P–273 Effects of ovulation induction with GnRH Agonist (GnRHa) on oocyte and embryo quality at the mitochondrial level: A retrospective and experimental study

Study question

Does the GnRHa trigger improve oocyte and embryo quality in patients younger than 40, and do mtUPPR have a role?

Summary answer

GnRHa trigger improves oocyte nuclear/cytoplasmic maturation, blastocyst utilization and downregulates HSP60 levels and upregulates ATF5 levels compared to hCG trigger. GnRHa trigger suppresses mitochondrial stress.

What is known already

hCG has been used for decades to achieve final oocyte maturation and, thereby, correct oocyte retrieval timing in connection with ovarian hyperstimulation protocols. As an alternative to hCG, a GnRH agonist has been used to trigger the endogenous release of LH (and FSH) in a fashion resembling the mid-cycle surge of gonadotrophins. GnRHa is as effective as hCG for the induction of ovulation. It has been very well known that the GnRHa trigger improves oocyte nuclear maturation, embryo quality, and implantation rate, but the underlying mechanism remains unknown.

Study design, size, duration

3054 women younger than 40; oocytes retrieved more than 10 (up to 20) analyzed. Male infertility was excluded. Ovulation triggered either by hCG (n = 1368) or GnRHa (1668). Female mice were divided into three groups as control, hCG-treated and GnRHa-treated group. Superovulation was performed by FSH + hCG or GnRHa. Oocytes were collected 13 hours after hCG/GnRHa injection. ATF5, BiP, and HSP60 levels were analyzed by Western blot. Statistical analysis was performed using Student’s t-test.

Participants/materials, setting, methods

This study has two parts. i) RCT and ii) Experimental. In the experimental part, three months old female BALB/C mice (25–30 g) were used and divided into three groups (n = 20/group) as control, hCG-treated and GnRHa-treated group. Superovulation was performed by administering an injection of 5 IU FSH (i.p.) and hCG (i.p.) or GnRHa (20 mg/kg) i.m. Oocytes were collected 13 hours after hCG/GnRHa injection. ATF5, BiP, and HSP60 levels were analyzed by Western blot.

Main results and the role of chance

The mean age (34.8 vs. 35.2 years), total gonadotropin dose (2176 vs. 2230 IU), and the number of oocytes picked up (14.9 vs. 13.4) were not statistically different among GnRHa and hCG group, respectively. No LH rise or any OHSS was noticed in any groups.

Oocyte maturation (79.8% vs. 75.9%), oocyte diameter (as a marker of cytoplasmic maturity) (10198 µm2 and 9474 µm2), fertilization rate (78% vs. 72%), and embryo utilization rate (52% vs. 47.2%) were significantly higher in GnRHa group compared to hCG group, respectively.

HSP60 level (activated by mtUPR) was statistically higher in the hCG group compared to the GnRHa group (55% vs. 22%, p < 0.05 respectively). On the other hand, the ATF5 level was significantly higher in the GnRHa group than the hCG group (p < 0.0001).

Limitations, reasons for caution

The limitation is that this is a proof-of-concept study to reveal the mechanism of good embryo quality with GnRHa trigger.

Wider implications of the findings: This application offers convenience and simplifies the IVF protocol with a better oocyte and embryo quality while reducing Ovarian Hyperstimulation Syndrome (OHSS) risk during IVF care

Trial registration number

Not applicable

P–010 Timing of TESE does not affect laboratory outcomes

Study question

What is the outcome of intracytoplasmic sperm injection (ICSI) using testicular spermatozoa obtained on the day of oocyte pick-up (OPU) or the day before OPU.

Summary answer

Testicular spermatozoa were obtaining the one day before OPU does not affect fertilization rate, top quality embryo on day 3, and blastocyst utilization rate.

