A novel stepwise micro-TESE approach in non obstructive azoospermia

Background: The purpose of the study was to investigate whether micro-TESE can improve sperm retrieval rate (SRR) compared to conventional single TESE biopsy on the same testicle or to contralateral multiple TESE, by employing a novel stepwise micro-TESE approach in a population of poor prognosis patients with non-obstructive azoospermia (NOA). Methods: Sixty-four poor prognosis NOA men undergoing surgical testicular sperm retrieval for ICSI, from March 2007 to April 2013, were included in this study. Patients inclusion criteria were a) previous unsuccessful TESE, b) unfavorable histology (SCOS, MA, sclerahyalinosis), c) Klinefelter syndrome. We employed a stepwise micro-TESE consisting three-steps: 1) single conventional TESE biopsy; 2) micro-TESE on the same testis; 3) contralateral multiple TESE. Results: SRR was 28.1 % (18/64). Sperm was obtained in both the initial single conventional TESE and in the following micro-TESE. The positive or negative sperm retrieval was further confirmed by a contralateral multiple TESE, when performed. No significant pre-operative predictors of sperm retrieval, including patients’ age, previous negative TESE or serological markers (LH, FSH, inhibin B), were observed at univariate or multivariate analysis. Micro-TESE (step 2) did not improve sperm retrieval as compared to single TESE biopsy on the same testicle (step 1) or multiple contralateral TESE (step 3). Conclusions: Stepwise micro-TESE could represent an optimal approach for sperm retrieval in NOA men. In our view, it should be offered to NOA patients in order to gradually increase surgical invasiveness, when necessary. Stepwise micro-TESE might also reduce the costs, time and efforts involved in surgery

Il valore del 'soft law' nell'ordinamento internazionale. Casi e questioni in materia di diritto internazionale della sanità pubblica e del commercio

La tesi insiste nella ricerca di una collocazione coerente per la categoria del 'soft law' rispetto alle fonti giuridiche dell'ordinamento internazionale. Diversamente da quanto sostenuto da una parte della dottrina, la ricerca mira a evidenziare come tale categoria di fonti normative non rappresenti una minaccia alla certezza del diritto, ma, anzi, concorra a salvaguardare la 'rule of law' internazionale. Nei primi tre capitoli si cerca di operare una sistematizzazione del rapporto che il 'soft law' intrattiene con il diritto internazionale generale e con quello pattizio, mettendo in luce le diverse forme di interazione che con queste fonti, volta per volta, possono venirsi a creare. L'analisi, quindi, procede attraverso casi e questioni legati a due settori specifici dell'ordinamento internazionale, ovvero il diritto della sanità e quello del commercio. Nei Capitoli IV e V, infatti, il 'soft law' viene preso in considerazione, rispettivamente, come strumento di 'governance' e quale possibile antidoto alla frammentazione del diritto internazionale

Dynamics and Hadronization at intermediate transverse momentum at RHIC

The ultra-relativistic heavy-ion program at RHIC has shown that at intermediate transverse momenta ($p_T \simeq 2$-6 GeV) standard (independent) parton fragmentation can neither describe the observed baryon-to-meson ratios nor the empirical scaling of the hadronic elliptic flow ($v_2$) according to the number of valence quarks. Both aspects find instead a natural explanation in a coalescence plus fragmentation approach to hadronization. After a brief review of the main results for light quarks, we focus on heavy quarks showing that a combined fragmentation and quark-coalescence framework is relevant also here. Moreover, within relativistic Langevin simulations we find evidence for the importance of heavy-light resonances in the Quark-Gluon Plasma (QGP) to explain the strong energy loss and collective flow of heavy-quark spectra as inferred from non-photonic electron observables. Such heavy-light resonances can pave the way to a unified understanding of the microscopic structure of the QGP and its subsequent hadronization by coalescence.Comment: Proceedings of the International Workshop on QCD - Martina Franca (Italy), June 2007. To be published in AIP. 6 pages, 6 figure

Anisotropic tunneling in {InGaAsP}/{InP} multi-quantum barrier structure

We present magneto-photoluminescence experiments on a multi-quantum-barrier structure consisting of 31 period of wide (58 nm) quaternary wells of InGaAsP with the same lattice parameter as InP separated by thin (8 nm) InP barriers. The anomalous diamagnetic shift and the asymmetric broadening of the luminescence spectra evidence strong band filling in the tail of the density of states of the quaternary alloy, suggesting that tunneling transport through the InP barrier is anisotropic along the growth axis, due to different band lineups for the direct (InGaAsP-on-InP) and inverse (InP-on-InGaAsP) interfaces. This finding is supported by high resolution X-ray patterns, yielding evidence that the direct and inverse interfaces are smooth and display different chemical compositions

