Gender-affirming hormone treatment: friend or foe? Long-term follow-up of 755 transgender people

PURPOSE

Gender-affirming hormone treatment (GAHT) is one of the main demands of transgender and gender diverse (TGD) people, who are usually categorised as transgender assigned-male-at birth (AMAB) and assigned-female-at birth (AFAB). The aim of the study is to investigate the long-term therapeutic management of GAHT, considering hormonal targets, treatment adjustments and GAHT safety.

METHODS

A retrospective, longitudinal, observational, multicentre clinical study was carried out. Transgender people, both AMAB and AFAB, were recruited from two Endocrinology Units in Italy (Turin and Modena) between 2005 and 2022. Each subject was managed with specific and personalized follow-up depending on the clinical practice of the Centre. All clinical data routinely collected were extracted, including anthropometric and biochemical parameters, lifestyle habits, GAHT regime, and cardiovascular events.

RESULTS

Three-hundred and two transgender AFAB and 453 transgender AMAB were included. Similar follow-up duration (p = 0.974) and visits' number (p = 0.384) were detected between groups. The transgender AFAB group reached therapeutic goals in less time (p = 0.002), fewer visits (p = 0.006) and fewer adjustments of GAHT scheme (p = 0.024). Accordingly, transgender AFAB showed a higher adherence to medical prescriptions compared to transgender AMAB people (p < 0.001). No significantly increased rate of cardiovascular events was detected in both groups.

CONCLUSION

Our real-world clinical study shows that transgender AFAB achieve hormone target earlier and more frequently in comparison to transgender AMAB individuals. Therefore, transgender AMAB people may require more frequent check-ups in order to tailor feminizing GAHT and increase therapeutic adherence.

Nanoscale Chemical Analysis of Thin Film Solar Cell Interfaces Using Tip-Enhanced Raman Spectroscopy

Interfacial regions play a key role in determining the overall power conversion efficiency of thin film solar cells. However, the nanoscale investigation of thin film interfaces using conventional analytical tools is challenging due to a lack of required sensitivity and spatial resolution. Here, we surmount these obstacles using tip-enhanced Raman spectroscopy (TERS) and apply it to investigate the absorber (Sb2Se3) and buffer (CdS) layers interface in a Sb2Se3-based thin film solar cell. Hyperspectral TERS imaging with 10 nm spatial resolution reveals that the investigated interface between the absorber and buffer layers is far from uniform, as TERS analysis detects an intermixing of chemical compounds instead of a sharp demarcation between the CdS and Sb2Se3 layers. Intriguingly, this interface, comprising both Sb2Se3 and CdS compounds, exhibits an unexpectedly large thickness of 295 ± 70 nm attributable to the roughness of the Sb2Se3 layer. Furthermore, TERS measurements provide compelling evidence of CdS penetration into the Sb2Se3 layer, likely resulting from unwanted reactions on the absorber surface during chemical bath deposition. Notably, the coexistence of ZnO, which serves as the uppermost conducting layer, and CdS within the Sb2Se3-rich region has been experimentally confirmed for the first time. This study underscores TERS as a promising nanoscale technique to investigate thin film inorganic solar cell interfaces, offering novel insights into intricate interface structures and compound intermixing.

High-Pressure Bulk Synthesis of InN by Solid-State Reaction of Binary Oxide in a Multi-Anvil Apparatus

We present a new method to synthesize bulk indium nitride by means of a simple solid-state chemical reaction carried out under hydrostatic high-pressure/high-temperature conditions in a multi-anvil apparatus, not involving gases or solvents during the process. The reaction occurs between the binary oxide In₂O₃ and the highly reactive Li₃N as the nitrogen source, in the powder form. The formation of the hexagonal phase of InN, occurring at 350 °C and P ≥ 3 GPa, was successfully confirmed by powder X-ray diffraction, with the presence of Li₂O as a unique byproduct. A simple washing process in weak acidic solution followed by centrifugation allowed us to obtain pure InN polycrystalline powders as a precipitate. With an analogous procedure, it was possible to obtain pure bulk GaN, from Ga₂O₃ and Li₃N at T ≥ 600 °C and P ≥ 2.5 GPa. These results point out, particularly for InN, a clean, and innovative way to produce significant quantities of one of the most promising nitrides in the field of electronics and energy technologies.

Exploring Cu-Doping for Performance Improvement in Sb2Se3 Photovoltaic Solar Cells

Copper-doped antimony selenide (Cu-doped Sb2Se3) thin films were deposited as absorber layers in photovoltaic solar cells using the low-temperature pulsed electron deposition (LT-PED) technique, starting from Sb2Se3 targets where part of the Sb was replaced with Cu. From a crystalline point of view, the best results were achieved for thin films with about Sb1.75Cu0.25Se3 composition. In order to compare the results with those previously obtained on undoped thin films, Cu-doped Sb2Se3 films were deposited both on Mo- and Fluorine-doped Tin Oxide (FTO) substrates, which have different influences on the film crystallization and grain orientation. From the current-voltage analysis it was determined that the introduction of Cu in the Sb2Se3 absorber enhanced the open circuit voltage (VOC) up to remarkable values higher than 500 mV, while the free carrier density became two orders of magnitude higher than in pure Sb2Se3-based solar cells.

