Technical aspects and clinical limitations of sperm DNA fragmentation testing in male infertility: a global survey, current guidelines, and expert recommendations.

PURPOSE: Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice. MATERIALS AND METHODS: Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured. RESULTS: The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%). CONCLUSIONS: This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial

Technical Aspects and Clinical Limitations of Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

PURPOSE: Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice. MATERIALS AND METHODS: Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured. RESULTS: The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%). CONCLUSIONS: This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial

Technical aspects and clinical limitations of sperm DNA fragmentation testing in male infertility: A global survey, current guidelines, and expert recommendations

Purpose Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice. Materials and Methods Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured. Results The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%). Conclusions This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial

Üç Devir Bir Fakülte / Three Eras One Faculty

The name Dârülfünûn was given to the university with a system similar to that of European models that was to be founded in the Ottoman Empire. This idea was introduced for the first time at the beginning of the Tanzimat, a period that can be considered the impetus for Ottoman modernization. In 1846, Board of General Education (Meclis-i Maarif-i Umûmiye) made the decision to set up a university, with Gaspare Trajano Fossati, a prominent architect of the time, being asked to design a massive building akin to European universities. The 1846 decision could not be implemented until 1863, and the first attempt at Dârülfünûn ended after two and a half years of free courses (serbest dersler). Afterward, the university building was allotted to the Ministry of Finance. The second attempt took place between 1869 and 1872 in the building that is now known as the Press Museum in Istanbul’s Çemberlitaş District, which had been built especially for Dârülfünûn. This second attempt also did not last long. However, the implementation of the General Education Regulations (Maarif-i Umûmiye Nizâmnâmesi) for the first time and the structuring of primary and secondary education in the following years in accordance with the aims of this regulation are included among the successful features of the second attempt. In fact, the fruits of this second attempt would be realized during the reign of Sultan Abdülhamid II (r. 1876-1909). In 1874- 1875, the third attempt occurred to found a university, this time under the name Dârülfünûn-ı Sultanî. For the first time, students at this new university, which included the Faculties of Law, Engineering, and Literature, were entitled to write a PhD dissertation in their field. Political instability generated by the period’s economic and social realities, as well as international pressure on the state, prevented this third attempt from producing the desired results. Nonetheless, while the expected outcome was yet to be realized, this third attempt paved the way for the establishment of independent educational institutions (i.e., modern schools). In 1900 and coinciding with the 25th anniversary of Sultan Abdülhamid II’s accession to the throne, the idea of establishing a university again came to the agenda, and the first university of the Ottoman Empire, Dârülfünûn-ı Şâhâne, finally began its uninterrupted education and training with five faculties: the Faculties of Literature, Science, and Ulûm-ı Âliye-i Dîniyye [Theology] and the previously established Faculties of Medicine and Law.PublishedElinizdeki bu çalışma, kaynaklarının tespitinden, veri dökümlerinin hazırlanması, bunların işlenmesi, planlanması, yazıya dökülmesi ve nihayet iki kapak arasına alınmasına kadar yaklaşık beş yıllık bir emeğin ürünüdür. Çalışmaya konu olan Dârülfünûn İlahiyat Fakültesi’nin akademik kadrosuna ve bunlarla ilintili çeşitli meselelere dair bugüne kadar bazı kıymetli araştırmalar hazırlanmışsa da, Fakülte’nin kuruluşundan kapanışına kadar gerek devlet gerekse hususî arşivindeki kayıtları esas alan kapsamlı bir eser ortaya konulamamıştır. Haliyle Fakülte’nin üniversite içindeki konumu ve medrese geleneğiyle bağlantıları, öğrencilerinin kimlikleri, idarî-ilmî oluşumu, maddî kaynaklarının niteliği, öğretim programı, etrafında yaşanan tartışmalar ve gelişmeler gibi pek çok mesele ilim âlemi için büyük oranda bilinmezliğini korumuştur. Mezkûr saiklerle yola çıkan bu çalışma, 1900- 14 ve 1924-33 yılları arasında Dârülfünûn bünyesinde yüksek düzeyde eğitim-öğretim veren hem Osmanlı hem de Cumhuriyet tarihinin ilk yüksek dereceli İslâmî eğitim kurumu olan Ulûm-ı Âliye-i Dîniyye/Şeriyye Şubesi ve nihayet İlahiyat Fakültesi isimleriyle anılan bir müesseseyi konu edinmektedir

