Experience in the use of docosahexaenoic acid (BrudiPlus) in patients with increased sperm DNA fragmentation index in Acad. V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology

Male factor is the reason of infertility in almost half of marriages. Infertile men have the percentage of sperm with violations of DNA integrity of over 30 %; with that, healthy fertile men have that indicator of less than 15 %. Understanding of importance of damages of sperm DNA is growing with distribution ofauxiliary reproductive technologies. As of today, these consequences have not been studies yet, and the therapeutic effect of intake of antioxidants has not direct correlation with the sperm DNA fragmentation level. Docosahexaenoic acid is one of the most valuable omega-3 polyunsaturated fatty acids for human health. Docosahexaenoic acid is the main component of the brain gray matter, retina, testes, and sperm cell membranes. In connection with that, a study was held the purpose of which was to assess the effect of the nutraceutical enzymatic docosahexaenoic acid triglyceride (BrudiPlus) in high concentrations on damaged sperm DNA of patients with idiopathic pathozoospermia. 40 patients with idiopathic pathozoospermia and the level of DNA fragmentation over the statutory value took part in this study. The following positive results were received: intake of BrudiPlus allowed decreasing sperm DNA damages and improving of antioxidant system of sperm

Difficulties in differential diagnosis between obstructive and non-obstructive azoospermia

Introduction. The difference between obstructive and non-obstructive azoospermia (OA and NOA) is important for the choice of treatment tactics and adequate counseling of a married couple.Objective. To describe, analyze, and classify possible challenges in differentiating between two types of azoospermiaMaterials and methods. The retrospective review of database on surgical sperm retrieval attempts performed our hospital (n = 754). A subpopulation of 216 patients who were preliminary diagnosed with OA, was selected for further analysis. All patients had testicular pathology data following sperm retrieval attempt. Rate of reclassification was assessed as a primary outcome. Reclassified cases were further analyzed to find a possible reason for incorrect differential diagnosis.Results. Among 216 patients with initially suspected OA, 131 (60.6%) had evidence of spermatogenic dysfunction on pathological examination of seminiferous tubules. Multivariate regression analysis showed that only regular exposure to high temperatures was an independent predictor of NOA detection in patients with normal endocrine and clinical parameters (OR = 1.989; 95% CI = 1.101 – 3.595). Analysis of the decision tree showed that patients with inhibin B levels below 93 pg/ml had the highest risk of an incorrect initial diagnosis (82.6%).Conclusions. Differential diagnosis of OA and NOA is not such a simple task. Any case of azoospermia against the background of normal semen volume by default should be considered as a case of NOA if there is no anamnestic or clinical data clearly indicating obstruction. Regular exposure to high temperature is likely to cause azoospermia in men with initially severe disorders of spermatogenesis. Finally, the reference values of inhibin B offered by most laboratories are not intended to assess reproductive function

Lipidomic profile of seminal plasma in non-obstructive azoospermia with sperm maturation arrest

Introduction. The difference between obstructive and non-obstructive azoospermia with sperm maturation arrest is important for the choice of treatment tactics and adequate counseling of a married couple.Purpose of the study. The study aimed to assess the semen lipid profile in patients with sperm maturation arrest. Materials and methods. Samples of seminal plasma for lipid composition of 24 men with normozoospermia and 64 men with azoospermia were studied. Patients with azoospermia underwent microdissection testicular biopsy followed by the detection of testicular tissue pathology. Lipid extracts were analyzed by liquid chromatography with mass spectrometry. Lipid data were compared with the results of pathomorphological studies.Results. Comparison of two groups revealed a statistically significant concentration differences for 22 lipids detected in positive-ion mode and 11 lipids detected in negative-ion mode. Those lipids mainly belong to the classes hexosylceramides, sphingomyelins and phosphatidylcholines — simple ethers and oxidized lipids. In multivariate analysis, the following lipids were found to be statistically significant predictors of sperm maturation arrest: PC 16: 0_22: 6 lipid (β-coefficient: -0.73; 95% confidence interval (95% CI): -1.42 to -0.27; odds ratio (OR): 0.48; OR CI: 0.24 to 0.76; Wald's test: -2.58; p = 0.01), SM d20: 1/22:2 lipid (β-coefficient 4.96; 95% CI 2.29 to 9.13; OR: 142.31; OR CI: 9.90 to 9.22^103; Wald's test: 2.93; p = 0.003); PG 20:3_22: 6 lipid (β-coefficient 2.52; 95% CI 1.13 to 4.49; OR: 12.37; OR CI: 3.10 to 89.27; Wald's test: 3.02; p = 0.002); PC O- 16: 1/16:0 lipid (β-coefficient 1.96; 95% CI -4.12 to 0.27; OR: 0.14; OR CI: 0.02 to 0.76; Wald's test: -2.05; p = 0.04). The prediction model characteristics of sperm maturation arrest, obtained during cross-validation in the positiveion mode composed: sensitivity 91%, specificity 85%; in negative-ion mode: sensitivity 75%; specificity 81%.Conclusions. Even though early stages of spermatogenesis are equally preserved in both fertile men and men with homogeneous sperm maturation arrest, the semen in the studied group of patients differed in its lipid profile. Patients with non-obstructive azoospermia, associated with meiosis arrest, may have unique lipidomic characteristics of seminal plasma, which in the future will make it possible to differentiate various variants of severe male infertility using non-invasive methods

