P-278 The presence of fragmentation during embryo cleavage does not reflect the chromosomal status of the blastocysts

Study question

Does the presence of fragmentation at day-2 and day-3 of embryo development correlate with blastocyst formation and chromosomal status?

Summary answer

Embryos with high fragmentation have low chances to develop into blastocysts due to cytoplasmic incompetence. However, there is no correlation between aneuploidy and embryo fragmentation.

What is known already

The assessment of cleavage stage embryos is carried out with the evaluation of some morphological features such as fragmentation rate, irregularities in blastomeres, multinucleation and the blastomere number. It has been described that the fragments formed during cell division are responsible for the arrest and necrosis of the adjacent blastomeres; Moreover, they may hinder the blastomeres’ division planes that increase the change of abnormal compaction, cavitation, and blastocyst formation. Studies have searched for a link between aneuploidy and altered embryo morphology. However, it is unknown if the blastocyst with high fragmentation at the cleavage stage can lead to chromosomal abnormalities.

Study design, size, duration

From March 2019 to December 2022, couples (N = 175) underwent 190 ICSI cycles with donor oocytes and had their embryos tested through Pre-implantation Genetic Test for Aneuploidy (PGT-A). We evaluate the degree of fragmentation at their day-2 and day-3 of development of 1765 embryos and compare the blastocyst, euploidy, implantation and clinical pregnancy rate (CPR) between embryos with grade 1 and 2 (Grade 1-2) and those with grade 3 and 4 (Grade 3-4) of fragmentation.

Participants/materials, setting, methods

The embryo score was assigned according to the following cleavage grading system: grade-1 with 0% of fragmentation, grade-2 with 0-10%, grade-3 with >10-25% and grade-4 with 25-50%. Implantation, CPR and delivery rate were calculated per transferred embryo. Embryo quality was assessed with time-lapse technology (Geri®), PGT-A test was carried out on blastocyst’s trophectoderm using NGS (Illumina®). All analysis were conducted using SPSS software.

Main results and the role of chance

This retrospective study includes 175 couples who underwent 190 ICSI cycles using donor oocytes. A total of 2518 oocytes were injected with ICSI procedure achieving a fertilization rate of 73.8% (1858/2518). Of these, 93 fertilized oocytes were excluded from the study because they showed no cell division at day-1 of their development. Significant difference was seen in the number of embryos that reached the blastocyst stage. The blastocyst rate of grade 1-2 embryos was 60.4% (815/1348) compared to 16.8% (70/417) of those with grade 3-4 (P < 0.0001). Interestingly, comparable euploidy rate was found between grade 1-2 and grade 3-4 embryos being 69% (548/794) and 68.5 % (48/70), respectively (P=NS). Although Implantation and CPR decrease from grade 1-2 to grade 3-4, no significant difference was found. The implantation rate was 44.2% (104/235) and 36.8% (7/19) while CPR was 59.6% (93/156) and 36.8% (7/19) in grade 1-2 and grade 3-4 group, respectively (P=NS). Pregnancy loss was 16.1% (15/93) in grade 1-2 and 5.2% (1/19) in grade 3-4 (P=NS).

Limitations, reasons for caution

This study was carried out on donor oocytes to exclude any female factor that could have affected the euploidy rate. Therefore, the number of patients is limited. Moreover, Implantation parameters like receptivity or immunologic disorders weren’t addressed. No data have been included on perinatal and obstetrical outcomes for pregnancies.

Wider implications of the findings

This study demonstrated that although embryos with high fragmentation have a lower change of reaching the blastocyst stage, the fragmentation parameter doesn’t reflect the chromosomal status of the resulting blastocysts.

Trial registration number

N/A

P-110 A novel Artificial Intelligence Microscopy: Mojo AISA, the new way to perform semen analysis

Study question

Can Mojo AISA, an Artificial Intelligence microscopy, release accurate and reliable semen analysis results for the daily routine?

Summary answer

Mojo AISA guarantee precise semen analysis results improving the objectiveness and minimizing human error. Moreover, embryologists can safe 50% of time per procedure.

What is known already

The current method to perform a semen analysis is through the manual microscope and/or computer-assisted semen analysis. The most automated sperm analyzers rely on a classic image processing algorithms which can distinguish spermatozoa by size and brightness. However, it has been demonstrated that these algorithms are not able to discriminate well spermatozoa heads from other cells that have similar size, leading to improper results. To overcome these limits, a new Artificial Intelligence Semen Analysis system, Mojo AISA, has been developed to carry out concentration and motility. Mojo AISA is based on a neural network classification, a series of embedded algorithms.

