Predictive factors for sperm retrieval and sperm injection outcomes in obstructive azoospermia: do etiology, retrieval techniques and gamete source play a role?

Obstructive azoospermia is a relatively common male infertility condition. The main etiologies of obstructive azoospermia include congenital, surgical-derived, traumatic and post-infectious cases. Although seminal tract reconstruction is a cost-effective treatment in most cases, this approach may not be feasible or desired in some cases. In such cases, assisted reproduction techniques offer a method for achieving pregnancy, notably via sperm retrieval and intracytoplasmic sperm injection. This process requires several considerations and decisions to be made, including the cause and duration of obstruction, which sperm retrieval technique to use, and whether to use fresh or frozen-thawed sperm. We present a review of obstructive azoospermia and assisted reproduction techniques, highlighting the most relevant aspects of the decision-making process for use in clinical practice

An update on the clinical assessment of the infertile male

Male infertility is directly or indirectly responsible for 60% of cases involving reproductive-age couples with fertility-related issues. Nevertheless, the evaluation of male infertility is often underestimated or postponed. A coordinated evaluation of the infertile male using standardized procedures improves both diagnostic precision and the results of subsequent management in terms of effectiveness, risk and costs. Recent advances in assisted reproductive techniques (ART) have made it possible to identify and overcome previously untreatable causes of male infertility. To properly utilize the available techniques and improve clinical results, it is of the utmost importance that patients are adequately diagnosed and evaluated. Ideally, this initial assessment should also be affordable and accessible. We describe the main aspects of male infertility evaluation in a practical manner to provide information on the judicious use of available diagnostic tools and to better determine the etiology of the most adequate treatment for the existing condition

Surgical treatment of male infertility in the era of intracytoplasmic sperm injection – new insights

Assisted reproductive technology is an evolving area, and several adjuvant procedures have been created to increase a couple's chance of conceiving. For male infertility, the current challenges are to properly accommodate old and new techniques that are both cost-effective and evidence-based. In this context, urologists are expected to diagnose, counsel, provide medical or surgical treatment whenever possible and/or correctly refer male patients for assisted conception. Urologists are sometimes part of a multiprofessional team in an assisted reproduction unit and are responsible for the above-cited tasks as well as the surgical retrieval of sperm from either the epididymides or testicles. We present a comprehensive review of the surgical treatment options for infertile males, including the perioperative planning and prognostic aspects, with an emphasis on the role of microsurgery in the optimization of treatment results. This review also discusses current techniques for sperm retrieval that are used in association with assisted reproductive technology and includes sperm retrieval success rates according to the technique and the type of azoospermia. New insights are provided with regard to each surgical treatment option in view of the availability of assisted conception to overcome male infertility

Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis: are there predictive factors for success?

OBJECTIVES: Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis is currently associated with great operative difficulty and surgical complications. Herein, we report on our single-center experience and describe predictive factors for successfully accomplishing this procedure. METHOD: Between March 1998 and April 2010, 66 patients (27 men and 39 women) underwent laparoscopic nephrectomy for the treatment of a unilateral nonfunctioning kidney. These patients had previous diagnoses of renal chronic inflammation associated with calculi and previous pyonephrosis. All of the nephrectomies were performed using the transperitoneal approach, and a similar technique was used for radical nephrectomy. RESULTS: Laparoscopic nephrectomy for the treatment of renal chronic inflammation was successful in 58/66 cases (87.9%). Eight cases were converted to the open technique because of difficulty in progression, which was related to the discovery of dense adhesions in the hilar or perirenal region. One major (colonic lesion) and two minor (wound infection) complications occurred in the conversion group. A diagnosis of xanthogranulomatous pyelonephritis was confirmed pathologically for all of the specimens. Of the factors examined, a longitudinal renal length greater than 12 cm (laparoscopy group - 7.2±1.8 cm, versus open group - 13.6±1.5 cm;