P-036 Analysis of semen cryopreservation in a cohort of cancer patients

Study question

To investigate the possible correlation between different types of cancer and sperm quality in patients preserving their fertility and evaluate the reproductive outcomes of patients

Summary answer

Testicular cancer was associated with lower sperm volumes (p = 0.041), lower total sperm concentration (p = 0.009) and oligozoospermia (p &lt; 0.001) compared to other cancers.

What is known already

The advancement in cancer treatments over the years frequently allowed a remission in most young patients. In males, spermatogonia are sensitive to chemotherapy and radiotherapy, causing an impairment of sperm production and competence. Moreover, up to two-thirds of patients with cancer have impaired semen parameters before any treatment but findings on whether and how specific types of malignancies can alter them remains heterogeneous. Today the advancement of Assisted Reproductive Technologies (ART) made male fertility preservation widely available, therefore counselling and sperm banking should be offered to all men in reproductive age with a diagnosis of cancer before any treatment.

Study design, size, duration

This was an observational cohort study conducted on cancer patients that underwent fertility preservation at the Center of reproductive Medicine and Surgery “P. Bertocchi” at the Department of Obstetrics and Gynecology in AUSL-IRCCS of Reggio Emilia, Italy between 2007 and 2018. The participation to the study was retrospectively proposed to all patients submitted to fertility preservation counselling from January 1st 2007 to March 28th 2018, and prospectively from March 29th 2018 to December 31st 2018.

Participants/materials, setting, methods

Semen parameters regarding volume, concentration, motility, and morphology were assessed according to the WHO criteria of 2010 in semen samples collected before any cancer treatment. Based on the macroscopic and microscopic evaluation of each sample, all those with at least cryptozoospermia were frozen. We also evaluated the reproductive outcomes of patients seeking a pregnancy with sperm frozen before cancer treatments. Semen parameters and pregnancy outcomes were compared between testicular versus other cancers.

Main results and the role of chance

During the study period, 329 patients were included with a mean age at enrollment of 32.7 ± 8.6 years. A successful cryopreservation was achieved in 94.5% of cases; the cryopreservation failed in 5.5% of cases, due to azoospermia or missed delivery samples. More than half of the cryopreservations were performed in patients affected by testicular cancer (53.3%), followed by those affected by Hodgkin (19.3%) and non-Hodgkin Lymphoma (13.5%), reflecting the increased incidence of these cancer histotypes in the age group of 20-40 years. Testicular cancer was associated with lower sperm volumes (p = 0.041) and lower total sperm concentration (p = 0.009) compared to other cancers. No difference was observed about sperm motility and morphology, while oligozoospermia was significantly more frequent in men with testicular cancer (p &lt; 0.001). In the cohort, the 8.4% of patients thawed their samples; the usage rate and the embryo transfer rate were significantly higher (p = 0.04) among those with a testicular cancer, while pregnancy and livebirth rates did not differ between the two groups.

Limitations, reasons for caution

Relevant limitations of the study included: the absence of a follow-up on fertility status after cancer remission, missing data about spontaneous pregnancies, and information on the seminal status of each patient before cancer diagnosis, precluding any etiopathological consideration between neoplastic pathology and seminal parameters.

Wider implications of the findings

Male fertility preservation is feasible, easy to be performed, non-invasive and does not delay cancer treatments. Men affected by testicular cancer had worse semen parameters at cryopreservation, but pregnancy and livebirth rates were similar to those achieved by men with other cancers and similar to those achieved with fresh sperm.

Trial registration number

not applicable

P-585 The (decision) tree of fertility: an innovative decision-making algorithm in assisted reproduction technique

Study question

To develop a decisional algorithm able to predict pregnancy and live birth rates after controlled ovarian stimulation (COS), helping to decide whether to perform oocytes pick-up.

Summary answer

A systematic approach allows to identify ovarian follicles, female age and sperm motility as predictors of ART outcome, reducing the socio-economic burden of ART failure

What is known already

The physician needs to estimate a priori the female response after the COS phase, leaving an extreme variability in the proposed therapeutic regimens. Indeed, the most cost-effective ART management in terms of pregnancy and live birth rates is still far to be achieve and the clinical application of predictive models is still scanty, considering their limited predictive ability. A predictive model able to estimate the chances of success in the time point after ovarian stimulation and before the pick-up could guide the decision to prosecute or not the ongoing ART path

Study design, size, duration

A single centre, retrospective analysis of data was carried out, considering all couples attending the Fertility Centre of the Department of Obstetrics and Gynaecology of Reggio Emilia (Italy). All consecutive ART cycles performed from 1998 to December 2020 were retrospectively extracted and couples fulfilling inclusion criteria were included in the final dataset with final included 12,275 ART cycles. The strong ART outcomes were considered, i.e. biochemical and clinical pregnancy and live birth rates.