Study design, size, duration

In the last nine months, semen parameters of 64 men were assessed simultaneously by manual microscopy method and by Mojo AISA. The manual semen analysis was performed by two certified andrologists following WHO 5th Edition guidelines. Concentration and motility parameters were assessed and compared between the two methods. Regarding the motility, we compare the following 3 categories: Progressive (PR), Non-Progressive (NP) and combined motility (PR+NP). Samples with normal and abnormal semen parameters were included.

Participants/materials, setting, methods

Semen samples were allowed to liquefy for at least 15 min at 37°C. For the manual method, 10 μL of raw sample was loaded onto a Makler chamber and for Mojo AISA, two 10 μl drops of raw samples were smeared side on the side on a glass slide. Mojo AISA delivered semen analysis results in 4 minutes per sample. The statistical analysis was carried out with SPSS 14.0 statistical software.

Main results and the role of chance

A semen analysis of 64 semen samples from 62 men (40±10 years old) was performed simultaneously with manual method and Mojo AISA, following WHO 5th Edition (2010) guidelines. The average and the standard deviation of semen concentration with manual method and with Mojo AISA was 52.7±46 and 50.6± 43.2 x 106/ml, respectively (P=NS). No significant difference was found when the combined motility (PR+NP) was evaluated. Indeed, the average and standard deviation was 53.5±20% with manual method and 49.1± 22.1% with Mojo AISA (P=NS). Similar results were seen with progressive motility showing an average and standard deviation of 38.5±19% and 34.1±20%, respectively (P=NS). Ultimately, the assessment of non-progressive motility showed an average and standard deviation of 12.3±12% with manual method and 13.9± 9% with Mojo AISA, showing no statistic difference.

Limitations, reasons for caution

The protocol of the slide’s preparation should be properly followed since the formation of air bubbles can impact on the correct semen evaluation of Mojo, misleading sperm results. Mojo AISA presents difficulty to assess sample with extremely low concentration and further evaluation are needed for this type of samples.

Wider implications of the findings

These findings show that the semen analysis results of mojo AISA and those of manual method are comparable. Mojo AISA can guarantee semen analysis results more precise, with lower inter-laboratory variability and in a 50% shorter time.

Trial registration number

N/A

P–270 Paternal age and reproductive potential with fresh and vitrified spermatozoa: An analysis of 11016 ICSI donor oocytes

Study question

Does paternal age impair embryo aneuploidy and clinical outcomes in ICSI donor-oocytes cycles when fresh (FRs) and vitrified (VTs) spermatozoa are used?

Summary answer

Paternal age affects clinical outcomes, not embryo aneuploidy. With VTs, young and old men had similar outcomes. With FRs, young men had higher reproductive potential.

What is known already

Advanced paternal age is associated with low quality of sperm and an increase of reactive oxidative species, responsible of the DNA fragmentation, as well epigenetic disorders. In these men, the DNA repair mechanisms have a reduced ability to repair damaged DNA enhancing the likelihood of replication errors in the germ line. This genomic instability of the male gamete entails to chromosome abnormalities, generating potentially a negative effect on implantation and clinical outcomes. In addition, when the maternal oocyte repair mechanisms are not able to compensate quantitatively and qualitatively the sperm damages unrepaired embryos might develop.

Study design, size, duration

This retrospective study includes 848 couples undergoing 905 ICSI donor-cycles between January 2019 and February 2020, with similar quality and number of mature oocytes retrieved. Maternal age of recipients was 40.9±6 years and only those with previously failed cycles with their own oocytes were included. The clinical outcomes and aneuploidy were analyzed in two groups with the male partner being younger (M ≤ 40) or older than 40 years (M > 40).

Participants/materials, setting, methods

This study includes couples that underwent ICSI cycles with donor-oocytes using FRs and VTs ejaculates. Samples were analyzed according to WHO 2010 criteria. An in house-protocol (Vitri-Sperm®) was used to perform spermatozoa vitrification/warming. Embryo quality was assessed with time-lapse technology (Geri®), Aneuploidy Testing (PGT-A) was carried out on blastocyst’s trophectoderm using NGS (Illumina®) and Fisher’s Exact test was used for statistical analysis. P-value was considered statistically significant at a threshold of < 0.05.

