Re: Comparison of Microdissection Testicular Sperm Extraction, Conventional Testicular Sperm Extraction, and Testicular Sperm Aspiration for Nonobstructive Azoospermia: A Systematic Review and Meta-Analysis

In contemporary medicine, testicular sperm extraction (TESE) and using testicular sperm for intracytoplasmic injection is the only fertility treatment in men with nonobstructive azoospermia (NOA). Different sperm retrieval techniques have been used to find a single sperm from the testes of men with NOA. In this study, three sperm retrieval techniques, microdissection TESE (micro TESE), conventional TESE (cTESE), and testicular sperm aspiration (TESA) were compared for yielding successful sperm recovery. Fifteen studies with total of 1890 patients were eligible for inclusion of meta-analysis. These studies were published between 1997 and 2012 and took places - six in Asia, four in Europe, three in North America and two in Africa. Using different tissue processing techniques and the patient heterogeneity that exists in the population of men diagnosed with NOA are the limitations of this study. In conclusion, meta-analysis of the studies has shown that performance of micro-TESE was higher compared with cTESE and performance of cTESE was higher compared with TESA for successful sperm retrieval

Plasmodium falciparum Malaria Elicits Inflammatory Responses that Dysregulate Placental Amino Acid Transport

Placental malaria (PM) can lead to poor neonatal outcomes, including low birthweight due to fetal growth restriction (FGR), especially when associated with local inflammation (intervillositis or IV). The pathogenesis of PM-associated FGR is largely unknown, but in idiopathic FGR, impaired transplacental amino acid transport, especially through the system A group of amino acid transporters, has been implicated. We hypothesized that PM-associated FGR could result from impairment of transplacental amino acid transport triggered by IV. In a cohort of Malawian women and their infants, the expression and activity of system A (measured by Na+-dependent 14C-MeAIB uptake) were reduced in PM, especially when associated with IV, compared to uninfected placentas. In an in vitro model of PM with IV, placental cells exposed to monocyte/infected erythrocytes conditioned medium showed decreased system A activity. Amino acid concentrations analyzed by reversed phase ultra performance liquid chromatography in paired maternal and cord plasmas revealed specific alterations of amino acid transport by PM, especially with IV. Overall, our data suggest that the fetoplacental unit responds to PM by altering its placental amino acid transport to maintain adequate fetal growth. However, IV more profoundly compromises placental amino acid transport function, leading to FGR. Our study offers the first pathogenetic explanation for FGR in PM