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

Role of a novel cationic gemini surfactant (CGS) on a one-step sol–gel process and photocatalytic properties of TiO2 powders

TiO2 nanoparticles were prepared using a sol–gel process in combination with a novel cationic gemini surfactant (CGS) with amide functional groups at low temperatures. Titanium (IV) isopropoxide (TIP) and CGS were used as the starting materials and as effective agents, respectively, to orient the nanoparticles during the sol–gel synthesis. To reveal both the structural and morphological properties of the nanopowders prepared in this work, they were characterized using X-ray diffraction (XRD) analysis, scanning electron microscope (SEM), and Brunauer–Emmett–Teller (BET) surface area apparatus. The pore volume and pore size were calculated using the Barrett–Joyner–Halenda (BJH) model on the desorption branch. The experimental results show that the surface area and average crystallite size of the obtained TiO2 nanopowders vary between 160–203 m2/g and 27–49 nm, respectively. It was observed that the N2 adsorption–desorption isotherms for almost all samples of TiO2–X% CGS (X: mass of CGS) show the typical Type I with a hysteresis loop of H4. The photocatalytic activities of the CGS-modified nanocomposites are evaluated not only by the photocatalytic degradation of methyl orange (MO) but also by the reduction of Cr(VI) as model pollutants in the presence of visible light. HIGHLIGHTS Excitable TiO2/CGS composites were prepared by the sol-gel method.; XRD, SEM, BET, and N2 adsorption-desorption measurements were done for structural properties.; Photocatalytic activity of TiO2/CGS nanocomposite was evaluated on both the photoreduction of Cr(VI) ions and photooxidation of methyl orange under irradiation from a 365 nm lamp.; Utilized in this survey is a cationic gemini surfactant that has a similar CTAB structure and has two long chains and cationic head groups and is a preferred morphology agents. Compared to one head group with CTAB, a novel synthesized cationic surfactant with two long chains is anticipated to positively affect both the properties of catalyst structures and data of photocatalytic degradation of model pollutants.

ANJİOEMBOLİZASYONA DİRENÇLİ HEMATÜRİSİ OLAN ECOG 3 HASTADA PALYATİF LAPAROSKOPİK RADİKAL NEFREKTOMİ

AMAÇ90 yaşında ECOG 3 erkek hasta 8 aydır devam eden hematüri şikayetiyle başvurdu. Hastanın yapılan tetkiklerinde ciddi anemisi olduğugözlendi. Sistoskopisinde mesane içersinde kitle saptanmayan hastanın sol üreter orifisinden hematürik idrar çıkışı olduğu gözlendi.Hastaya post operatif dönemde ürografi çekildi. Sol böbrek üst pol kalikslerinden kaynaklanan yaklaşık 6 cm’lik üst üriner sistem tümörütespit edildi. Hastanın genel durumu orta komorbiditesi çok olduğu için anjioembolizasyon yapılması kararı alındı. Anjio embolizasyonarağmen hematürisi gerilemeyen anemisi derinleşen hastaya palyatif radikal nefrektomi kararı alındı.GEREÇ-YÖNTEMHastaya 70 derece sol flank pozisyonda laparoskopik radikal nefrektomi yapıldı. İşlem 60 dakika sürdü. Operasyon esnasındakomplikasyon gözlenmedi.BULGULARNefrektomi patolojisi T3 ürotelyal karsinom ve karsinoma in situ olarak sonuçlandı. Hasta post operatif 5’ inci gününde taburcu edildi.SONUÇLaparokopik cerrahi deneyimli ellerde hızlı ve güvenilir olması nedeniyle kötü performansı olan hastalarda tercih edilebilecek bir cerrahitürüdür</p

Yaşlı Kalça Çevresi Kırıklarda Femur Başı Kemik Mineral Yoğunluğunun Değerlendirilmesi

Amaç: Kalça çevresi kırıklarda tespit veya kalça replasmanı kararı vermek bazen kolay olmayabilir. Tespit sonrası implant yetmezliği ihtimalini azaltmak adına femur başında tespit materyallerinin yerleştirildiği bölgelerin kemik mineral yoğunluğunun bilinmesi faydalı olabilir. Bu çalışmada rutin DEXA ölçümü ile ölçülemeyen femur başı primer kompresif trabekül bölgesinin kemik yoğunluğunu belirlemeyi ve proksimal femurun diğer bölgeleri ile olan ilişkisini belirlemeyi amaçladık. Yöntemler: Kalça kırığı nedeniyle hemiartroplasti uygulanan 29 hastadan çıkarılan femur başlarının kemik mineral yoğunlukları DEXA yöntemi ile değerlendirildi. Elde edilen ölçümler hastanın sağlam olan diğer kalça DEXA değerleri ile karşılaştırıldı. Bulgular: Ortalama femur başı primer kompresif trabekül bölgesine ait kemik mineral yoğunluğu (PK-KMY) 0.610 ± 11 (g/cm²) olarak belirlendi. Beklendiği üzere elde edilen KMD değerleri proksimal femurda rutin DEXA ölçümü ile değerlendirilen diğer bölgeler (boyun, Ward's ve toplam proksimal femur) ile uyum gözlenirken, en güçlü ilişki boyun bölgesi KMY yoğunlukları ile gözlendi. Kemik mineral yoğunluklarında cinsiyet açısından herhangi bir fark gözlenmedi. Sonuç: Beklendiği üzere primer kompresif trabekül bölgesi kemik mineral yoğunluğu ile en kuvvetlisi boyun ile olmak üzere, Ward's ve toplam proksimal femur kemik mineral yoğunluğu arasında olumlu ilişki gözlendi. Ameliyat öncesi özellikle boyun bölgesi olmak üzere, sağlam kalçanın kemik mineral yoğunluğunun ölçülmesi tespit yapılması planlanan hastalarda erken mekanik yetmezliğin önlenmesi adına faydalı olabilir.Objective: It is usually challenging to decide which hip fractures should be fixed and which should be replaced to avoid fixation failure and revision. Therefore, it may be of benefit to evaluate the bone mineral density of the fixation point of the femoral head preoperatively. In this study we tried to investigate the relationship between the bone mineral density (BMD) of the fixation point of femoral head, which is the primary compressive trabeculation area, and other parts of the proximal femur evaluated routinely during Dual-Energy X-ray absorptiometry (DXA) measurements. Methods: Retrieved femoral heads of 29 patients during hemiarthroplasty for hip fracture were evaluated using DXA. These results were correlated with the DXA measurements of proximal femora of uninvolved hips of patients. Results: Mean BMD values of retrieved femoral head primary compressive trabecular region (PC-BMD) values were 0.610 ± 11 (g/cm&sup2;). Although there were significant positive correlation of PC-BMD with neck, Ward's and total proximal femoral region as expected, highest correlation coefficient was calculated at femoral neck region. These results did not differ when patients were regrouped according to uninvolved side BMD values as osteoporotic and osteopenic. There were no difference in both sexes in this relationship between values of PC-BMD, neck BMD, Ward's BMD and total BMD. Conclusion: As expected, a positive relationship was found between PC-BMD values and neck BMD, ward's BMD and total BMD values with neck BMD revealing the highest correlation. Preoperative bone mineral densitometric evaluation of the uninvolved hip, especially the neck region seems to be helpful to evaluate the densitometric status of femoral head to predict early failure when fixation was attempted