Main results and the role of chance

Fresh ejaculate was used in 192 cycles with M ≤ 40 (concentration: 39.4±35 x 106/mL; motility: 35.1±16%) and 242 with M > 40 (concentration: 36±34 x 106/mL; motility: 30±16%) yielding similar fertilization: 75.3% (1785/2369) Vs 75.6% (2232/2938). Comparing M ≤ 40 with M > 40 implantation decreased significantly from 66.6% (92/138) to 54.4% (79/145, P = 0.03), Clinical Pregnancy Rate (CPR) from 68% (85/125) to 54.3% (75/138 P = 0.03). Pregnancy loss from 15.2% (19/125) to 17.3% (24/138), not statistically significant.

Vitrified spermatozoa in 195 cycles with M ≤ 40 (concentration: 4.9±7 x 106/mL; motility: 13.4±9%), and 276 with M > 40 (concentration: 4.3±4 x 106/mL; motility: 13.9±12%) yielded significant difference in fertilization, 76.2% (1841/2416) Vs 72.4% (2386/3293, P < 0.001), respectively. In M ≤ 40 and M > 40 implantation was 51.9% (40/77) Vs 49.1% (60/122) (p < 0.05), CPR was 53% (38/71) Vs 54% (59/109). Pregnancy loss was 16.9% (12/71) Vs 13.7% (15/109), not statistically significance.

In M ≤ 40 undergoing ICSI+PGT-A cycles (N = 43) with FRs, euploidy was 71% (157/221) Vs 73.5% (256/348) in M > 40 cycles (N = 71). Implantation and CPR were equal in FRs groups, 77.1% (27/35) Vs 75.8% (44/58). Using VTs euploidy in M ≤ 40 cycles (N = 63) was 71.9% (210/292), compared to 70.0% (279/399) in M > 40 cycles (N = 82). Implantation and CPR were higher in both groups, 76.5% (36/47) Vs 73.6% (53/72), not statistically significant.

Limitations, reasons for caution

Normo- and oligo-zoospermic patients, with quite different parameters and ethnicities have been included, allowing an analysis on a larger study population, but suitable of being analyzed further by subgroups. Implantation parameters like receptivity or immunologic disorders weren’t addressed. No data have been included on perinatal and obstetrical outcomes for pregnancies.

Wider implications of the findings: Paternal age affects the clinical outcomes and embryo viability, it does not affect embryo aneuploidy when FRs and VTs are used. In ICSI donor-oocytes cycles with VTs, no significant difference in clinical outcome was found between young and older men. However, young men with fresh ejaculate have higher reproductive.

Trial registration number

N/A

P–262 Comparison of embryo aneuploidy rate and reproductive outcomes of ART cycles using fresh and vitrified donor oocytes

Study question

Is there any difference in blastocyst morphology, embryo aneuploidy rate and ART clinical outcomes when using fresh or vitrified donor oocytes?

Summary answer

Frequency of good quality blastocyst obtained from fresh oocytes is significantly higher compared to vitrified.No difference in embryo aneuploidy rates nor clinical outcomes were found.

What is known already

Oocytes vitrification is an efficient method that allows non only fertility preservation but also the creation of donor oocytes banks, optimizing clinical resources for patients undergoing Assisted Reproductive Technology. Although the benefits of donor oocytes vitrification are well known, some studies have shown that this cryopreservation process can induce spindle abnormalities and chromosomal changes, leading to aneuploidy. Comparative studies between fresh and vitrified oocytes to evaluate embryo developmental competence, aneuploidy and clinical pregnancy rate (CPR) are needed.

Study design, size, duration

This retrospective study includes ICSI cycles with fresh donor oocytes(N = 2795) and vitrified donor oocytes (N = 1225) between January 2019 and September 2020. Pre-implantation Genetic Testing for Aneuploidy (PGT-A) was performed on Day 5 and Day 6 blastocysts. Fertilization rate, blastocyst morphology, aneuploidy status and CPR were analysed and compared between the groups. Recipients were equally distributed in terms of maternal age (40.86 years) and previous history, sperm samples were also similar in profile and origin (fresh-frozen).