HIGHER EDUCATION IN THE SYSTEM OF POLITICAL SOCIALIZATION

The article deals with the problem of political socialization of young people in the system of higher education. College students - this generation, which in a few years will determine the character of our country, to generate political, economic and cultural elite. Political socialization of youth is the key to further effective development of our country, and to achieve these goals it is necessary to ensure asystem of political education and training. The article analyzes the nature and underlying factors hindering political socialization of students

Sperm oxidative stress: clinical significance and management

Oxidative stress is one of the leading causes of sperm dysfunction. Excessive amounts of reactive oxygen species can damage sperm membranes and disrupt their DNA integrity, which affects not only the likelihood of getting pregnant naturally, but also the clinical outcomes of assisted reproductive technologies and the risk of miscarriage. Sperm cells are extremely vulnerable to oxidative stress, given the limited functional reserve of their antioxidant systems and the DNA repair apparatus. Lifestyle factors, most of which are modifiable, often trigger generation of reactive oxygen species.  Both the lifestyle modification and use of antioxidant dietary supplements are adequate and compatible ways to combat male oxidative stress-associated infertility. The search for other internal and external sources of reactive oxygen species, the identification of the etiology of oxidative stress and treatment of respective diseases are necessary for the successful regulation of redox processes in the male reproductive system in clinical practice, which is required not only to overcome infertility, but also to prevent induced epigenetic disorders in subsequent generations. The article presents the analysis of the molecular mechanisms of male idiopathic infertility. The authors provide an overview of how to prevent oxidative stress as one of the causes of subfebrile fever. The article provides an overview of modern therapeutics, as well as the options for eliminating the consequences of the effect of reactive oxygen species on spermatogenesis and male reproductive system in general

Surgical correction of urinary incontinence associated with orgasm (climacturia) using a compression graft (clinical cases)

Climacturia is a rarely discussed functional complication of radical prostatectomy. Various methods of medical and surgical treatment of climacturia have been described. In this article we present two clinical cases of successful surgical treatment of climacturia which involved three-piece penile prosthesis implantation and placement of compression graft made of porcine dermal collagen on urethra

New approaches to management of erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia

This paper addresses the background of phosphodiesterase-5 inhibitors use in erectile dysfunction and lower urinary tract symptoms, as well as a special position which is held by tadalafil as an only drug from its class suitable for daily intake. Tadalafil pharmacodynamics and hypotheses concerning its mechanism of action on prostatic tissue are discussed. Special attention is paid to drug»s efficacy and safety in elderly men, who often require therapy for benign prostatic hyperplasia with lower urinary tract symptoms. It is mentioned that tadalafil may be used in penile rehabilitation programs in men who underwent radical prostatectomy