What is known already

Usually, TESE is performed just before OPU. OPU is generally cancelled if no sperm is retrieved. The use of fresh testicular spermatozoa, obtained the day before OPU could offer the couple and the caring team both medical and practical advantages. The benefits of this approach, however, has not been evaluated in detail. An uncontrolled preliminary study has revealed that regular fertilization and pregnancy rates could be achieved with sperm extraction performed one day before OPU.

Study design, size, duration

This was a single-center retrospective study in Bahceci BIH IVF center. Sixty-six patients suffering from azoospermia from January 2015 to December 2020 were evaluated. TESE was performed either on the OPU day (43 patients; group A) or one day before OPU (23 patients; group B).

Participants/materials, setting, methods

In this study, primary outcomes were motile spermatozoa at ICSI, fertilization, top quality embryo on day 3, and blastocyst utilization rate. Statistical analyses were performed with chi-squared tests.

Main results and the role of chance

There is no statistical difference fertilization rate (72.3% vs. 72.2, p > 0.05), top quality embryo rate on day 3 (58.3% vs 58.3%, p > 0.05) and blast utilization rate (43.98% vs 49.58%, p > 0.05) between group A and B, respectively.

Limitations, reasons for caution

The retrospective nature of this study may not eliminate potential bias. On the contrary, the strength of our study is that all procedures were performed by the same operators, so there are no operator-dependent differences. More research is needed to prove our findings.

Wider implications of the findings: TESE procedure can be performed one day before OPU without compromising success.

Trial registration number

1

Prognostic importance of RASSF2 expression in patients with gastric cancer who had undergone radical gastrectomy

BACKGROUND

Although Ras-association domain family of gene 2 (RASSF2) has been shown to undergo promoter methylation at high frequency in some cancer types and in brain metastases, its clinical utility as a useful prognostic molecular marker remains unclear in gastric cancer.

METHODS

Prognostic significance of RASSF2 expression was retrospectively analysed by immunohistochemically in 105 patients with gastric cancer who underwent curative gastrectomy.

RESULTS

Low RASSF2 expression was detected in 58 (55 %) patients, whereas 47 patients (45 %) had high RASSF2 expression. Lymph node involvement, pT stage, TNM stage, vascular invasion, perineural invasion and the presence of recurrence were found to be significantly related to RASSF2 expression levels. Low PRL-3 expression was closely correlated with lymph node metastasis (p = 0.001), advanced pT stage (p = 0.021), advanced TNM stage (p < 0.001), the presence of vascular invasion (p < 0.001), perineural invasion (p = 0.018) and high prevalence of recurrence (p = 0.003) compared with high RASSF2 expression. The median disease-free survival (DFS) time for patients with low RASSF2 expression was significantly worse than that of patients with high RASSF2 expression (10.2 vs. 50.6 months, p < 0.001). In addition, patients with high RASSF2 expression had the higher overall survival (OS) interval compared to patients with low RASSF2 expression (NR vs. 14.9 months, p < 0.001). In the multivariate analysis, the rate of RASSF2 expression levels was an independent prognostic factor, for DFS [p < 0.001, HR 0.12 (0.10-0.88)] and OS [p < 0.001, HR 0.10 (0.04-0.46)], as were pT stage and TNM stage, respectively.

CONCLUSIONS

RASSF2 may be an important molecular marker for carcinogenesis, prognosis and progression in gastric cancer, but the potential value of RASSF2 expression as a useful molecular marker in gastric cancer progression should be evaluated, comprehensively. It would be possible to develop treatments targeting RASSF2 and advance new treatment strategies for gastric cancer.

Long-acting progestin-only contraceptives enhance human endometrial stromal cell expressed neuronal pentraxin-1 and reactive oxygen species to promote endothelial cell apoptosis

CONTEXT

Despite the absence of progesterone receptor protein in human endometrial endothelial cells (HEECs), endometria of women receiving long-acting progestin-only contraceptives (LAPCs) display reduced uterine blood flow, elevated reactive oxygen species generation, increased angiogenesis, and irregularly distributed, enlarged, fragile microvessels resulting in abnormal uterine bleeding.