Participants/materials, setting, methods

A total of 266 subfertile couples participated in the study, ICSI was carried out in all cycles. Vitrification and warming protocols were performed with a commercial kit. All embryos were cultured to blastocyst stage in a Time-Lapse incubator and assessed by Gardner’s blastocyst grading scale. PGT-A testing was performed on trophectoderm biopsies by Next Generation Sequencing (NGS). Single/double embryo transfers were performed in all cases. Odd-ratios were calculated,and Chi-square was performed for the statistical analysis.

Main results and the role of chance

A total of 266 patients underwent 289 donor oocyte cycles yielding an overall of 4557 oocytes. ICSI was performed on 2795 fresh and 1225 vitrified mature oocytes. Similar fertilization rates were achieved with fresh and vitrified oocytes (75.9% (2122/2795) and 75.2% (921/1225), respectively (P = 0.6)) yielding a significant difference in blastocyst rate of 71.7% (1522/2122) and 62.5% (576/921) (OR 1,519; 95% CI 1,290–1,789; p < 0.001). In addition, when blastocysts morphology was analysed, a significant difference was shown in the frequency of good quality embryos that decreases from 56.6% (861/1522) with fresh oocytes to 51% (294/576) with vitrified oocytes (OR 1,249; 95% CI 1,031–1,514; P < 0.02). PGT-A testing of blastocysts revealed not significant differences in euploidy rates (73.6% in fresh oocytes vs 76.8% vitrified oocytes, P = 0.2). With regards to clinical outcomes, similar results were found between the groups. A total of 322 embryo transfers were performed (237 from fresh and 85 vitrified) achieving a CPR of 48.9% (116/237) with fresh oocytes and 54% (46/85) with vitrified (P = 0.7) and a pregnancy loss of 6.7%(16/237) in fresh oocytes and 11.7%(10/85) vitrified oocytes (P = 0.1).

Limitations, reasons for caution

The study was conducted on a small number of cases. Further studies are needed to confirm our findings. Moreover, although the same stimulation protocol was used, donors from different background were included.

Wider implications of the findings: This study supports the use of vitrified oocytes in the laboratory routine without compromising clinical outcomes. Although oocyte vitrification may have an influence on embryo morphology, blastocyst rate, no impact of this cryopreservation process is seen on embryo aneuploidy, developmental competence and CPR.

Trial registration number

Not applicable

A treatment algorithm for couples with unexplained infertility based on sperm chromatin assessment

OBJECTIVE

To design a reproductive treatment algorithm based on the sperm DNA fragmentation (SDF) for couples with unexplained infertility following a poor intrauterine insemination (IUI) outcome.

DESIGN

Couples that failed IUI with no apparent reproductive issue in both partners were allocated to diverse reproductive treatments on the basis of SDF.

SETTING

Reproductive medical center in an academic setting.

PATIENT(S)

Over 4 years, couples with an unexpected poor IUI outcome and no apparent female or male partner reproductive issues were recruited.

INTERVENTION(S)

IUI, IVF, and ICSI were performed in the standard fashion following sperm SDF assays.

MAIN OUTCOMES MEASURE(S)

Fertilization rate, implantation rate, pregnancy characteristics, and delivery rates.

RESULT(S)

A total of 354 couples with unexplained infertility and normal semen parameters underwent 1133 IUI cycles. Clinical pregnancy rate (CPR) with IUI at our center in an age-matched cohort is 23.9% while the study cohort had 1.8%. Following SDF assessment, couples with failed IUI attempts but normal SDF (SCSA 9.8 ± 4.6%; TUNEL 11.8 ± 6.2%) underwent IVF with a CPR of 12.7%; those with abnormal SDF underwent ICSI with ejaculated spermatozoa, resulting in a CPR of 18.7%. This group included couples with normal SDF that had failed IVF. Couples with abnormal SDF that failed ICSI with ejaculated spermatozoa achieved a CPR of 31.0% with surgically retrieved spermatozoa.

CONCLUSION(S)

Couples with unexplained infertility that present with unexpectedly poor IUI outcomes can be funneled into a treatment algorithm guided by the integrity of the sperm genome for higher chances of pregnancy using an alternate method of insemination.