Beneficial effects of a low-nickel diet on relapsing IBS-like and extraintestinal symptoms of celiac patients during a proper gluten-free diet: nickel allergic contact mucositis in suspected non-responsive celiac disease

Background and Aim: Nickel (Ni)-rich foods can induce allergic contact mucositis (ACM) with irritable bowel syndrome (IBS)-like symptoms in predisposed subjects. Ni ACM has a high prevalence (>30%) in the general population and can be diagnosed by a Ni oral mucosa patch test (omPT). Many celiac disease (CD) patients on a gluten-free diet (GFD) often show a recrudescence of gastrointestinal and extraintestinal symptoms, although serological and histological remission has been achieved. Since a GFD often results in higher loads of ingested alimentary Ni (e.g., corn), we hypothesized that it would lead to a consequent intestinal sensitization to Ni in predisposed subjects. We wanted to (1) study Ni ACM prevalence in still symptomatic CD patients on a GFD and (2) study the effects of a low-Ni diet (LNiD) on their recurrent symptoms. Material and Methods: We recruited 102 consecutive CD patients (74 female, 28 male; age range 18–65 years, mean age 42.3 ± 7.4) on a GFD since at least 12 months, in current serological and histological remission (Marsh–Oberhuber type 0–I) who complained of relapsing gastrointestinal and/or extraintestinal symptoms. Inclusion criteria: presence of at least three gastrointestinal symptoms with a score ≥5 on the modified Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. Exclusion criteria: IgE-mediated food allergy; history of past or current cancer; inflammatory bowel diseases; infectious diseases including Helicobacter pylori; lactose intolerance. All patients enrolled underwent Ni omPT and followed a LNiD for 3 months. A 24 symptoms questionnaire (GSRS modified according to the Salerno Experts’ Criteria, with 15 gastrointestinal and 9 extraintestinal symptoms) was administered at T0 (free diet), T1 (GFD, CD remission), T2 (recurrence of symptoms despite GFD), and T3 (GFD + LNiD) for comparisons. Comparisons were performed using Wilcoxon signed-rank test. RESULTS: Twenty patients (all female, age range 23–65 years, mean age 39.1 ± 2.9) out of 102 (19.6%) were finally included. All 20 patients enrolled (100%) showed positive Ni omPT, confirming an Ni ACM diagnosis. A correct GFD (T0 vs. T1) induced the improvement of 19 out of the total 24 (79.2%) symptoms, and 14 out of 24 (58.3%) were statistically significant (p-value <0.0083 according to Bonferroni correction). Prolonged GFD (T1 vs. T2) revealed the worsening of 20 out of the total 24 (83.3%) symptoms, and 10 out of 24 (41.7%) were statistically significant. LNiD (T2 vs. T3) determined an improvement of 20 out of the total 24 (83.4%) symptoms, and in 10 out of 24 (41.7%) symptoms the improvement was statistically significant. Conclusions: Our data suggest that the recrudescence of gastrointestinal and extraintestinal symptoms observed in CD subjects during GFD may be due to the increase in alimentary Ni intake, once gluten contamination and persisting villous atrophy are excluded. Ni overload can induce Ni ACM, which can be diagnosed by a specific Ni omPT. Improvement of symptoms occurs after a proper LNiD. These encouraging data should be confirmed with larger studies

The role of geological origin of smectites and of their physico-chemical properties on aflatoxin adsorption

Since 2013, bentonite in the form of dioctahedral smectite is an additive authorised in the EU as a substance for the reduction of the contamination of feed by aflatoxins. Several studies indicate a big difference in the effectiveness of smectites in sequestering aflatoxins. A clear correlation between mineralogical and physico-chemical properties of smectites and aflatoxin adsorption has not been well established. In the effort to identify the most critical mineralogical, chemical, and physical properties that affect aflatoxin adsorption by smectites, 29 samples of bentonites obtained from different sources around the world were evaluated. “As received” samples were divided into two main groups, i.e. hydrothermal (n=14) and sedimentary (n=15) bentonites depending on their geological origin. The characterization studies showed that all samples contained dioctahedral smectite as major mineral; a moderate CEC value (60-116 cmol/kg); the presence of iron; a small organic matter content; a near-neutral pH; and a fine and uniform particle size (<45μm). They differed substantially in their sodium, calcium and magnesium contents, and in the swelling properties depending on the geological origin. Several in vitro adsorption studies showed that they also differed in a significant manner in adsorbing aflatoxin B1 (AFB1). A correlation between geological origin and AFB1 adsorption capacity was found (p<0.001), being sedimentary smectites significantly more effective than hydrothermal ones in adsorbing the toxin at different pH values. The extent of AFB1 adsorption by all samples was negatively and linearly correlated to the extent of desorption, and sedimentary smectites were significantly more effective than hydrothermal smectites in keeping bound the adsorbed fraction of the toxin (p < 0.001). In addition, correlation studies using the Pearson statistical method showed a significant relationship among some physico-chemical properties of smectites and the amounts of adsorbed toxin. In particular, AFB1 adsorption by smectites correlated positively with sodium content and swell index, but negatively with d001-value, magnesium and calcium contents. In conclusion, it seems that the geological origin of smectite is a useful guide for the selection of bentonites for AFB1 detoxification. Sedimentary bentonites containing sodium/swelling-smectite should be preferred to hydrothermal samples as potential aflatoxin binders. Taking into account the geographical origin of our samples, this approach should be applicable to bentonites worldwide

