MRI in the evaluation of the azoospermic male

PURPOSEWe aimed to show the usefulness of magnetic resonance imaging (MRI) in the evaluation of infertile men and its ability to distinguish obstructive from nonobstructive azoospermia. METHODSBetween April 2015 and February 2018, 45 azoospermic men underwent scrotal MRI. We evaluated the images with an emphasis on signal characteristics of the testis and morphologic changes typical for obstruction. Testicular volume (TV), apparent diffusion coefficient (ADC) value, T1 and T2 signal ratios (testis/muscle) were measured for every testis. On the basis of histologic results, patients were divided into two groups: obstructive azoospermia (OA) and nonobstructive azoospermia (NOA).RESULTSTestes of patients in the OA group had significantly lower ADC values (mean 0.876±101 ×10-3 mm2/s) than in the NOA group (mean, 1.114±147 ×10-3 mm2/s). TV was significantly higher in patients with OA (median, 17.61 mL; range, 11.1–38.4 mL) than in those with NOA (median, 10.5 mL; range, 5.2–22.2 mL). ROC analysis showed that both TV and ADC values were highly predictive for distinguishing between OA and NOA patients, with an area under the ROC curve of 0.82 and 0.92 respectively. A cutoff value of ≥12.4 mL could distinguish obstructive from nonobstructive azoospermia with a sensitivity of 92% and specificity of 63%, whereas for ADC measurements a cutoff value of ≥0.952 ×10-3 mm2/s exhibited a sensitivity of 81% and specificity of 90% There was no statistically significant difference in T1 and T2 signal ratios between both groups. Abnormalities typical for obstruction of the male reproductive tract (e.g., dilatation of ejaculatory ducts, prostatic or seminal vesicle cysts) were found in 78% of patients (14/18) in the obstructive group.CONCLUSIONScrotal MRI is a very effective tool for the evaluation of azoospermic men and may provide important information facilitating interventional treatment of infertility

Novel immunomodulators from hard ticks selectively reprogramme human dendritic cell responses

Hard ticks subvert the immune responses of their vertebrate hosts in order to feed for much longer periods than other blood-feeding ectoparasites; this may be one reason why they transmit perhaps the greatest diversity of pathogens of any arthropod vector. Tick-induced immunomodulation is mediated by salivary components, some of which neutralise elements of innate immunity or inhibit the development of adaptive immunity. As dendritic cells (DC) trigger and help to regulate adaptive immunity, they are an ideal target for immunomodulation. However, previously described immunoactive components of tick saliva are either highly promiscuous in their cellular and molecular targets or have limited effects on DC. Here we address the question of whether the largest and globally most important group of ticks (the ixodid metastriates) produce salivary molecules that specifically modulate DC activity. We used chromatography to isolate a salivary gland protein (Japanin) from Rhipicephalus appendiculatus ticks. Japanin was cloned, and recombinant protein was produced in a baculoviral expression system. We found that Japanin specifically reprogrammes DC responses to a wide variety of stimuli in vitro, radically altering their expression of co-stimulatory and co-inhibitory transmembrane molecules (measured by flow cytometry) and their secretion of pro-inflammatory, anti-inflammatory and T cell polarising cytokines (assessed by Luminex multiplex assays); it also inhibits the differentiation of DC from monocytes. Sequence alignments and enzymatic deglycosylation revealed Japanin to be a 17.7 kDa, N-glycosylated lipocalin. Using molecular cloning and database searches, we have identified a group of homologous proteins in R. appendiculatus and related species, three of which we have expressed and shown to possess DC-modulatory activity. All data were obtained using DC generated from at least four human blood donors, with rigorous statistical analysis. Our results suggest a previously unknown mechanism for parasite-induced subversion of adaptive immunity, one which may also facilitate pathogen transmission

The correlation between the MRI-evaluated ectopic fat accumulation and the incidence of diabetes mellitus and hypertension depends on body mass index and waist circumference ratio.