Intracytoplasmic sperm injection: state of the art in humans

Among infertile couples, 25% involve both male and female factors, while male factor alone accounts for another 25% due to oligo-, astheno-, teratozoospermia, a combination of the three, or even a complete absence of sperm cells in the ejaculate and can lead to a poor prognosis even with the help of assisted reproductive technology (ART). Intracytoplasmic sperm injection (ICSI) has been with us now for a quarter of a century and in spite of the controversy generated since its inception, it remains in the forefront of the techniques utilized in ART. The development of ICSI in 1992 has drastically decreased the impact of male factor, resulting in millions of pregnancies worldwide for couples who, without ICSI, would have had little chance of having their own biological child. This review focuses on the state of the art of ICSI regarding utility of bioassays that evaluate male factor infertility beyond the standard semen analysis and describes the current application and advances in regard to ICSI, particularly the genetic and epigenetic characteristics of spermatozoa and their impact on reproductive outcome.

Efficacy and safety of tenofovir, entecavir, and telbivudine for chronic hepatitis B in heart transplant recipients

BACKGROUND

Treatment of chronic hepatitis B (CHB) with polymerase inhibitors is key to prevent disease flares and progression toward advanced liver disease. Efficacy and tolerability of newer agents has been reported anecdotally in transplant recipients.

METHODS

In this prospective, observational study, we assessed outcomes of therapy with tenofovir (TDF), entecavir (ETV), and telbivudine (LdT) in 13 heart transplant recipients (HTR) with CHB.

RESULTS

Most patients were hepatitis B e antigen negative, had low baseline hepatitis B virus (HBV) DNA, and normal aminotransferases. Liver biopsy showed a median fibrosis score of 1.5 (range 0-4). Glomerular filtration rate (GFR) was <50 mL/min in 7 patients (54%). Two patients were started on de novo ETV before transplant. Eleven previously treated patients were switched to TDF (n = 9) or LdT (n = 2). Median treatment duration was 33 months (range 1-71). HBV DNA remained suppressed in 6 patients and became undetectable in 5. Aminotransferases went down to the normal range in all patients, with a single flare in 1 patient. One patient lost hepatitis B surface antigen. No cases occurred of hepatic decompensation, hepatocellular carcinoma, or liver-related death. The GFR remained largely stable, and no cases of TDF-related hyper-phosphaturia were observed.

CONCLUSIONS

This study indicates that newer antivirals are effective and safe in HTR with CHB.

Genotoxicity of Aqueous Extract From Heated Cooking Oils and its Suppression by Lactobacilli

In the present study the mutagenic and genotoxic effects of aqueous extracts from six cooking oils (extra vergine olive, peanut, sunflower, soybean, corn, and various seeds oils) heated to the respective smoke point were investigated. The Ames test and the SOS Chromotest were carried out for this evaluation. The same oils were also tested after their re-frying, simulating domestic reuse process. Furthermore, the ability of different lactobacilli to reduce the potential genotoxic activity of the fried and re-fried oils was determined applying SOS Chromotest after co-incubation of samples with lactobacilli. The results showed that all the fried oils did not produce mutagenic effects while they induced a SOS response with the highest induction factor for the corn oil. Double heat-treatment caused an increase of the genotoxic activity until two times the first heating. The most susceptible oil to the re-frying procedure was the sunflower oil. The antigenotoxicity results were expressed as percent of genotoxicity inhibition. All the tested strains of lactobacilli exhibited antigenotoxic properties on the fried oils.

Mural inflammation in Crohn disease: location-matched histologic validation of MR imaging features

PURPOSE

To validate proposed magnetic resonance (MR) imaging features of Crohn disease activity against a histopathologic reference.

MATERIALS AND METHODS

Ethical permission was given by the University College London hospital ethics committee, and informed written consent was obtained from all participants. Preoperative MR imaging was performed in 18 consecutive patients with Crohn disease undergoing elective small-bowel resection. The Harvey-Bradshaw index, the C-reactive protein level, and disease chronicity were recorded. The resected bowel was retrospectively identified at preoperative MR imaging, and wall thickness, mural and lymph node/cerebrospinal fluid (CSF) signal intensity ratios on T2-weighted fat-saturated images, gadolinium-based contrast material uptake, enhancement pattern, and mesenteric signal intensity on T2-weighted fat-saturated images were recorded. Precise histologic matching was achieved by imaging the ex vivo surgical specimens. Histopathologic grading of acute inflammation with the acute inflammatory score (AIS) (on the basis of mucosal ulceration, edema, and quantity and depth of neutrophilic infiltration) and the degree of fibrostenosis was performed at each site, and results were compared with MR imaging features. Data were analyzed by using linear regression with robust standard errors of the estimate.