Participants/materials, setting, methods

Couple with both partners older than 18 years and attending fresh ART cycles are available are included in the study. The ART procedure was evaluated collecting several variables, considering male parameters, COS approach and variables of COS response. The fertilization rate was calculated as the ratio between the number of fertilized oocytes and the number of either injected (ICSI method) or inseminated (IVF cycles) oocytes.

Main results and the role of chance

The final database included 12,275 ART cycles, consisting of 7,826 ICSI (63.8%) and 4,449 IVF (36.2%) procedures. The 87.5% of the entire cohort (10,375 couples) were treated for primary couple infertility. Linear regression analyses highlighted a relationship between number of ovarian follicles &gt;17 mm detected at ultrasound before pick-up (OF17), embryos number and fertilization rate, and biochemical and clinical pregnancy rates (p &lt; 0.001), but not live birth rate. Decisional Tree (DT) were created for biochemical pregnancy (statistical power–SP:80.8%), clinical pregnancy (SP:85.4%) and live birth (SP:87.2%). Thresholds for OF17 entered in all DT, while sperm motility entered the biochemical pregnancy’s model, and female age entered the clinical pregnancy and live birth DT. In case of OF17&lt;3, the chance of conceiving was &lt;6% for all DT. Logistic regression analyses confirmed the relationship between strong ART outcomes and those variables detected before pick-up. Interestingly, these connections appeared only when pregnancy rates were considered, suggesting that the classical statistical approach is not able to overcome the higher number of biases influencing live birth rates. In the biochemical pregnancy decision tree, alongside to OF17, sperm motility entered the model introducing the threshold of 34%.

Limitations, reasons for caution

In the study were included only those cycles in which all ART variables were available. During the long interval of data collection, ART technologies evolved, as well as the regulatory rules for ART access. This data heterogeneity over the years could mitigate the reliability of results.

Wider implications of the findings

The identification of three decision trees helping the clinician to decide whether or not to perform oocytes pick-up, continuing the ongoing ART path. In mathematical models, three predictors of ART success at a very early stage emerged, such as ovarian follicles higher than 17 mm, sperm motility and female age.

Trial registration number

not applicable

O-132 Is there an association between sDF index and serum testosterone in human follicle stimulating hormone alfa (r-hFSH alfa) treated males with idiopathic infertility?

Study question

Is there correlation between testosterone serum levels and sperm DNA fragmentation (sDF) index before and after follicle-stimulating hormone (FSH) administration in male idiopathic infertility?

Summary answer

Correlation between testosterone and sDF was highlighted for the first time in FSH-treated men. Significant amelioration of conventional semen parameters and sDF index were confirmed.

What is known already

Testicular overstimulation is the yearned therapeutic goal when exogenous FSH is empirically administered in male idiopathic infertility. Although a robust physiological rationale theoretically supports the FSH use in male idiopathic infertility, useful markers to evaluate its efficacy are still far to be identified. Whether pregnancy outcomes remain the expected valuable endpoint for couple infertility treatment, the identification of reliable, and possibly early, markers of therapeutic response to FSH in males is mandatory. Randomized controlled clinical trials (RCTs) on this topic focused, as main outcomes of FSH treatment effectiveness, on testicular seminiferous component, not considering involvement of testosterone-secreting compartment.

Study design, size, duration

A retrospective post-hoc analysis of raw data extracted from two RCTs in which 148 idiopathic infertile men were treated with FSH.

Participants/materials, setting, methods

A retrospective post-hoc re-analysis was performed on raw data of RCTs in which idiopathic infertile men were treated with FSH and both testosterone serum levels and sDF were reported among primary and/or secondary endpoints. Additional data regarding couple infertility history, age, anthropometric variables, FSH treatment scheme and semen variables were included in a single dataset. Data were evaluated by logistic regression analyses.

Main results and the role of chance

Two RCTs were included accounting for 148 patients (median age 37, 25-52 years).  After three months of FSH administration, a significant increase was observed in FSH levels (p &lt; 0.001), inhibin B (p = 0.012), sperm concentration (p = 0.003), total sperm number (p = 0.021), progressive motility (p &lt; 0.001) and normal sperm morphology (p &lt; 0.001). Moreover, an overall sDF index reduction was confirmed after treatment (19.3±9.4 versus 16.4±6.8, p = 0.002). SDF was found significantly inversely related to sperm concentration both at baseline and after FSH treatment (Rho -0.325, p &lt; 0.001 and Rho -0.316, p = 0.001, respectively). Interestingly, sDF index after treatment showed a significant inverse correlation with testosterone serum levels (Rho -0.327, p = 0.002). Multivariate stepwise linear regression analyses using sDF index as dependent variable identified testosterone as a predictor for sDF index change (p = 0.005). Similarly, logistic regression analysis highlighted testosterone and SHBG levels as predictive of sDF reduction after FSH administration (p = 0.043 and p = 0.005, respectively). Combining raw data of published RCTs investigating FSH administration to idiopathic infertile men, a significant amelioration of conventional semen parameters together with a reduction in sDF were confirmed. Intriguingly, a potential correlation between serum testosterone and sDF was highlighted for the first time.