The time of spontaneous resolution of monosymptomatic nocturnal enuresis (MNE) is familial

Sarikaya, Selcuk/0000-0001-6426-1398; Aykac, Aykut/0000-0001-7078-0135WOS: 000355885000014PubMed: 25661820Purpose: To investigate whether or not the age of spontaneous resolution of monosymptomatic nocturnal enuresis (MNE) was familial. Patients and Methods: A questionnaire was administered to more than 1,500 people, and 100 appropriate participants were identified from four referral hospitals. We included the participants who had MNE and whose parents also had MNE with spontaneous resolution. Then the association between the spontaneous resolution time of MNE in parents and that in their children was investigated. Results:The mean ages of spontaneous resolution were 10.7 (10-30 years), 9.4 (6-17 years) and 10.9 (6-18 years) in participants, their mothers and their fathers, respectively. According to the statistical analysis, there was a positive correlation between participants and both their mothers and fathers (p 0.05). Conclusion: As a conclusion, the age of spontaneous resolution of MNE is familial. Although the exact reasons of spontaneous resolution still remain a mystery; further genetic investigations may be able to resolve this mystery. (C) 2015 S. Karger AG, Base

PANÜRETRAL DARLIKTA DORSAL İNLEY BUKKAL GREFT ÜRETROPLAST

AMAÇ42 yaş erkek hasta araç dışı trafik kazası sonrası 1 ay yoğun bakımda sondalı takip ediliyor. O dönemden sonra başlayan işeme güçlüğünedeniyle başvuruyor. Yapılan retrograd üretragrafide penil üretrada yaklaşık 10 cm’lik dar segment tespit edildi.GEREÇ-YÖNTEMHastaya yüksek litotomi pozisyonunda dorsal inley bukkal greft üretroplasti yapıldı. Operasyon 3 saat sürdü. Post operatif 3’üncü haftadasondası çekildi.BULGULAROperasyon sonrası alt üriner sistem semptomlarının tamamen ortadan kalktığı ve normal işeme eğrisine ulaştığı gözlendi.SONUÇSegment çok uzun olsa da bukkal greft ile panüretral darlıklara etkin tedavi verilebilmektedir.</p

The effects of pelvic floor muscle therapy on symptoms, voiding, and pelvic floor muscle activity parameters in children with overactive bladder

Introduction Refractory overactive bladder (OAB) in children can be treated with second line modalities such as as biofeedback, transcutaneous electrical stimulation (TENS), and botulinum toxin. In this study, we aimed to investigate the efficacy of biofeedback-assisted pelvic floor muscle therapy (PFMT) on symptoms, bladder capacity, uroflowmetry, and pelvic floor muscle activity (PFMA) in children with resistant OAB or dysfunctional voiding (DV) with associated seconder bladder overactivity (DV/SBO). Materials and Methods A total of 24 children with resistant OAB were included in the study. Patients were divided into two groups as: group-1 pure OAB and group-2 DV/SBO. Children were evaluated with voiding diary, uroflowmetry-EMG, PFMA before and after treatment. All patients were treated with PFMT. Results Urgency cured or improved in 12 of 17 (71%) of children in group-1 and in six of seven (86%) children in group-2 (P < 0.0001 and 0.031, respectively). Other symptoms cured or improved with 64%-100% recovery rates in group-1 and 50%-80% in group-2. Maximum voided volume (maxVV) in voiding diary increased from 81.6 to 150.9 mL in group-1 and from 115.6 to 175.7 mL in group-2 (P < 0.0001 and 0.063, respectively). Mean work value of PFMA increased and mean rest value of PFMA decreased significantly (P < 0.0001, 0.018 and P = 0.002 and 0.018, respectively). Conclusion The measurement of PFMA in children with refractory OAB or DV/SBO gives information on the strength and endurance of PFMs. In children with refractory OAB or DV/SBO, biofeedback-assisted PFMT provides symptomatic improvement and increases functional bladder capacity