RESULTS

AIS was positively correlated with mural thickness and mural/CSF signal intensity ratio on T2-weighted fat-saturated images (P < .001 and P = .003, respectively) but not with mural enhancement at 30 and 70 seconds (P = .50 and P = .73, respectively). AIS was higher with layered mural enhancement (P < .001), a pattern also commonly associated with coexisting fibrostenosis (75%). Mural/CSF signal intensity ratio on T2-weighted fat-saturated images was higher in histologically edematous bowel than in nonedematous bowel (P = .04). There was no correlation between any lymph node characteristic and AIS.

CONCLUSION

Increasing mural thickness, high mural signal intensity on T2-weighted fat-saturated images, and a layered pattern of enhancement reflect histologic features of acute small-bowel inflammation in Crohn disease.

Occurrence of salmonella and Listeria spp. on retail poultry products in south Italy and comparison of conventional and rapid methods for their detection

Salmonella and Listeria spp. are frequently detected in poultry meats. Conventional isolation and identification methods to detect these microrganisms in food are laborious and time-consuming. In the present study the occurrence of Salmonellae and Listeriae on 362 samples of retail poultry in Caserta, South Italy was evaluated and standard microbiological and rapid methods were compared. Furthermore, the samples were collected and analyzed twice a week, on Monday and Friday to establish their possible variability from storage. Both methods showed a strong contamination of samples by Listeria spp. (about 50% for both methods) with 12% Listeria monocytogenes while the contamination of Salmonella was poorer (14-15%). The two procedures showed a good agreement for the detection of Listeriae while the sensitivity of the Rapid test for Salmonellae was poorer (75%). Data about sampling on Monday and Friday highlighted a significant increase in Listeria spp. at the end of the week.

Chemical and toxic evaluation of a biological treatment for olive-oil mill wastewater using commercial microbial formulations

Olive-oil-mill wastewater (OMW) has significant polluting properties due to its high levels of chemical oxygen demand (COD), biochemical oxygen demand (BOD), and phenols. In the present study, different commercial bacterial formulations were used in the biological treatment of OMW. COD and toxicity testing using primary consumers of the aquatic food chain (the rotifer Brachionus calyciflorus and the crustacean Daphnia magna) were employed to evaluate abatement of the organic load and reduction of the toxic potential. In addition, the four most active formulations were tested mixed pair-wise on the basis of their unique characteristics in order to evaluate the improvement of treatment. The effect of treatment was assessed by measuring COD removal, reduction of total phenols, and decreased toxicity. The results obtained with the mixed formulations showed that the maximum removal of the organic load was about 85%, whereas phenols were reduced by about 67%. The toxicity for rotifers decreased by 43% and for crustaceans by about 83%.

[Quality evaluation multiapproach of sediments in water bodies in Southern Italy]

This study reports the toxicity of sediments from rivers and canals collected at two six-month intervals from 19 sampling points of the province of Naples in Southern Italy. The toxicity of the pore-water from sediments was determined with a battery composed of different freshwater microbiotests. The toxicity varied substantially from station to station, but none of the Toxkit tests was either the most or the least sensitive for all stations. Chemical analyses were accomplished on some heavy metals. Furthermore, the in situ biological communities of macroinvertebrates were assessed. Most of tested sediments were found to be very toxic for several if not all the microbiotests as well as the biological communities (EBI). Comparison between toxicological data and heavy metals revealed a positive correlation for zinc and copper. This study confirms that only an integrated approach is suitable for the evaluation of contaminated sediments and that single parameters are not always able to define a situation of environmental deterioration.

[Environmental quality of Volturno river with toxic and genotoxic findings]

In order to assess the environmental quality of Volturno river in Southern Italy, the Extended Biotic Index, chemical and microbiological parameters were determined in nine sampling points as provided for D. Lgs. 152/99. Furthermore, this study reported toxicity of surface waters and pore waters from sediments and genotoxicity of pore waters to improve the definition of the ecological condition of the investigated watercourse. Results showed that toxicity and genotoxicity testing contributed to assess environmental quality and pore waters are an useful tool to combine investigations.