Hemodiyaliz Uygulanan Hastalarda Kemoterapi

Kronik böbrek yetmezliği olan hastalarda malignite tedavisi 1970’li yılların ortalarından itibaren tartışılmaya başlanmıştır. Maligniteli hastalarda, %50-60 gibi yüksek oranlarda kronik böbrek hastalığının herhangi bir evresine rastlanılmaktadır. Günümüzde son dönem böbrek yetmezliği (SDBY) sıklığı tüm dünyada giderek artmakta ve bunların büyük çoğunluğu da hemodiyaliz tedavisi görmektedir. Bu hastalarda, eşlik eden malignite varlığında sitotoksik tedavilerin dozu ve diyaliz tedavi seansları dikkate alınarak doğru zamanlama ile uygulanması, tedavinin etkinliği veya yan etkileri açısından çok önemlidir.Bu yazıda hemodiyaliz tedavisi gören son dönem böbrek yetmezlikli hastalarda, eşlik eden solid tümörlerin tedavisinde kullanılan kemoterapi ilaçlarının tolerans ve doz ayarlanması güncel literatür eşliğinde gözden geçirildi

A cross-sectional study in patients with pre-dialysis chronic kidney disease: Quality of life and related factors

AMAÇ: Kronik Böbrek Hastalığı (KBH) insidansı ve prevalansı tüm dünyada artmaktadır. KBH’da sıklıkla komplikasyonlar fazladır ve kötü yaşam kalitesi ile birliktedir. Bu çalışmanın amacı Kısa form-36 (SF-36) ölçeği ile KBH’da yaşam kalitesinin değerlendirilmesi ve böbrek fonksiyonları, yaş, cinsiyet, eğitim düzeyi, sosyo ekonomik durum, hemoglobin, albumin, HBA1c, 25OHvitamin D düzeyinin yaşam kalitesi üzerindeki etkisinin araştırılmasıdır. GEREÇ VE YÖNTEM: Bu kesitsel çalışma Antalya Eğitim ve Araştırma Hastanesinde takipli 211 KBH tanılı hastada (ortalama yaş 56 ± 13 yıl), Ocak-Haziran 2016 tarihleri arasında yapıldı. Hastaların yaşam kalitesini saptamak için SF-36 ölçeği kullanıldı ve laboratuvar testleri, klinik ve demografik verileri kayıt edildi. BULGULAR: KBH-EPI formülü kullanılarak hastalar KBH evrelerine ayrıldı. Hastaların %59,2’si Evre 1-3, %40,8’i Evre 4-5 olarak saptandı. Evre 4-5 hastalarda fiziksel rol güçlüğü skoru daha düşük saptandı. Yaşın yaşam kalitesini negatif etkilediği görüldü. Hemoglobin, albumin ve 25 OH vitamin D düzeylerindeki artışın fiziksel fonksiyon ve fiziksel rol güçlüğü skorlarında artışla birlikte olduğu saptandı. Artmış HbA1C düzeylerinin kötü fiziksel fonksiyon skoruyla ilişkili olduğu görüldü. Eğitim düzeyi ,sosyo ekonomik durum ile yaşam kalitesi arasında ilişki saptandı. SONUÇ: KBH tanılı hastada böbrek fonksiyonları, yaş, cinsiyet, eğitim düzeyi ve sosyoekonomik durum yaşam kalitesini etkilemektedir. KBH’da yaşam kalitesini artırmak için; hemoglobin, albumin, HbA1c ve 25 OH vitamin D düzeyleri gibi değiştirebileceğimiz faktörleri iyileştirmeliyiz.OBJECTIVE: The incidence and prevalence of patients with chronic kidney disease (CKD) is increasing worldwide. It is often associated with a high prevalence of complications and worse quality of life. The main objective of this study is to evaluate quality of life (QOL) using the generic instrument short form-36 (SF-36) in patients with CKD and identify the possible influence of the degree of renal function, age, gender, education level, socioeconomic status, hemoglobin, albumin, HbA1c and 25 hydroxy vitamin D level on QOL. MATERIALS AND METHODS: For this cross-sectional study, we included 211 CKD patients ( median age 56 ± 13 years) admitted to the outpatient clinic of Antalya Research and Training Hospital Nephrology Unit between January and June 2016. Participants completed the short form-36 health survey (SF-36). Laboratory tests and clinical and demographic data were obtained. RESULTS: The patients were classified into CKD stages according to the CKD-EPI equation: 59,2% were in CKD Stage 1-3 and 40,8% were in Stage 4-5. The patients in Stage 4-5 had lower scores in physical aspects. Age influence QOL negatively. CKD patients with higher hemoglobin, albumin and 25 hydroxy vitamin D levels has better functional capacity and physical aspects. High HbA1c levels significantly associated with bad functional capacity. Education level and socioeconomic status is associated with QOL. CONCLUSIONS: Renal function, age, gender, education level and socioeconomic status influenced QOL. To imrove QOL in CKD patients we need to focus on factors that can be changed, such as improving the hemoglobin, albumin, HbA1c and 25 hydroxy vitamin D levels