OBJECTIVE

We propose that paracrine factors from LAPC-treated human endometrial stromal cells (HESCs) impair HEEC functions by shifting the balance between HEEC viability and death in favor of the latter.

DESIGN AND SETTING

Proliferation, apoptosis, and transcriptome analyses were performed in HEECs treated with conditioned medium supernatant (CMS) derived from HESCs treated with estradiol (E2) ± medroxyprogesterone acetate or etonogestrel under normoxia or hypoxia. Mass spectrometry interrogated the CMS secretome while immunostaining for neuronal pentraxin-1 (NPTX1), cleaved caspase-3, and cytochrome c was performed in cultured HEECs and paired endometria from women using LAPCs.

MAIN OUTCOME

HEEC apoptosis and its underlying mechanism.

RESULTS

HESC CMS from E2 + medroxyprogesterone acetate or E2 + etonogestrel incubations under hypoxia induced HEEC apoptosis (P < .05), whereas mass spectrometry of the CMS revealed increased NPTX1 secretion (P < .05). Endothelial cleaved caspase-3 and stromal NPTX1 immunoreactivity were significantly higher in LAPC-treated endometria (P < .001). Transcriptomics revealed AKT signaling inhibition and mitochondrial dysfunction in HEECs incubated with HESC CMS. In vitro analyses proved that CMS decreased HEEC AKT phosphorylation (P < .05) and that recombinant NPTX1 (P < .05) or NPTX1 + H2O2 (P < .001) increase HEEC apoptosis and cytosolic cytochrome c levels.

CONCLUSIONS

LAPC-enhanced NPTX1 secretion and reactive oxygen species generation in HESCs impair HEEC survival resulting in a loss in vascular integrity, demonstrating a novel paracrine mechanism to explain LAPC-induced abnormal uterine bleeding.

Evaluation of contralateral kidney, liver and lung after extracorporeal shock wave lithotripsy in rabbits

An experimental study was carried out to evaluate the effects of extracorporeal shock wave lithotripsy (ESWL) on contralateral kidney, liver and lung by histopathological and biochemical methods. Twelve New Zealand rabbits were allocated to two groups (n = 6). Tissues of control group (CG, n = 6) were harvested without any intervention. In ESWL group (EG), right kidneys were exposed to 3,000 shock waves at 14 kV energy using electro-hydraulic type ESWL device three times every other day. Both kidneys, liver, and right lobe of lung tissues in EG were harvested on seventh day. Kidneys were examined histopathologically for presence of glomerular and tubular injury, interstitial edema, congestion, inflammation and fibrosis. Livers were examined for hepatocyte vacuolization, congestion, portal inflammation and fibrosis. Lung tissues were examined for loss of normal structure, emphysema, interstitial congestion-edema, prominent alveolar septal vessels, interstitial inflammation, intra-alveolar hemorrhage, intraluminal hemorrhage, peribronchial edema, congestion, inflammation in bronchial wall and epithelial desquamation. Biochemical analysis of tissue samples was performed for oxidative injury markers. Histopathological evaluations revealed that tubular injury was found in both shocked and contralateral kidneys (p < 0.05). EG showed higher grades of portal fibrosis in liver and higher grades of peribronchial congestion in lung when compared to CG (p < 0.05). Biochemical evaluations of both kidneys showed that malondialdehyde levels were higher in EG than in CG (p < 0.05). ESWL causes histopathologic alterations both in shocked and contralateral kidneys. Extrarenal tissues such as liver and lung can be affected by shock waves histopathologically and oxidative injury of contralateral kidney may occur acutely after ESWL.