Role of diagnostic imaging in abdominal lymphadenopathy

Abdominal lymph node chains and route of lymph drainage of various organs (stomach, duodenum, liver, gallbladder, pancreas, small intestine, appendix, blind intestine, colon rectum) are analyzed according to their location. The role of conventional radiology and diagnostic imaging is evaluated in the study of abdominal lymphatic system with particular reference to lymphangiography and the new procedures of sonography, CT and MRI. Present methods used in inflammatory abdominal lymphadenopathy with special attention to tuberculous lymphadenitis, liver cirrhosis, neoplastic abdominal lymphadenopathy, colorectal and pancreatic cancer, are illustrated. Combined modality imaging is considered in gastric cancer based on the evolution of the classification of gastric lymph nodes. The role of sonography, endoscopic ultrasonography, spiral CT and MRI is assessed in gastric cancer N staging. A retrospective study is analyzed and perspectives for the application of a new CT protocol are proposed. PET potentialities in the study of abdominal lymph nodes are examined.

[Intestinal preparation for colon enema with fleet sodium phosphate: comparative study with the conventional method]

PURPOSE

To evaluate the possible optimization of a well-tolerated and versatile method of intestinal preparation able to adequately free the lumen and consequently improve diagnostic results with a lower risk of prolonged hospital stay for incorrectly prepared patients.

MATERIAL AND METHODS

We examined 40 patients, namely 20 men (mean age 70 years, range 52-87) and 20 women (mean age 68 years, range 49-81) referred to the Institute of Radiology of the Università Cattolica del Sacro Cuore, Gastrointestinal tract Unit, to undergo double contrast colonic enema. The patients were divided into two groups by one-to-one randomization: group 1 was prepared with the conventional method and group 2 with the new protocol for intestinal preparation. On the two days before the examination a low-residue diet was administered; the day before the examination a phial of Fosfo-soda fleet was administered in two times (at 8 am and 4.30 pm), which was diluted with half a glass of water. Bread, pasta and vegetables were strictly forbidden at lunch and soup or milk at supper; the patients were fasted on the examination day. Two evaluations were performed: one to assess tolerance to the preparation and the other, a radiographic study, to assess the grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting.

RESULTS

Of the 20 patients given X-prep, 3 had to discontinue it and 4 exhibited severe side-effects, but completed the treatment; tolerance was satisfactory in the remaining 13 patients. The grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting were considered satisfactory in 9, 17 and 16 patients respectively. None of the patients given Fosfo-soda fleet had to discontinue it and tolerance was satisfactory in 19 patients. The grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting were considered satisfactory in 15, 18 and 18 patients respectively. The statistical analysis of all data was performed with Wilcoxon test.

DISCUSSION

Intestinal preparation with Fosfo-soda fleet appeared to be definitely better than the conventional method relative to tolerance (p = .02, a statistically significant difference), while providing similarly satisfactory data relative to the other parameters.

CONCLUSIONS

Our results, coupled with the versatility of Fosfo-soda fleet (possible application in colonoscopy) and its ease of use recommend this preparation not only for inpatients but also for outpatients in whom self-administration is feasible.

Enhanced expression of glucose-6-phosphate dehydrogenase in human cells sustaining oxidative stress

Recent reports have demonstrated that glucose-6-phosphate dehydrogenase (G6PD) activity in mammalian cells is necessary in order to ensure cell survival when damage is produced by reactive oxygen intermediates. In this paper we demonstrate that oxidative stress, caused by agents acting at different steps in the biochemical pathway controlling the intracellular redox status, determines the increase in G6PD-specific activity in human cell lines of different tissue origins. The intracellular level of G6PD-specific mRNA also increases, with kinetics compatible with the induction of new enzyme synthesis. We carried out experiments in which cells were exposed to oxidative stress in the presence of inhibitors of protein or RNA synthesis. These demonstrated that increased G6PD expression is mainly due to an increased rate of transcription, with a minor but significant contribution of regulatory mechanisms acting at post-transcriptional levels. These results provide new information on the defence systems that eukaryotic cells possess in order to prevent damage caused by potentially harmful oxygen derivatives.

Digitization of radiologic images

Information technology is at present an integrating part of the department of radiology. The applications to radiology involve the new imaging procedures as CT and MRI as well as exams which to-date are performed with analog methods. Besides off-line digital conversion of images by video camera or scanner, on-line systems are available with which conventional images are directly converted to digital images. Digital radiography using photostimulable phosphors is based on the capability of barium fluorohaldeide plates to emit light when stimulated by a laser beam. Digital spot fluorography is a dedicated system which enables the digital acquisition of dynamic images. The diffusion and evolution of digital systems dedicated to conventional exams will permit in a near future a fully digital radiology department.