A cross-sectional study in patients with pre-dialysis chronic kidney disease: Quality of life and related factors

AMAÇ: Kronik Böbrek Hastalığı (KBH) insidansı ve prevalansı tüm dünyada artmaktadır. KBH’da sıklıkla komplikasyonlar fazladır ve kötü yaşam kalitesi ile birliktedir. Bu çalışmanın amacı Kısa form-36 (SF-36) ölçeği ile KBH’da yaşam kalitesinin değerlendirilmesi ve böbrek fonksiyonları, yaş, cinsiyet, eğitim düzeyi, sosyo ekonomik durum, hemoglobin, albumin, HBA1c, 25OHvitamin D düzeyinin yaşam kalitesi üzerindeki etkisinin araştırılmasıdır. GEREÇ VE YÖNTEM: Bu kesitsel çalışma Antalya Eğitim ve Araştırma Hastanesinde takipli 211 KBH tanılı hastada (ortalama yaş 56 ± 13 yıl), Ocak-Haziran 2016 tarihleri arasında yapıldı. Hastaların yaşam kalitesini saptamak için SF-36 ölçeği kullanıldı ve laboratuvar testleri, klinik ve demografik verileri kayıt edildi. BULGULAR: KBH-EPI formülü kullanılarak hastalar KBH evrelerine ayrıldı. Hastaların %59,2’si Evre 1-3, %40,8’i Evre 4-5 olarak saptandı. Evre 4-5 hastalarda fiziksel rol güçlüğü skoru daha düşük saptandı. Yaşın yaşam kalitesini negatif etkilediği görüldü. Hemoglobin, albumin ve 25 OH vitamin D düzeylerindeki artışın fiziksel fonksiyon ve fiziksel rol güçlüğü skorlarında artışla birlikte olduğu saptandı. Artmış HbA1C düzeylerinin kötü fiziksel fonksiyon skoruyla ilişkili olduğu görüldü. Eğitim düzeyi ,sosyo ekonomik durum ile yaşam kalitesi arasında ilişki saptandı. SONUÇ: KBH tanılı hastada böbrek fonksiyonları, yaş, cinsiyet, eğitim düzeyi ve sosyoekonomik durum yaşam kalitesini etkilemektedir. KBH’da yaşam kalitesini artırmak için; hemoglobin, albumin, HbA1c ve 25 OH vitamin D düzeyleri gibi değiştirebileceğimiz faktörleri iyileştirmeliyiz.OBJECTIVE: The incidence and prevalence of patients with chronic kidney disease (CKD) is increasing worldwide. It is often associated with a high prevalence of complications and worse quality of life. The main objective of this study is to evaluate quality of life (QOL) using the generic instrument short form-36 (SF-36) in patients with CKD and identify the possible influence of the degree of renal function, age, gender, education level, socioeconomic status, hemoglobin, albumin, HbA1c and 25 hydroxy vitamin D level on QOL. MATERIALS AND METHODS: For this cross-sectional study, we included 211 CKD patients ( median age 56 ± 13 years) admitted to the outpatient clinic of Antalya Research and Training Hospital Nephrology Unit between January and June 2016. Participants completed the short form-36 health survey (SF-36). Laboratory tests and clinical and demographic data were obtained. RESULTS: The patients were classified into CKD stages according to the CKD-EPI equation: 59,2% were in CKD Stage 1-3 and 40,8% were in Stage 4-5. The patients in Stage 4-5 had lower scores in physical aspects. Age influence QOL negatively. CKD patients with higher hemoglobin, albumin and 25 hydroxy vitamin D levels has better functional capacity and physical aspects. High HbA1c levels significantly associated with bad functional capacity. Education level and socioeconomic status is associated with QOL. CONCLUSIONS: Renal function, age, gender, education level and socioeconomic status influenced QOL. To imrove QOL in CKD patients we need to focus on factors that can be changed, such as improving the hemoglobin, albumin, HbA1c and 25 hydroxy vitamin D levels

Yaşlı Bireylerde Fiziksel Aktivite Düzeyinin Yaşam Kalitesi Üzerine Etkisinin İncelenmesi