The widespread presence of overweight and obesity increases with every decade, and the number of people with body mass index (BMI) >30 kg/m2 has doubled in the last 30 years. The aim of the study is to assess the correlation between MRI-evaluated ectopic fat accumulation in pancreas, skeletal muscles and liver and the incidence of type 2 diabetes and hypertension, depending on BMI and waist circumference ratio. This prospective study included 267 consecutive patients who were referred to abdominal MRI and underwent a standard clinical assessment with BMI and waist circumference ratio calculation. Ectopic fat accumulation in pancreas, skeletal muscles and liver was evaluated in magnetic resonance imaging using the fat-water separated Dixon imaging. There were statistically significant differences in mean steatosis of all assessed organs in the group of patients with type 2 diabetes or hypertension in comparison to the non-diabetic group as well as to the group without hypertension. It has been observed that pancreas and skeletal muscles are more susceptible to fat accumulation than liver. According to our results, there is a relation between the fat content in muscles, pancreas and liver, the incidence of type 2 diabetes and hypertension and also body mass index and waist circumference ratio. We believe that future studies should aim to determine whether the use of fat content measurement in certain organs could be used as a biomarker that can enable early detection of reversible metabolic changes, as well as their subsequent monitoring

PAMAM Dendrimers as Potential Carriers of Gadolinium Complexes of Iminodiacetic Acid Derivatives for Magnetic Resonance Imaging

This is the first study describing the utilization of PAMAM dendrimers as delivery vehicles of novel magnetic resonance imaging (MRI) contrast agents. The purpose of this paper was to establish the potential of G4 PAMAM dendrimers as carriers of gadolinium complexes of iminodiacetic acid derivatives and determine imaging properties of synthesized compounds in in vivo studies. Furthermore, we examined the influence of four synthesized complexes on the process of clot formation, stabilization, and lysis and on amidolytic activity of thrombin. Biodistribution studies have shown that the compounds composed of PAMAM G4 dendrimers and gadolinium complexes of iminodiacetic acid derivatives increase signal intensity preferably in liver in range of 59–116% in MRI studies which corresponds with the greatest accumulation of gadolinium after administration of the compounds. Synthesized compounds affect kinetic parameters of the proces of clot formation, its stabilization, and lysis. However, only one synthesized compound at concentration 10-fold higher than potential plasma concentrations contributed to the increase of general parameters such as the overall potential of clot formation and lysis (↑CLAUC) and total time of the process (↑T). Results of described studies provide additional insight into delivery properties of PAMAM dendrimers but simultaneously underscore the necessity for further research

Zmiana astygmatyzmu rogówkowego wraz z wiekiem

The work is theoretical in nature and was created to test the relationship between age and changes in astigmatism. The analysis was carried out on the basis of the available studies described in the literature on the subject. The collected statistical data and medical information allow for the conclusion that astigmatism may change with age. The implemented project presents results that have both cognitive and application value. The identified bindings can be used in the medical practice of patients with astigmatism.Praca ma charakter teoretyczny i powstała w celu sprawdzenia związku między zmianami astygmatyzmu a wiekiem. Analiza została przeprowadzona na podstawie dostępnych badań opisanych w literaturze przedmiotu. Zebrane dane statystyczne i informacje medyczne pozwalają na sformułowanie wniosku, że astygmatyzm może ulegać zmianie wraz z wiekiem. Zrealizowany projekt przedstawia wyniki, które posiadają zarówno wartość poznawczą, jak i aplikacyjną. Stwierdzone powiązania mogą być wykorzystane w praktyce lekarskiej pacjentów z niezbornością

Obustronny przedni stożek soczewki w przebiegu zespołu Alporta – opis przypadku

Alport syndrome is a genetic disease that leads not only to chronic kidney disease but also to loss of hearing and vison. The article presents a case of a 34-year-old with anterior lenticonus in Alport syndrome. Due to the progressive deterioration of vision and the ineffectiveness of the selection of glasses, he was qualified for the surgery - the phacoemulsification for immature cataract of distorted lenses.Zespół Alporta jest chorobą genetyczną, która doprowadza nie tylko do przewlekłej choroby nerek, ale również do utraty słuchu i wzroku. W artykule został przedstawiony przypadek 34-letniego mężczyzny ze zdiagnozowanym przednim stożkiem soczewki w przebiegu zespołu Alporta. W związku z postępującym pogorszeniem widzenia i nieskutecznością doboru okularów pacjent został zakwalifikowany do zabiegu chirurgicznego. Przeprowadzono operację fakoemulsyfikacji zaćmy początkowej zniekształconych soczewek

Owrzodzenia rogówki w przebiegu układowych chorób o podłożu autoimmunologicznym. Rozpoznanie i leczenie