[Evaluation of the exposure levels to radioactivity in the hot-spring environment of the Island of Ischia during a year]

It is known that the decay products of the U-238 are findable in nature in certain materials (such as tufa, limestone, etc.), therefore some populations are naturally exposed to radiations originated by building materials, houses and isotopes present in drinking-waters. It is evident that, for example, the residents of Campania or Lazio will be involved, on such conditions and during their whole life, in the action of natural radiations of decay products of Uranium and consequently of Radon, which is originated and, as gas, also findable in the air of those indoor areas, at a concentration inversely proportional to the relevant ventilation factors. Furthermore, it is known that this isotope is always found in thermal waters too and sometimes at levels which make them classify as radioactive and with therapeutic properties still subjects of studies and researches. Actually, presence of Radon in warm waters is particularly evident in some basins (the Baths of Badgastein in Austria) and is also findable in some italian thermal towns such as Merano Laurisia, Abano, Baths of Lucca or the island of Ischia itself. All underground waters and especially the warm ones, including, those of Ischia basins, hold radioactive isotopes, since their composition is related to the nature of the underground, which they come from, and is strongly influenced by the kind of rocks present in that area, by the granulometry of the geological strata or by existent fractures, by flow speed and finally by solubilization capacity. On such conditions it is evident that all waters, during their scouring, will be enriched by Radon 222 (a gaseous, therefore more soluble, element); just because of its physical state, it will be more present in external environment in case of warm waters such as those ones now examined. Consequently the environmental state from a radioecological point of view of the utilized waters has to be considered, as well as any other thermal resort, fundamentally due to Radon (Rn) and to the relevant decay products. As a matter of fact, whereas from the family of Uranium come Radon (Rn 222), Lead (Pb 210) and Polonium (Po 210), these last two, respectively with halving-times of 22.3 years and 138.4 days, from the family of Thorium (Th 232) originates Radon (Rn 220 in past times defined "Toron" according to its "forebear") and Lead (Pb 212 with a halving-time of 10.6 hours).(ABSTRACT TRUNCATED AT 400 WORDS)

[Research, education and environmental health related to pollution in the Gulf]

At Italian-Russian International Conference on "Rôle of the University on ecological education and training", was illustrate six topics of 30 years of our scientific and didactic activity on Environmental Hygiene, here below summarized: I. At first time, sludges of biological treatment plants and domestic sewage were frequently utilized under bacteriological control as economical and ecological fertilizers of land and waters. At present such a custom is very rare owing the chemical pollution of sewage continuously increasing; but in some countries it is still in use, and is our opinion and experience that organic waste material must be reused as fertilizer of land, more and more devoid of humus and subject to erosion of winds and waters. Some treatment plants are shown, and related plankton pyramid's. II. Pilot sewage treatment plants are frequently used in our experiments and training, for study and control of the biological degradation of organic matter, for evaluate the disappearance rate of bacteria and viruses, for investigate the foric action and behaviour of chemical and radioactive pollutants, for quantify their accumulation in the sludges of sewage treatment plants, and so forth. Different pilot plants are used, located both in our laboratories both in industries; in nuclear power plant are tested at the same time 3 models of 3 different plants (biodiscs, activated sludges, biofiltering channels), working with prevalent algal growth. III. Many species of microorganisms (metazoa, protozoa, algae, fungi, bacteria, viruses and new species like Bdellovibrio) are present in aerobic sewage treatment plants (activated sludge, bacterial bed, biodiscs, lagooning, etc.); in anaerobic treatment (digesters) prevail only methane-producing bacteria. Some of these organisms are very abundant and very active as consumers of organic matter; others are characteristic indicators of well balanced purification or of bad purification owing acute variation of organic load or presence of toxic substances in sewage. Many strains are antibiotic-producing, or Vit. B12 producing; others explain a strong lytic activity or are neuraminidase-formers. Production of great amount of biofloculant polysaccharides useful on sedimentation of organic matter is enhanced by adding particular organic pollutants like distillery wastes and others. Sewage treatment plants are good means for scientific research of particular biota continuously available and for food microbiological training for students and technicians on pathogens present in treated and untreated sewage and in sludges. IV. Big fecal pollution of coastal waters is clearly dangerous because of bathing beaches, shellfish farming, bacterial aerosols, damage to marine biota, eutrofication, aesthetic problems.(ABSTRACT TRUNCATED AT 400 WORDS)