Determination of DNA damage after exposure to inhalation anesthetics in human peripheral lymphocytes and sperm cells in vitro by comet assay

In this study, genotoxic activities of four halogenated anesthetics (halothane, isoflurane, sevoflurane and desflurane) were investigated in human peripheral blood lymphocytes (PBLs) and sperm cells in vitro by alkaline comet assay. For this purpose, sperm or lymphocyte suspension was exposed to different concentrations (0.1 mM, 1 mM, 10 mM and 100 mM) of anesthetic agents and 1% dimethyl sulfoxide (DMSO) or phosphate-buffered saline (PBS) as controls. The DNA strand breaks as well as alkali-labile sites were measured as percentage tail intensity with comet assay. The results of this study demonstrate that all analyzed drugs were capable of inducing DNA damage on PBLs in a dose-dependent manner in vitro. However, the results in sperm cells were slightly different since we did not observe any genotoxic effect for desflurane in any of the exposure doses, and the genotoxic effect of halothane was not dose dependent. This experimental study points out to the presence of DNA damage after exposure to halogenated anesthetics in both PBLs and sperm cells, although this effect seems to be higher in PBLs.

Current concepts in the diagnosis and management of metabolic complications of HIV infection and its therapy

Changes in fat distribution, dyslipidemia, disordered glucose metabolism, and lactic acidosis have emerged as significant challenges to the treatment of human immunodeficiency virus (HIV) infection. Over the past decade, numerous investigations have been conducted to better define these conditions, identify risk factors associated with their development, and test potential therapeutic interventions. The lack of standardized diagnostic criteria, as well as disparate study populations and research methods, have led to conflicting data regarding the diagnosis and treatment of metabolic and body shape disorders associated with HIV infection. On the basis of a review of the medical literature published and/or data presented before April 2006, we have prepared a guide to assist the clinician in the detection and management of these complications.

Can sensitivity of voided urinary cytology or bladder wash cytology be improved by the use of different urinary portions?

OBJECTIVE

To improve sensitivity by using different portions of voided urine cytology (VUC) and bladder wash material cytology (BWC).

MATERIALS AND METHODS

52 patients with biopsy-proven superficial transitional cell carcinoma (TCC) of the bladder were studied. Voided urine specimens were divided into a first stream, mid-stream and terminal stream. Bladder wash material was also divided into a first portion, mid-portion and last portion. All portions were investigated for cytology abnormalities.

RESULTS

Sensitivity for the detection of malignant cells was 34.6, 38.5 and 38.5% for the first, mid- and terminal stream of VUC and 34.6, 38.5 and 34.6% for the first, mid- and last portion of BWC, respectively. The sensitivity of VUC was 20-25% for grade I, 30-40% for grade II, and 50-75% for grade III tumors, respectively. The sensitivity of BWC was 25% for grade I, 35-45% for grade II, and 33-50% for grade III tumors, respectively. There was no statistical significant difference for sensitivities between either grades (p = 0.06) or portions or streams (p = 0.3) of VUC and BWC.

CONCLUSIONS

In this small group of patients, we did not find any significant difference, but we found highest sensitivity in grade III tumors with the terminal portion of the voided urine when compared to other portions of VUC. Therefore, we believe that further study in a large series is necessary to investigate this approach of differentiated BWC and especially VUC.

Penile Mondors' disease: an underestimated pathology

OBJECTIVE

To report the aetiological, diagnostic and therapeutic aspects of penile Mondor's disease treated with non-steroidal anti-inflammatory drugs (NSAIDs) or surgery.

PATIENTS AND METHODS

During the last 3 years, 10 patients (mean age 35 years, range 20-57) were treated for superficial penile vein thrombophlebitis. The main aetiological factors were prolonged and excessive sexual intercourse, operations for inguinal hernia and deep vein thrombosis. All patients had noticed sudden and almost painless cord-like induration on the penile dorsal surface. Doppler ultrasonography was useful in both diagnosis and follow-up. Eight patients were treated with NSAIDs and platelet drugs.

RESULTS

The mean interval to resolution of symptoms was 3 weeks. Two patients who did not respond to drug therapy underwent surgery (dorsal vein resection).

CONCLUSION

Medical therapy and, when indicated, vein resection are successful and effective in treating penile Mondor's disease.