Limitations, reasons for caution

Since the analysis was performed on raw data obtained in previous RCTs, heterogeneity among patients enrolled and evaluated should be considered interpreting these results. Moreover, a real and accurate evaluation of intratesticular testosterone levels, rather than serum levels should be more informative to the objective of the study.

Wider implications of the findings

The highlighted significant correlation between testosterone serum levels and sDF is opening a completely unexplored field in the possibility to identify early predictors of FSH therapy response in male idiopathic infertility.

Trial registration number

Not applicable

P-032 Sperm parameters can predict the success of assisted reproductive technology. Single-center and retrospective analysis of assisted reproductive technology cycles from 1992 to 2020

Study question

Male parameters are largely underestimated in assisted reproductive technology (ART) success, so it was evaluated whether conventional semen parameters could predict assisted reproductive technology success

Summary answer

Sperm motility plays a role in predicting in vitro fertilization (IVF) success, while sperm morphology is the relevant parameter in intracytoplasmic sperm injection (ICSI) cycles.

What is known already

The detection of predictive markers would be very useful to choose the ART type and usually the male counterpart was relegated to a secondary role. Obviously, no convincing evidence that ART outcomes may be dependent on sperm parameters exists. The variation over the years of the reference values in semen analysis, together with the poor inter-laboratory standardization of sperm assessment, contributes to this very complex scenario. It remains undeniable that identifying thresholds of seminal parameters with prognostic significance in terms of pregnancy rate would have a considerable clinical impact in the assisted reproduction field.

Study design, size, duration

A single-center, retrospective, observational study was carried out including couples attending the Santa Maria Nuova Hospital-IRCCS of Reggio Emilia for infertility between January 1992 and December 2020. Only fresh ART cycles performed in a single third-level fertility center were considered for this study with a total of 22,013 cycles. Fertilization rate was the primary end-point, representing a parameter immediately dependent on male contribution. Pregnancy and live birth rates were considered in relation to semen variables.

Participants/materials, setting, methods

Both partners were aged over 18 years and satisfied national criteria to access ART procedures. The studies considering common sperm parameters obtained by conventional semen analysis, that is, sperm number, motility, and morphology. Semen analyses were performed according to the World Health Organization (WHO) manual available at the time of the ART cycle. Ovarian stimulation was performed applying different hormone stimulating protocols and ART approach used are IVF or the ICSI.

Main results and the role of chance

Considering the entire ART cohort, 5819 cycles were IVF (26.4%) and 16,194 were ICSI (73.6%). Considering strong ART outcomes, the overall pregnancy rate was 20.4% (4,368 cycles) for biochemical and 20.2% (4,314 cycles) for clinical pregnancies, respectively. Among the latter, the overall live birth rate was 63.3%. Interestingly, both biochemical (20.8% vs. 19.1%, p &lt; 0.001) and clinical (20.7% vs. 18.5%, p &lt; 0.001) pregnancy rates were significantly higher in ICSI than IVF cycles. On the contrary, the live birth rate was not significantly different between ART methodologies (64.0% in ICSI vs. 60.9% in IVF, p = 0.074). Only 610 cycles (2.8%) were interrupted since no oocytes were retrieved after gonadotropins stimulation. Considering only cycles with oocytes retrieved, the fertilization rate was significantly higher in ICSI (42.4±39.7%) compared to IVF cycles (38.4±49.2%) (F = 27.343, p &lt; 0.001). In IVF setting, both progressive motility (p = 0.012) and motility after capacitation (p = 0.002) significantly predicted the fertilization rate (statistical accuracy = 71.1%). Sperm motilities also predicted pregnancy (p &lt; 0.001) and live birth (p = 0.001) rates. In ICSI, sperm morphology predicted fertilization rate (p = 0.001, statistical accuracy = 90.3%).

Limitations, reasons for caution

These results, although statistically significant, show confidence intervals at the limits of significance. Therefore, this data must be carefully considered. From entering the ART path to its outcome, the variables encountered are numerous. The identification of a single parameter that influences, slightly, the final outcome, indicates a considerable clinical weight.

Wider implications of the findings

Interestingly, sperm motility plays a role in predicting in vitro fertilization success, while sperm morphology is the relevant parameter in ICSI. These parameters may be considered reliable tools to measure the male role on ART outcomes, potentially impacting the clinical management of infertile couples.