Maternal and neonatal health care service utilisation in the wake of active conflict and socio-economic downturn in Torit County, Republic of South Sudan: a multimethod locally driven study

Recurrent conflicts and economic downturn hamper access to health care. We examined how renewed conflict in July 2016 in Torit County, South Sudan affected health facility utilization for pregnancy care. We analyzed key quantitative indicators before and since renewed conflict through monthly facility data covering January 2015 to December 2016 on Antenatal Care (ANC) visits, facility-based births, and major obstetric complications. A qualitative descriptive study explored perceptions on access through key informant interviews and focused group discussions. ANC visits declined by 21%; health facility births declined from 23.6% to 16.7% while the proportion of all obstetric complications treated declined from 58.9% to 43.9%. Lack of human resources, inadequate medicines supply, perceived poor quality of care and economic hardships were the main factors affecting access to care. Our multidisciplinary and multistakeholder approach and leadership by South Sudanese team members enhanced research quality and its potential impact on practice and policy. &nbsp; Les conflits armés récurrents et la récession économique entravent l'accès aux services de santé. Au mois de juillet 2016, des conflits armés ont repris au Soudan du Sud. Nous avons mené une étude mixte sur l’impact de la reprise des conflits armés de 2016 sur l’utilisation des services de santé maternelle dans le comté de Torit au Soudan du Sud. La composante quantitative a évalué les consultations prénatales, les accouchements en milieu hospitalier, et les complications obstétricales majeures. Nous avons consulté les données des établissements de santé durant la période de janvier 2015 à décembre 2016. La composante qualitative a exploré les perceptions de l’accès aux services de santé. Nous avons mené des entretiens individuels et des groupes de discussion avec des informateurs clés (ministère de la Santé du comté de Torit, gestionnaires et professionnels de la santé, membres d’organisations non gouvernementales).Les résultats quantitatifs ont montré que les consultations prénatales ont diminué de 21%. Les accouchements en milieu hospitalier sont passés de 23.6% à 16.7% tandis que la proportion des complications obstétricales majeures traitées est passée de 58.9% à 43.9%. L’absence des ressources humaines en santé, les problèmes d’approvisionnement en médicaments, la qualité perçue des soins, et le manque de ressources économiques des ménages sont les principaux facteurs influençant l’accès aux services de santé maternelle. L’implication des décideurs politiques, la multidisciplinarité de l’équipe de recherche et le leadership des membres de l’équipe sud-soudanaise ont contribué à améliorer la qualité de la recherche et à son impact potentiel sur les pratiques et les politiques sanitaire

Nonlinear absorption and gain in InGaAs/GaAs quantum wells

We present a detailed study of the excitonic nonlinearities in InGaAs/GaAs multiple quantum wells based on both stationary and transient pump-and-probe transmission spectroscopy. Bleaching of the excitonic resonance and free carrier gain have been observed. A quantitative analysis of the observed nonlinearity is provided by means of a rigorous solution of the Bethe–Salpeter equation for the investigated heterostructures

Decontamination of Mycotoxin-Contaminated Feedstuffs and Compound Feed

Mycotoxins are known worldwide as fungus-produced toxins that adulterate a wide heterogeneity of raw feed ingredients and final products. Consumption of mycotoxins-contaminated feed causes a plethora of harmful responses from acute toxicity to many persistent health disorders with lethal outcomes; such as mycotoxicosis when ingested by animals. Therefore, the main task for feed producers is to minimize the concentration of mycotoxin by applying different strategies aimed at minimizing the risk of mycotoxin effects on animals and human health. Once mycotoxins enter the production chain it is hard to eliminate or inactivate them. This paper examines the most recent findings on different processes and strategies for the reduction of toxicity of mycotoxins in animals. The review gives detailed information about the decontamination approaches to mitigate mycotoxin contamination of feedstuffs and compound feed, which could be implemented in practice