Urethral sleeve advancement in repairement of distal hypospadias

Thirtyfive boys with distal hypospadias were operated on using urethral sleeve advancement procedure between 1990 and 1994. Early complications such as hematoma and wound infection, and late complications such as fistula formation and meatal retraction were not seen in the patients except meatal stenosis in first month control in only eight patients. Four of them underwent dilatation and meatotomy was performed in the rest. Both cosmetic and functional results were excellent in the patients in sixth month control.

Isthmus hypertrophy mimics tumour in horseshoe kidney: a case report

We present a case of horseshoe kidney. He was operated because of nephrolithiasis, and was found to have a tumour-like mass in the isthmic localization 2 years after the operation. The tumour-like mass was proven to be an isthmus hypertrophy after detailed research.

Could standardized cavernosometry be helpful in therapeutic management of veno-occlusive dysfunction?

PURPOSE

Due to the lack of a gold standard for performing cavernosometry, we selected 30 patients with veno-occlusive dysfunction to evaluate the internal relationships of cavernosometric parameters and their reliability for therapeutic decisions.

MATERIALS AND METHODS

Cavernosometry was performed after injection of 20 to 40 micrograms of prostaglandin E1. Maintenance flow rates, intracavernous pressure decay following cessation of flow and intracavernous pressure changes after compression maneuvers were the main parameters considered.

RESULTS

Cavernosometric results were standardized as grade 1-7 patients with maintenance flow rate less than 20 ml. per minute (mean 18 +/- 2.5) and intracavernous pressure decay 27.5 +/- 15%, grade 2-11 with maintenance flow rates significantly lower (p < 0.001) than grade 1 (mean 37 +/- 11 ml. per minute) and intracavernous pressure decay 33 +/- 20%, and grade 3-12 with only recorded induction flows greater than 70 ml. per minute and intracavernous pressure less than 50 mm. Hg. A strong statistical correlation (p < 0.01) was noted between maintenance flow rate and percent of intracavernous pressure decays.

CONCLUSIONS

These parameters allowed us to choose different therapies, such as complex venous surgery, mixed pharmacotherapy or prosthetic implants. Good sexual function was restored in 85% of the cases. We can conclude that our model of standardized cavernosometry has made easier the therapeutic choices in patients who do not respond to intracavernous drugs.

Sonourethrography in anterior urethral stricture: comparison to radiographic urethrography

Twenty-three male patients with known or suspected urethral stricture disease were evaluated using sonourethrography and standard retrograde x-ray urethrography for comparative analysis of two techniques. Results were evaluated statistically. These two methods can substitute each other in determining the stricture area length of anterior urethra. Due to advantages, if both of these methods are used combining each other, we believe that they will be much more sensitive.

Trial with bacillus Calmette-Guérin and epirubicin combination in the prophylaxis of superficial bladder cancer

The efficacy and side effects of the prophylactic intravesical bacillus Calmette-Guérin and epirubicin combination therapy were evaluated in 14 patients who underwent transurethral resection for Ta-T1 superficial bladder cancer. Therapy was started 7-10 days after the operation and maintained weekly for 6 weeks and then monthly for 6 months unless withdrawal due to side effects. Instillation of 50 mg epirubicin (Farmorubicin, Farmitalia Carlo Erba) diluted in 50 ml saline was followed by 80 mg of the Connaught strain bacillus Calmette-Guérin (ImmuCyst, Pasteur Mérieux) in 50 ml saline and the duration of instillation was 2 h for each drug. All the patients experienced moderate to severe cystitis and fever. Side effects necessitated discontinuation of the therapy in 5 patients (35.7%). Therapy was delayed in 7 patients (50%) for reasons related or unrelated to the side effects. Of the 9 patients who completed the course, 8 (89%) had no tumor recurrence 10-16 months (mean 14 months) after therapy. Results obtained revealed that this treatment schedule cannot be tolerated by a considerable number of the patients. Mainly the side effects of the combination are emphasized in this report. The therapeutic efficacy of such a combination has yet to be determined and further clinical studies are warranted.