Trial registration number

not applicable

Computational methods on food contact chemicals: Big data and in silico screening on nuclear receptors family

According to Eurostat, the EU production of chemicals hazardous to health reached 211 million tonnes in 2019. Thus, the possibility that some of these chemical compounds interact negatively with the human endocrine system has received, especially in the last decade, considerable attention from the scientific community. It is obvious that given the large number of chemical compounds it is impossible to use in vitro/in vivo tests for identifying all the possible toxic interactions of these chemicals and their metabolites. In addition, the poor availability of highly curated databases from which to retrieve and download the chemical, structure, and regulative information about all food contact chemicals has delayed the application of in silico methods. To overcome these problems, in this study we use robust computational approaches, based on a combination of highly curated databases and molecular docking, in order to screen all food contact chemicals against the nuclear receptor family in a cost and time-effective manner.

Sb2Se3: a possible future for thin-film photovoltaics?

Antimony selenide (Sb2Se3) is today one of the most promising alternative materials for p-type absorbers in thin-film photovoltaics, with an optimal band-gap and a very high absorption coefficient. However, its crystal structure is extremely anisotropic and its natural carrier density is generally very low. Sb2Se3 thin films have been deposited by two different high-energy techniques: magnetron RF-sputtering (MS) and low-temperature pulsed electron deposition (LT-PED). Their dominant crystallographic orientations have been studied as a function of deposition parameters and of the different used substrates, while complete solar cells have been subsequently made with the obtained samples to confirm the dependence of conversion efficiencies on the observed (Sb4Se6)n ribbon orientation. Cu-doped Sb2Se3 thin-films have been also preliminary prepared in order to evaluate a possible route to further improve the free charge-carrier density and the cell performance.

P–735 Spontaneous pregnancies among infertile couples during assisted reproduction lockdown for COVID–19 pandemic

Study question

Evaluate the population attending Assisted reproductive techniques (ART) who have suffered the interruption of fertilization paths because of the SARS-CoV–2 italian national lockdown declared under goverment provision.

Summary answer

The research show that some infertile couples candidate to ART paths obtained a spontaneous pregnancy during the lockdown due to SARS-CoV–2 pandemic.

What is known already

The real impact of psychological stress on couple infertility in terms of pregnancies obtained is largely under-investigated in the literature and the potential low frequency of sexual activity is usually poorly considered in the management of couple infertility and its role on pregnancies failure is unclear, but probably underestimated. Moreover, the worldwide spread of the SARS-CoV–2 infection has profoundly affected all aspects of human life, with tangible consequences in several contexts, including reproduction. This allowed to highlight the interrelation between psychological distress and reproductive medicine are still conflicting.

Study design, size, duration

This is a study conducted at the Fertility Centre of the Department of Obstetrics and Gynaecology of Reggio Emilia (Italy), that evaluated the conception ability of couples who suffered the postponement of ART cycles during the SARS-CoV–2 pandemic. In particular, we collected anamnestic, anthropometrical and demographic data of those women attending ART straddling the lockdown period, from March 2020 to April 2020.

Participants/materials, setting, methods

The study evaluated couples attending ART, who had an interruption of the fertilization paths due to the SARS-CoV–2 pandemic. The variables as women age, BMI, duration of infertility, number of sexual intercourses per week and infertility aetiology were considered in a multivariate logistic analysis. The statistical analysis was performed setting pregnancy (categorical data) as the dependent variable, and all other available data as either covariates or cofactors.

Main results and the role of chance

Among the 431 couples recalled to reschedule ART cycles 34 couples (7.9%) obtained a spontaneous pregnancy during the COVID–19 lockdown. The statistical analysis for the 431 couples recalled showed that average duration of couple infertility was 3.5 ± 2.8 years, while an exclusively female causal factor was observed in the 23.7% of cases (102 couples), an exclusively male one in the 32.7% (141 couples), a coexistence of male/female factor in the 18.6% (80 couples), and an idiopathic form in the 25.1% (108 couples). The 34 couples obtained a spontaneous pregnancy presented a female infertility factor in the 26.5% of cases (9 couples), a male factor in the 29.4% (10 couples), a male/female factor in the 11.8% (4 couples), and idiopathic infertility in the 32.4% (11 couples). The male factor of infertility was not evaluated in all couples, thus this definition came from the anamnestic evaluation of the couple. In a multivariate logistic analysis we highlighted that the infertility history duration and the sexual intercourses frequency were significantly related to pregnancy (F = 4.8, degrees of freedom=1, p = 0.030 and F = 81.6, degrees of freedom=1, p &lt; 0.001, respectively).

Limitations, reasons for caution

Despite the short observation period (two months of italian national lockdown declared under goverment provision), the large sample size of women evaluated attending to a single ART centre constitutes a point of strength of our study. However, the absence of a control group represents the most important limit.