Yaşlandıkça ortaya çıkan fiziksel ve fizyolojik fonksiyon kayıpları, yaşam kalitesinde azalma-ya neden olmaktadır. Sağlıklı yaşlanma sürecinde düzenli ve orta şiddette yapılan fiziksel aktivitenin ileri yaşlarda yaşanan fonksiyonel kayıpları azalttığı bilinmekle birlikte, bu süreçte fiziksel aktivite seviyesinin yaşam kalitesi üzerinde ne derecede etkili olduğu merak edilmek-tedir. Bu nedenle bu çalışmada yaşlı bireylerin fiziksel aktivite düzeylerinin, yaşam kaliteleri üzerine olan etkilerinin incelenmesi amaçlanmıştır. Araştırmaya Kayseri ve çevresinde yaşa-yan yaş ortalaması 69,01±2,10 yıl olan 88 kadın, ve yaş ortalaması 70,73±3,69 yıl olan 118 erkek olmak üzere toplam 206 gönüllü katıldı. Çalışmaya katılan gönüllülerin boy uzunluğu, vücut ağırlığı, vücut kitle indeksi değerleri ölçüldükten sonra, yaşam kalitesi değerleri SF 36 yaşam kalitesi ölçeği ile, fiziksel aktivite düzeyleri ise üç eksenli ölçüm yapan akselerometre (StayHealty RT6, USA) cihazı ile belirlendi. Kadın gönüllülerin hem akselerometre toplam kalori hem de akselerometre aktivite kalori değerleri ile yaşam kalitesi alt indekslerinden fiziksel fonksiyon arasında anlamlı bir ilişki (p<0,001), ayrıca akselerometre aktivite kalori değerleri ile sosyal işlevsellik değerleri arasında anlamlı bir ilişki tespit edildi (p<0,05). Erkek gönüllülerde ise hem akselerometre toplam kalori hem de akselerometre aktivite kalori de-ğerleri ile fiziksel fonksiyon (p<0,001), fiziksel rol güçlüğü (p<0,001), enerji/vitalite/canlılık (p<0,001), ruhsal sağlık (p<0,001), sosyal işlevsellik (p<0,001), ağrı (p<0,001), genel sağlık algısı (p<0,001) değerleri arasında, ayrıca akselerometre aktivite kalori ve emosyonel rol güçlüğü arasında (p<0,05) anlamlı bir ilişki tespit edildi. Sonuç olarak, yaşlı bireylerde fiziksel aktivite değerleri arttıkça yaşam kalitesi değerlerinin de arttığı tespit edildi. Daha sağlıklı ve verimli bir yaşlılık dönemi geçirilmesi açısından, bireylerin gençlik dönemlerinde düzenli olarak egzersiz yapma bilinci ve alışkanlıklarını kazanarak yüksek fiziksel aktivite değerlerine sahip olmaları, ve bu seviyeyi yaşlılık dönemlerine de taşıyarak sağlıklı yaşlanma sürecine katkı sağlayabilecekleri düşünülmektedi

Breast artery calcification as an opportunistic predictor of cardiovascular disease

Background Atherosclerotic cardiovascular disease is still the leading cause of mortality for women. Breast cancer screening with mammography is recommended in all women aged over 40 years. Aims Whether breast artery calcification (BAC) is associated with cardiovascular disease is not clear. We aimed to evaluate the association between BAC and the presence of coronary atherosclerosis determined by CT. Methods All patients who underwent both mammography and coronary CT angiography between January 2010 and December 2016 were screened, and patients with a duration of less than 12 months between CT and mammography were included. Results A total of 320 women were included and BAC was detected in 47 (14.6%) patients. BAC was correlated with age and CT coronary calcium score. Both the frequency of critical coronary artery stenosis (34% vs 10.6%; p = 0.001) and CT coronary calcium score (5.5 vs 0; p = 0.001) was significantly higher in patients with BAC. The absence of BAC was a strong predictor of the absence of significant coronary artery disease (p = 0.001). BAC was independently associated with all-cause mortality after excluding patients with breast cancer (HR: 5.32; p = 0.013). Conclusion Breast artery calcification is associated with coronary calcium score and significant coronary stenosis. A high BAC score is related to increased mortality

Autosomal Dominant Polycystic Disease is Associated with Depressed Levels of Soluble Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand

Background: Autosomal dominant polycystic kidney disease (ADPKD) is characterized by multiple, large renal cysts and impaired kidney function. Although the reason for the development of kidney cysts is unknown, ADPKD is associated with cell cycle arrest and abundant apoptosis of renal tubular epithelial cells. Aims: We asked whether serum-soluble TNF-related apoptosis-inducing ligand (sTRAIL) might underlie ADPKD. Study Design: Case-control study. Methods: Serum sTRAIL levels were measured in 44 patients with ADPKD and 18 healthy volunteers. The human soluble TRAIL/Apo2L ELISA kit was used for the in vitro quantitative determination of sTRAIL in serum samples. Results: Mean serum sTRAIL levels were lower in patients with ADPKD as compared to the control group (446.9±103.1 and 875.9±349.6 pg/mL, p0.05). Conclusion: Our results show that ADPKD patients have depressed sTRAIL levels, indicating apoptosis unrelated to the stage of chronic renal failure