statistically significantly raised if the internal mammary chain and supraclavicular nodes were irradiated. However, we found that the relative risk of the second malignancies could be reduced if all the locoregional lymph nodes (the internal mammary chain, supraclacicular nodes, axillary nodes) and chest wall are irradiated at the same time. If this finding can be verified by other large cohort studies or randomized clinical trials, it may have implications in clinical practice when deciding upon the targeted areas for radiotherapy;partial radiation treatment of the locoregional lymph nodes could raise the risk of second malignancies and should ideally be avoided.

How to recognize late-onset hypogonadism in men wit sexual dysfunction

Late-onset hypogonadism （LOH） has been considered the most common form of male hypogonadism with a prevalence of approximately 1 in 100 men. Diagnosis of LOH should be made in symptomatic men with unequivocally low serum testosterone （T） levels. However, its clinical presentation is often insidious and difficult to recognize because it is characterized by nonspecific symptoms that make differential diagnosis with physiological ageing problematic. Sexual dysfunction is the most important determinant for medical consultation and the most specific symptom associated with low T. We therefore analysed a consecutive series of 1734 subjects who attended our unit for sexual dysfunction to investigate the associations between low T （different thresholds）, sexual parameters, medical history data （delayed puberty, pituitary disease or cryptorchidism） and their physical exam results. Metabolic parameters, in particular waist circumference, display the greatest accuracy in detecting low T. We found that only the association of several symptoms and signs could significantly raise the clinical suspicion of low T. Structured inventories, which cluster together symptoms and signs of hypogonadism, can help clinicians suspect androgen deficiency. In particular, structured interviews, such as ANDROTEST, have been demonstrated to have a greater accuracy when compared to self reported questionnaires in detecting low T levels.

CT colonography after incomplete colonoscopy in subjects with positive faecal occult blood test

AIM： To report our experience with computed tomography colonography （CTC） systematically performed in subjects with positive faecal occult blood test （FOBT） and an incomplete colonoscopy in the setting of a population-based screening for colorectal cancer （CRC）. METHODS： From April 2006 to April 2007, 43 290 individuals （age range 50-70） who adhered to the regional screening program for the prevention of CRC underwent immunochemical FOBT. FOBT was positive in 1882 subjects （4.3%）. 1463 （77.7%） of these subjects underwent colonoscopy, 903 performed in a single center. Of 903 colonoscopies 65 （7.2%） were incomplete. Forty-two of these subjects underwent CTC. CTC was performed with a 16-MDCT scanner after standard bowel prep （polyethyleneglycole） in both supine and prone position. Subjects whose CTC showed polyps or masses were referred to the endoscopist for repeat colonoscopy under sedation or underwent surgery. Perlesion and per-segment positive predictive values （PPV） were calculated. RESULTS： Twenty-one （50%） of 42 CTCs showed polyps or masses. Fifty-five of these subjects underwent a repeat colonoscopy, whereas 2 subjects underwent surgery for colonic masses of indeterminate nature. Four subjects refused further examinations. CTC correctly identified 2 colonic masses and 20 polyps. PPV for masses or polyps greater than 9 mm was of 87.5%. Per-lesion and per-segment PPV were, respectively, 83.3% and 83.3% for polyps greater or equal to 10 mm, and 77.8% and 85.7% for polyps of 6-9 mm. CONCLUSION： In the context of a screening program for CRC based on FOBT, CTC shows high per-segment and per-lesion PPV for colonic masses and polyps greater than 9 mm. Therefore, CTC has the potential to become a useful technique for evaluation of the non visualized part of the colon after incomplete colonoscopy.

全肺密度测量和肉眼评价肺气肿的对照研究

本研究对全肺密度测量值和肉眼评价肺气肿的结果进行了对照研究。对30例患有慢性阻塞性肺病的病人行多层螺旋CT扫描（150mAs，准直0．75），并采取了2种方法重组，厚层（5mm）柔和滤过用于全肺的密度评价，薄层（1mm）锐化滤过用于肉眼评价肺气肿改变（每10层进行一次评价）。3名操作者均进行了密度测量和肉眼评价。