The use of tadalafil on demand in specific categories of patients

Patients with erectile dysfunction require special approach. Any therapy should be prescribed with patient’s individual features, comorbidities and concominant medication in mind. Considering good efficacy and safety profile of tadalafil, together with appearance of its generic forms on the market, making such treatment more accessible for our patients, soon it may become the most commonly prescribed drug from phosphodiesterase-5 inhibitors class. Therefore, evidence on its use in special groups of men with specific anamnestic features should be systematized. In this article we discuss the use of 20 mg tadalafil on demand in specific categories of patients suffering from erectile dysfunction: in men with metabolic syndrome, benign prostate diseases, neurological conditions and, finally, in men who express wish to become fathers

Predictors of Early Retinal Changes in Diabetes Mellitus

Purpose. Determining the functional state of the outer and inner retina’s layers in patients with diabetes mellitus (DM) type 1 and 2 before the clinical manifestations and in the early stages of diabetic retinopathy (DR) using the methods of multifocal electroretinography (mfERG) and microperimetry (MP).Patients and methods. 91 patients were examined (182 eyes). The patients were divided into 4 groups: 1st — 23 people (46 eyes) with diabetes without DR (the duration of the disease is up to 2 years); 2nd — 22 people (44 eyes) with diabetes without DR (diabetes from 2 to 8 years); 3rd — 24 people (48 eyes) with NPDR on the background of diabetes; 4th — 22 people (44 eyes) of the control group (healthy eyes). In addition to the standard ophthalmologic examination, all patients were registered mfERG (FOK1) on the diagnostic equipment EP-1000 Multifocal (Tomey, Germany) and carried out MP using the device “MAIA” (CenterVue, Italy).Results. According to mfERG, it has been established that the components of mfERG, the biopotential density and the amplitude of P1, are most sensitive to diabetic changes. In groups with type 1 and type 2 diabetes, there is a significant decrease in the density of P1 in comparison with the control group (p < 0.005, Mann-Whitney test), as well as a decrease in the amplitude of P1 on almost all tested rings (p < 0.005). In all groups, there is an increase in the latency of P1 in the central ring (0–2.3°). According to MP data, it was found that patients with type 1 and type 2 diabetes showed a decrease in the average light sensitivity in comparison with the control group, however, our data are within the reference values, regardless of the presence or absence of clinical manifestations of PD.Conclusion. As a result of the study, early functional and morphological disorders of the neurosensory apparatus of the eye in diabetes were identified. It is proved that mfER and MP allow to detect violations at the preclinical stage of DR and are necessary studies for the dynamic control of the progression of DR

Comparative analysis of the myopic astigmatism correction by the SMILE surgery with and without cyclotorsion compensation

Purpose. To develop an alternative method of cyclotorsion compensation to improve the clinical and functional results in the correction of myopic astigmatism during the SMILE surgery.Material and methods. Two equivalent groups were formed: without (the group I) and with (the group II) cyclotorsion compensation, 30 people (30 eyes) in each group. In both groups, cyclotorsion was determined to obtain equivalent samples. Immediately before the operation, the patient cornea had been marked using the slit lamp. To obtain numerical cyclotorsion data, a corneal protractor with a scale of 1-degree accuracy was developed. The corneal protractor was applied to the eye, comparing the scale of 0 degree and the horizontal section of the microscope eyepiece. The observed deviation of the corneal mark from the horizontal section indicated the value of cyclotorsion. All patients were examined by a UDVA, CDVA, objective refraction 3 months after the SMILE surgery, Furthermore, indices of efficiency and safety were calculated. Results. The mean and standard deviations of cyclotorsion in the groups I and II were 6.16±1.31 and 7.10±1.37 degree, respectively (p<0.05). An increase of 1 or more lines of CDVA in 20% and 7%, respectively was noted 3 months postoperatively in the groups I and II. The efficacy index was higher in the group II 3 months postoperatively, with a comparable safety index. The predictability of the cylindrical component within ±0.5D relatively to the target refraction (emmetropia) in the groups I and II was 40% and 100%, respectively (p<0.05). Conclusion. The proposed method of cyclotorsion compensation allows to increase safely the predictability of laser correction for myopic astigmatism during the SMILE surgery and it is available because it doesn’t require expensive equipment. This method is recommended for a determination of cyclotorsion with a myopic astigmatism from -0.75 D and for an alignment of the astigmatism axis in a detection of cyclotorsion of more than ±5 degrees