Wider implications of the findings: In conclusion, the lockdown allowed to increase the knowledge about under-explored causes of idiopathic infertility: the frequency of sexual intercourses. This aspect in reproductive medicine could help to identify those couples able to conceive spontaneously, avoiding unnecessary over-treatment, and to correctly apply ART to those couples who really need it.

Trial registration number

none

O-226 The microscopic se men improvement after surgical varicocele repair

Study question

Evaluation of the effect of varicocele correction on conventional and microscopic seminal parameters and evaluation of which factors might predict sperm improvement after surgical treatment.

Summary answer

The detailed morphologic sperm evaluation has been identified as a novel parameter expressing the post-surgical semen amelioration after varicocelectomy.

What is known already

Generally, varicocele develops during puberty and occurs more often on the left side for anatomic reasons. However, its diagnosis is commonly delayed, especially in asymptomatic cases, until the man consults an andrologist for couple infertility. A causative relationship between varicocele and impairment of semen quality has been largely investigated in the context of male infertility. Despite the florid literature available on this topic, the clinical benefit in terms of semen quality improvement after varicocele surgical repair remains controversial.

Study design, size, duration

An observational, retrospective clinical trial was carried out including patients undergoing surgical treatment for varicocele at the Day Surgery of the Urology Operative Unit of the Santa Maria Nuova Hospital-IRCCS of Reggio Emilia from September 2011 to March 2020. Primary outcome was the detailed morphologic microscopic sperm evaluation. Secondary outcomes were conventional semen analyses. Each patient was considered two times (before and after the surgery) and evaluated by both physical examination and ultrasonography.

Participants/materials, setting, methods

The inclusion criteria considered the patients with diagnosis of varicocele at ultrasound examination, attending surgical resolution and with at semen analyses before and after the surgery, were excluded patients with diagnosis of varicocele without surgical indication, and/or semen analyses performed only before or only after the surgery. In the statistical analysis a logistic multivariate regression analysis was performed in order to evaluate the change before and after surgery.

Main results and the role of chance

The post-surgical semen analysis was performed after a mean of 183.7 + 112.5 days since the surgery for a total of 121 males (mean age 24.6 + 4.1 years) enrolled. The surgical treatment leads to a significant increase in sperm concentration (p = 0.015) and percentage of progressive and total motility (p = 0.022 and p = 0.039, respectively), with a significant decrease in the percentage of immobile sperms (p = 0.013). In particular, semen concentration improved in 71.7% of patients (p = 0.010). Considering the detailed morphologic microscopic evaluation, a significant improvement was detected: head abnormalities showed a significant reduction, considering microcephaly (3.3 + 3.6 versus 2.2 + 2.9%, p = 0.015), macrocephaly (1.4 + 0.6 versus 1.2 + 0.9%, p = 0.043) and cytoplasmic appendix (1.4 + 0.8 versus 0.9 + 1.2%, p = 0.041). Moreover, surgery led to a significant reduction of tails abnormalities, considering absence (0.6 +2.3 versus 0.1 + 0.7, p = 0.048) and coiled tail (5.2 + 1.5 versus 6.6 + 2.0, p = 0.037). Thus, surgical varicocele resolution leads to a significant improvement in specific morphological semen parameters. The multivariate logistic analysis identified the ultrasound varicocele degree before surgery as a main predictor of the sperm concentration improvement (p = 0.016). The semen parameters improvement was higher for varicocele of I and II degree (p = 0.008).

Limitations, reasons for caution

The retrospective study design precluded from carrying out a case-control study to compare the surgical techniques. Moreover, the study design limited the availability of patients’ clinical data in order to performed a more comprehensive predictive analysis.

Wider implications of the findings

Using a complex statistical approach, it emerged that the greatest improvement in semen quality was obtained in case of mild varicocele, increasing the knowledge on the therapeutic potential of surgery. This result has clinical implications, since it could help to select those patients ‘to treat or not to treat’.

Trial registration number

none

The hypothalamic-pituitary-adrenal and -thyroid axes activation lasting one year after an earthquake swarm: results from a big data analysis

PURPOSE

To cope physical and/or psychological threats, the human body activates multiple processes, mediated by a close interconnection among brain, endocrine and inflammatory systems. The aim of the study was to assess the hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid (HPT) axes involvement after an acute stressful event (Emilia Romagna earthquake swarm) with a big data approach.

METHODS

A retrospective, observational trial was performed, collecting all biochemical examinations regarding HPA and HPT axes performed in the same laboratory the year before and the year after the earthquake swarm (20-29 May 2012).

