Role of NLRP3 in an experimental model of testicular ischemia and reperfusion in mice

Inflammasomes are multi-protein complexes composed of one of several leucinerich repeat receptors (NLRs) including NLRP1, NLRP3, NLRC4 and AIM2: NLRP3 is currently the most fully characterized inflammasome. Testicular torsion leads to tissue degeneration and, after reperfusion, results in production of reactive oxygen species and triggers the apoptosis machinery. To better understand the role of NLRP3 during testicular ischemia/reperfusion (TI/R), we investigated the morphological aspects of spermatogenesis underlying the effects of inflammasome in KO mice during TI/R. KO (Nlrp3tm1bhk) and wild-type (WT: C57Bl6) animals underwent 1h testicular-ischemia followed by reperfusion. The mice were killed after 1 day and 7 days of reperfusion and the determination of caspase-3 activity was executed. Furthermore, both the tubular (mean seminiferous tubule diameter and Johnsen’s scoring system [1]) and extratubular (edema, hemorrhagic extravasation, vessels dilation, and Leydig cells changes [2]) compartments were evaluated. The TUNEL assay for apoptosis was also performed. After 1 and 7 days of reperfusion in WT mice an increase of caspase-3 was observed. Structurally, marked histological damages characterized by altered spermatogenesis, evident extratubular changes and increased TUNEL activity were observed. In KO mice caspase-3 was inhibited. Histological damages were significantly decreased, TUNEL activity was reduced and extratubular changes were significantly milder. We suggest that NLRP3 inhibition might have a protective role on spermatogenesis and it can be proposed in patients with unilateral testicular torsion

Effectiveness of lithium in subjects with treatment-resistant depression and suicide risk: results and lessons of an underpowered randomised clinical trial

BACKGROUND: As lithium treatment might be effective in reducing the risk of deliberate self-harm (DSH) in adult patients with unipolar affective disorders, we designed a pragmatic randomised trial to assess its efficacy in more than 200 patients with treatment-resistant depression. However, we randomised 56 patients only. The aim of this report is therefore twofold: first, to disseminate the results of this underpowered study which may be incorporated into future meta-analytical reviews; second, to analyse some critical aspects of the study which might explain failure to reach the target sample size.METHODS: We carried out a randomised, parallel group, assessor-blinded superiority clinical trial. Adults with a diagnosis of major depression, an episode of DSH in the previous 12 months and inadequate response to at least two antidepressants given sequentially at an adequate dose for an adequate time for the current depressive episode were allocated to add lithium to usual care (intervention arm) versus usual care alone (control arm). Suicide completion and acts of DSH during the 12 months of follow-up constituted the composite primary outcome.RESULTS: Of 58 patients screened for inclusion, 29 were allocated to lithium plus usual care and 27 were assigned to usual care without lithium. Six patients in the lithium plus usual care group and seven in the usual care group committed acts of DSH during the follow-up phase. The survival probability did not differ between the two treatment arms (Chi2 = 0.17, p =0.676). With regard to changes in the severity of depressive symptomatology from baseline to endpoint, no significant differences were detected.CONCLUSIONS: The present study failed to achieve the minimum sample size needed to detect a clinically meaningful difference between the two treatment arms. Consequently, the finding that lithium, in addition to usual care, did not exert a positive effect in terms of reduction of DSH after 12 months of follow-up is likely due to the lack of sufficient statistical power to detect a difference, if a difference existed. The dissemination of the results of this underpowered study will inform future meta-analytical reviews on lithium and suicide-related outcomes.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00927550

Acute Delta Hepatitis in Italy spanning three decades (1991–2019): Evidence for the effectiveness of the hepatitis B vaccination campaign

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p < .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p < .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come