Estudo comparativo, prospectivo e randomizado entre uroterapia e tratamento farmacológico em crianças com incontinência urinária

OBJECTIVE: To verify and compare the results of behavioral modification plus pelvic floor muscle training and behavioral modifications plus oxybutynin chloride in children with nonmonosymptomatic enuresis. METHODS: A total of 47 children were randomized using opaque and sealed envelopes sequentially numbered. Group I was composed of 21 children who underwent antimuscarinic treatment (oxybutynin), and Group II was composed of 26 patients who underwent pelvic floor muscle training. Both groups were instructed as to behavioral modifications. RESULTS: The voiding diary results were compared each month between Groups I and II. In the first month of treatment, children in Group I presented 12.2 dry nights, 13.4 in the second month, and 15.9 in the last month. In Group II, the results were: 14.9 dry nights in the first month, 20.8 dry nights in the second and 24.0 dry nights in the last month. There was a significant difference between the groups in second and third months. CONCLUSION: Pelvic floor exercises associated with behavioral changes were more effective than pharmacological treatment in children with urinary incontinence.OBJETIVO: Verificar e comparar os resultados da modificação comportamental associado ao treinamento dos músculos do assoalho pélvico e modificação comportamental associado ao uso de cloridrato de oxibutinina em crianças com enurese não monossintomática. MÉTODOS: Foram randomizadas 47 crianças por meio de envelopes opacos e selados com numeração sequencial. O Grupo I foi composto por 21 crianças que receberam tratamento com antimuscarínico (oxibutinina) e o Grupo II por 26 pacientes que receberam treinamento dos músculos do assoalho pélvico. Ambos os grupos foram instruídos em relação à modificação comportamental. RESULTADOS: Os resultados do diário miccional foram comparados cada mês entre os Grupos I e II. No primeiro mês de tratamento, as crianças do Grupo I apresentaram 12,2 noites secas, 13,4 no segundo mês e 15,9 no último mês. No Grupo II, os resultados foram: 14,9 noites secas no primeiro mês, 20,8 no segundo mês e 24,0 no último mês. Houve diferença significativa entre os grupos no segundo e no terceiro mês. CONCLUSÃO: Os exercícios do assoalho pélvico associados a mudança comportamental foram mais efetivos do que o tratamento farmacológico em crianças com incontinência urinária.20320

Inibição do crescimento de bactérias Gram-negativas em microdiluição por tratamento com Nisina e EDTA

The outer membrane composition of Gram-negative bacteria provides more resistance against the action of antimicrobial agents from the class of bacteriocins, in comparison to Gram-positive bacteria, naturally more susceptible. Aiming the control of proliferation Escherichia coli, Pseudomonas aeruginosa and Salmonella Typhimurium, antimicrobial assays were performed with nisin as biocidal agent (concentrations 123 to 1,111 AU mL-1) and EDTA as chelating agent, compared to a Gram-positive (Staphylococcus aureus ATCC25923). The susceptibility evaluations were performed in broth microdilution with Mueller-Hinton medium and inoculum with 106 CFU mL-1 of indicator bacterium, and the results were obtained by optical density readings (630 nm) at regular intervals during the incubation period. It was observed that EDTA is capable of reducing cell viability of P. aeruginosa. The bacteriocin nisin demonstrated effective antimicrobial action to four indicator bacteria, under different concentrations. The combined treatments of nisin+EDTA obtained high inhibition rates, and the presence of EDTA was significant only to Gram-negative bacteria. Thus, treatments accounted effective strategies to promote inhibition of cell growth during microdilution broth assays.A composição da membrana externa das bactérias Gram-negativas fornece mais resistência à ação dos agentes antimicrobianos da classe das bacteriocinas, em comparação às bactérias Gram-positivas, naturalmente mais suscetíveis. Com o objetivo de controlar a proliferação de Escherichia coli, Pseudomonas aeruginosa e Salmonella Typhimurium, foram realizados ensaios antimicrobianos com nisina como agente biocida (concentrações 123 a 1.111 AU mL-1) e EDTA como agente quelante, comparado a um Gram-positivo (Staphylococcus aureus ATCC25923) . As avaliações de suscetibilidade foram realizadas em microdiluição em caldo com meio Mueller-Hinton e inóculo com 106 UFC-1 de bactéria indicadora, e os resultados foram obtidos por leituras de densidade óptica (630 nm) em intervalos regulares durante o período de incubação. Observou-se que o EDTA é capaz de reduzir a viabilidade celular de P. aeruginosa. A bacteriocina nisina demonstrou ação antimicrobiana eficaz para quatro bactérias indicadoras, sob diferentes concentrações. Os tratamentos combinados de nisina + EDTA obtiveram altas taxas de inibição e a presença de EDTA foi significativa apenas para bactérias Gram-negativas. Assim, os tratamentos representaram estratégias eficazes para promover a inibição do crescimento celular durante ensaios de caldo de microdiluição