RESULTS

Comparing 2576 pre-earthquake to 3021 post-earthquake measurements, a cortisol serum level increase was observed (p < 0.001). Similar increase was evident for urinary free cortisol (p = 0.016), but not for adrenocorticotropic hormone (p = 0.222). The biochemical hypercortisolism incidence increased from 7.6 to 10.3% after earthquakes (p = 0.001). Comparing 68,456 pre-earthquake to 116,521 post-earthquake measurements, a reduction in thyroid-stimulating hormone (TSH) levels was evident (p = 0.018), together with an increase in free triiodothyronine and free thyroxine levels (p < 0.001 and p < 0.001). Moreover, a significant increase in altered TSH after earthquakes was registered considering the epicenter-nearest measurements (p < 0.001). No clinically relevant alterations were observed considering thyroid-specific autoantibodies.

CONCLUSION

A long-term HPA axis activation in the inhabitants of the earthquake-affected areas was highlighted for the first time. Moreover, an increased incidence of biochemical hypercortisolism emerged after earthquakes. We confirmed a recruitment of HPT axis after stressful events, together with increased incidence of altered TSH in the. Our big data study allowed to increase knowledge about the connection between external stressors and endocrine regulation.

Risk-benefit in food safety and nutrition - Outcome of the 2019 Parma Summer School

Risk-benefit assessment is the comparison of the risk of a situation to its related benefits, i.e. a comparison of scenarios estimating the overall health impact. The risk-benefit analysis paradigm mirrors the classical risk analysis one: risk-benefit assessment goes hand-in-hand with risk-benefit management and risk-benefit communication. The various health effects associated with food consumption, together with the increasing demand for advice on healthy and safe diets, have led to the development of different research disciplines in food safety and nutrition. In this sense, there is a clear need for a holistic approach, including and comparing all of the relevant health risks and benefits. The risk-benefit assessment of foods is a valuable approach to estimate the overall impact of food on health. It aims to assess together the negative and positive health effects associated with food intake by integrating chemical and microbiological risk assessment with risk and benefit assessment in food safety and nutrition. The 2019 Parma Summer School on risk-benefit in food safety and nutrition had the objective was to provide an opportunity to learn from experts in the field of risk-benefit approach in food safety and nutrition, including theory, case studies, and communication of risk-benefit assessments plus identify challenges for the future. It was evident that whereas tools and approaches have been developed, more and more case studies have been performed which can form an inherent validation of the risk-benefit approach. Executed risk-benefit assessment case studies apply the steps and characteristics developed: a problem formulation (with at least 2 scenarios), a tiered approach until a decision can be made, one common currency to describe both beneficial and adverse effects (DALYs in most instances). It was concluded that risk-benefit assessment in food safety and nutrition is gaining more and more momentum, while also many challenges remain for the future. Risk-benefit is on the verge of really enrolling into the risk assessment and risk analysis paradigm. The interaction between risk-benefit assessors and risk-benefit managers is pivotal in this, as is the interaction with risk-benefit communicators.

Endogenous transient doping: physical exercise acutely increases testosterone levels-results from a meta-analysis

PURPOSE

Although endogenous testosterone levels are demonstrated to be affected by both acute exercise and resistance training, the dynamic regulation of androgen production after physical activity is still a matter of debate. This meta-analysis was designed to assess whether physical exercise acutely affects testosterone levels in men.

METHODS

The literature search was conducted to identify longitudinal trials evaluating the acute change of both total testosterone (TT) and free testosterone (fT) after physical activity in adult men. Sensitivity analyses were performed considering the sample collected (blood or saliva), the intensity of the physical exercise and the interval between the end of the exercise and the sample collection.

RESULTS

Forty-eight studies were included in the analysis, accounting for 126 trials. A total of 569 patients were enrolled (mean age 29.7 ± 13.1 years). The physical activity increased acutely TT (standardized mean difference 0.74, 95%CI: 0.56, 0.91 nmol/L), considering both serum and saliva samples (p < 0.001). Testosterone increased after moderate (p < 0.001) and high-intensity (p < 0.001) exercises, but not after mild physical activity (p = 0.19). Moreover, the testosterone increase was evident when measured immediately at the end of the exercise and within 30 min (p < 0.001), but not after 30 min (p = 0.930). Similar significant results were obtained considering fT, while SHBG did not change after physical activity (p = 0.090).

CONCLUSION

The comprehensive evaluation of the acute physical activity effect on testosterone levels identified a clear increase after exercise, irrespective of the sample collected. The main determinant of this fluctuation was the exercise intensity, with a mechanism that seems to be mostly SHBG independent. In particular, moderate/intense physical activity resulted able to increase endogenous androgenic production, albeit acutely and transitory.

TRIAL REGISTRATION NUMBER

PROSPERO registration ID: 157348.

Metastable (CuAu-type) CuInS2 Phase: High-Pressure Synthesis and Structure Determination

We report on the high-pressure solid-state synthesis and the detailed structural characterization of the metastable, CuAu-type CuInS₂ (CA-CIS) phase. Although often present in CIS thin films as unwanted phase, it has been never synthesized in pure form, and its effect on the performance of CIS-based solar cells has been long debated. In this work, pure CA-CIS phase is synthesized in bulk polycrystalline form through a high-pressure-high-temperature solid-state reaction. Single-crystal X-rays diffraction reveals the formation of tetragonal CA-CIS (a = 3.9324(5), c = 5.4980(7) Å) either in cation-ordered and disordered phase, pointing out the role of the pressure/temperature increase on the Cu/In ordering. The resistivity measurements performed on CA-CIS show low resistivity and a flat trend vs temperature and, in the case of the ordered phase, highlight a bad-metallic behavior, probably due to a high level of doping. These findings clearly rule out the possibility of a beneficial effect of this phase on the CIS-based thin film solar cells.

Hormonal profile of menopausal women receiving androgen replacement therapy: a meta-analysis

PURPOSE

Ovarian and adrenal aging leads to a progressive decline in androgen levels and deleterious effects on the quality of life. Despite this, specific replacement is not routinely recommended in the management of women with a physiological or pathological decline in their production, mainly due to the lack of long-term follow-up safety data. The purpose of this paper was to meta-analyze and summarize the existing data about hormonal profile changes in menopausal women receiving androgen replacement treatments. Full-text articles published through May 30, 2018 were found via MEDLINE and Embase and selected according to the strict inclusion criteria.

METHODS

Randomized clinical trials and case-control studies were enrolled. Studies not reporting steroid serum levels or not providing a control group were excluded from the analysis. Studies enrolling women with genetic defects or severe chronic systemic diseases were excluded. 113 papers fulfilled the inclusion criteria and 56 papers were included in the analysis. Desired data were compiled and extracted by independent observers.

RESULTS

Androgen administration increases E1, E2, testosterone, DHEA and DHEAS serum levels, and reduces SHBG. However, the E1 and E2 increase is evident only when DHEA is administered.

CONCLUSIONS

Whatever androgen formulation we choose in postmenopausal women, the end result is a rise in testosterone serum levels. However, DHEA regimen is also associated with an increased estrogenic availability. This might be crucial when choosing the best possible treatment for each patient individually taking into consideration if potential benefits outweigh the risks.

Training in Colposcopy: Experience with a Videocolposcopy Test

The authors evaluate the results of a videocolposcopy test (330 total cases, 12 cases of histologically confirmed CIN2 or more severe lesions) taken by 9 accredited and 17 unaccredited colposcopists during 1995. Seven of 9 accredited and 4 of 13 unaccredited colposcopists reached the requested standard (sensitivity >90%, biopsy rate «60%). Performance was definitely better when the test was not blind to the cytologic report (4 of 13 reached the requested standard) with respect to blind reading (none of 17). The study confirmed that colposcopy at unaccredited practices is poorly accurate. Colposcopy assessment of patients with abnormal smears should be centralized in accredited practices, which should undergo periodic quality control to guarantee screening efficacy. Tape-recorded videocolposcopy tests are a good, simple, practical and inexpensive method for interobserver quality control of colposcopic performance.

Impairment of sperm DNA methylation in male infertility: a meta-analytic study

Considering the widespread use of assisted reproductive techniques (ART), DNA methylation of specific genes involved in spermatogenesis achieves increasingly clinical relevance, representing a possible explanation of increased incidence of syndromes related to genomic imprinting in medically assisted pregnancies. Several trials suggested a relationship between male sub-fertility and sperm DNA methylation, although its weight on seminal parameters alteration is still a matter of debate. To evaluate whether aberrant sperm DNA methylation of imprinted genes is associated with impaired sperm parameters. Meta-analysis of controlled clinical trials evaluating imprinted genes sperm DNA methylation comparing men with idiopathic infertility to fertile controls. Twenty-four studies were included, allowing a meta-analytic evaluation for H19, MEST, SNRPN, and LINE-1. When a high heterogeneity of the results was demonstrated, the random effect model was used. H19 methylation levels resulted significantly lower in 879 infertile compared with 562 fertile men (7.53%, 95% CI: 5.14-9.93%, p < 0.001), suggesting a 9.91-fold higher risk ratio to show aberrant sperm DNA methylation (95% CI: 5.55-17.70, p < 0.001, I²  = 19%) in infertile men. The mean MEST methylation level was significantly higher in 846 infertile compared with 353 fertile men (3.35%, 95% CI: 1.41-5.29%, p < 0.001), as well as for SNRPN comparing 301 infertile men with 124 controls (3.23%, 95% CI: 0.75-5.72%, p < 0.001). LINE-1 methylation levels did not differ between 291 infertile men and 198 controls (0.44%, 95% CI: -2.04-1.16%, p = 0.63). The meta-analytic approach demonstrated that male infertility is associated with altered sperm methylation at H19, MEST, and SNRPN. Although its role in infertility remains unclear, sperm DNA methylation could be associated with the epigenetic risk in ART. In this setting, before proposing this analysis in clinical practice, an accurate identification of the most representative genes and a cost-effectiveness evaluation should be assessed in ad hoc prospective studies.