Peripheral ulcerative keratitis is an inflammatory condition, usually crescent shaped and occurring in the corneal stromal region, where it is always associated with corneal stromal thinning. Peripheral ulcerative keratitis often occurs in the course of rheumatic diseases but is most commonly associated with rheumatoid arthritis. Peripheral ulcerative keratitis is also seen in granulomatosis with polyangiitis, polyarteritis nodosa, relapsing chondritis, and systemic lupus erythematosus. These diseases are analyzed in the article in relation to peripheral ulcerative keratitis with a discussion of individual treatment methods in specific cases.Obwodowe wrzodziejące zapalenie rogówki jest stanem zapalnym, zwykle w kształcie półksiężyca, występującym w okolicy rąbka rogówki, gdzie zawsze wiąże się ze ścieńczeniem zrębu rogówki. Niejednokrotnie występuje w przebiegu chorób reumatoidalnych, natomiast najczęściej związane jest z reumatoidalnym zapaleniem stawów. Obwodowe wrzodziejące zapalenie rogówki obserwuje się także w: ziarniniakowatości z zapaleniem naczyń, guzkowatym zapaleniu tętnic, nawracającym zapaleniu chrząstek oraz w toczniu rumieniowatym układowym. Wymienione choroby opisano w odniesieniu do obwodowego wrzodziejącego zapalenia rogówki, z omówieniem poszczególnych metod leczenia w określonych przypadkach

Wylew krwi do plamki żółtej – terapia

Submacular hemorrhage treatment is still an important issue in ophthalmology. At present we lack algorithms of treatment that could be used in clinical practice. Efficacy of every treatment method seems to differ by individual factors simultaneously existing in each patient. Therefore, anti-VEGF agents remain crucial in treating patients with coexisting vasculopathy, while in posttraumatic hemorrhage we should lean towards other approaches, like pneumatic displacement. Operative methods, despite being more invasive and burdened with higher potential risk, are indispensable in large hemorrhages, significantly speeding up clot removal. The primary aim of this work is to collect recent data regarding this issue and to determine usefulness of treatment methods in specific cases, regarding factors such as hemorrhage pathophysiology. The following article pertains to currently used treatment methods, such as: pneumatic displacement, anti-VEGF therapy, rtPA and operative methods.Krwotok podsiatkówkowy do plamki żółtej i jego leczenie pozostają poważnym zagadnieniem okulistycznym. Obecnie brakuje dokładnych algorytmów, które można byłoby stosować w praktyce klinicznej. Użyteczność każdej z metod leczenia jest zależna od indywidualnych czynników współistniejących. Preparaty anty-VEGF wydają się w związku z tym kluczowe w leczeniu pacjentów ze zmianami o charakterze waskulopatii, natomiast w leczeniu pourazowego krwotoku do plamki ustępują one miejsca pneumatycznemu przesunięciu. Operacje, mimo większej inwazyjności i ryzyka, pozostają niezastąpione w przypadku dużych wylewów, znacznie przyspieszając ewakuację skrzepu. Celem poniższej pracy jest zbiorcze przedstawienie aktualnych badań dotyczących tego zagadnienia, a dzięki temu usystematyzowanie użyteczności danej metody ze względu chociażby na pierwotną przyczynę wystąpienia krwotoku. W niniejszym zestawieniu znalazły się obecnie stosowane w praktyce klinicznej metody, tj.: pneumatyczne przesunięcie krwi, terapia anty-VEGF, rtPA oraz metody operacyjne

Imaging in scrotal trauma: a European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) position statement.

Imaging plays a crucial role in the evaluation of scrotal trauma. Among the imaging modalities, greyscale ultrasound and Colour Doppler ultrasound (CDUS) are the primary techniques with the selective utilisation of advanced techniques such as contrast-enhanced ultrasound (CEUS) and elastography. Despite ultrasound being the mainstay of imaging scrotal trauma, its diagnostic performance is not fully established. Considering these difficulties and their impact on clinical practice, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) established an expert task force to review the current literature and consolidate their expertise on examination standards and imaging appearances of various entities in scrotal trauma. This paper provides the position statements agreed on by the task force with the aim of providing guidance for the use of imaging especially multiparametric US in scrotal trauma.Key Points• Greyscale and Colour Doppler ultrasound are the mainstay of imaging in patients with scrotal trauma.• Contrast-enhanced ultrasound and elastography are the advanced techniques useful as a problem-solving modality in equivocal cases.• This paper summarises the position statements of the ESUR-SPIWG on the appropriate utilisation of multiparametric ultrasound and other imaging modalities in the evaluation of scrotal trauma.The article is available via Open Access. Click on the 'Additional link' above to access the full-text.Published version, accepted version (12 month embargo