Selection of Bacillus thuringiensis Berliner strains to control Aedes aegypti Linnaeus

The present study aimed to select strains of Bacillus thuringiensis with insecticidal activity against Aedes aegypti. It was tested sixteen strains of bacteria, isolated from Paraná state, Brazil, that were used in laboratory assays with mosquito larvae. Tests were carried out in two stages, first one to select the most efficient strains (screening) and second to estimate LC50. The protein profile of the highest toxicity of strain was obtained by SDS-PAGE (sodium dodecyl sulfate polyacrylamide gel electrophoresis). The best performance of larval mortality was produced by BR-01 strain, which 96.7% mortality rate, significantly higher than others. In the second part, there was obtained a LC50 of 9.07 µL.L-1 fermented extract. The protein profile revealed many peptides between 15 and 140kDa, similar to that reported in Bacillus thuringiensis ser. israelensis strains which high toxicity to mosquito species.O presente trabalho buscou selecionar cepas de Bacillus thuringiensis com atividade inseticida contra Aedes aegypti. Foram testadas 16 estirpes da bactéria provenientes do estado do Paraná, Brasil, que foram utilizadas em ensaios laboratoriais com larvas do culicídeos. Os testes foram realizados em duas etapas, a primeira com a seleção de cepas e a segunda para estimar a CL 50 das cepas com melhores resultados. O perfil protéico do isolado de maior toxicidade foi obtido por SDS-PAGE (dodecil sulfato de sódio –eletroforese em gel de poliacrilamida). O melhor resultado de mortalidade foi produzido com a cepa BR-01, que produziu 96,7% de mortalidade de A. aegypti, valor significativamente superior aos demais. Na segunda fase, obteve-se CL50 de 9,07 μL.L -1 de extrato fermentado. O perfil protéico revelou peptídeos entre 15 e 140 kDa, resultado semelhante ao relatado nas cepas de Bacillus thuringiensis var. israelensis de maior toxicidade às espécies de culicídeo

Cnidarians as a Source of New Marine Bioactive Compounds—An Overview of the Last Decade and Future Steps for Bioprospecting

Marine invertebrates are rich sources of bioactive compounds and their biotechnological potential attracts scientific and economic interest worldwide. Although sponges are the foremost providers of marine bioactive compounds, cnidarians are also being studied with promising results. This diverse group of marine invertebrates includes over 11,000 species, 7500 of them belonging to the class Anthozoa. We present an overview of some of the most promising marine bioactive compounds from a therapeutic point of view isolated from cnidarians in the first decade of the 21st century. Anthozoan orders Alcyonacea and Gorgonacea exhibit by far the highest number of species yielding promising compounds. Antitumor activity has been the major area of interest in the screening of cnidarian compounds, the most promising ones being terpenoids (monoterpenoids, diterpenoids, sesquiterpenoids). We also discuss the future of bioprospecting for new marine bioactive compounds produced by cnidarians

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie