Lifestyle, environmental exposures and male fertility in healthy young men in North Italy

Background

Human semen quality is affected by metabolic, lifestyle and environmental factors. We planned a randomized controlled trial to evaluate the effects of lifestyle changes on semen quality in healthy young men living in Italian highly polluted areas. We present here some preliminary baseline data on the association between lifestyle and semen quality.

Methods

150 non-smokers, non-alcohol drinkers and non-obese young healthy men, aged 18-22 years, have been assigned to an intervention or control group according to a 1:1 randomization plan. The intervention group follows a 4-month nutritional pathway based on a Mediterranean dietary pattern and receives suggestions on practice of physical activity. All subjects undergo urologic examination, measurement of weight, height and abdominal circumference, an interview on lifestyle variables, and provide blood and semen samples in fasting conditions, at the enrollment and at the end of the intervention and follow-up (after 8 months). Adherence to Mediterranean diet is assessed using the “PREvención con DIeta MEDiterránea” (PREDIMED) tool, and physical activity using the “International Physical Activity Questionnaire” (IPAQ). Automated sperm analysis for all semen parameters is performed on the SQA-V GOLD.

Results

The data of 101 subjects living in a highly industrialized area in North Italy (mean±SD: age: 20.3±1.2 years, BMI: 22.3±2.2) were analyzed. The sperm cell concentration was higher in subjects with IPAQ score > median than those with lower values (68.3±48.6 vs 63.7±47.0 106/mL). Total percent motility was higher in subjects with abdominal circumference < median (50.7±13.6 vs 41.2±18.8, p = 0.004), in subjects with IPAQ score > median (48.2±16.8 vs 44.2±16.8), and in subjects with PREDIMED score > 7 (47.6±18.8 vs 45.0±15.0).

Conclusions

These preliminary data suggest that semen quality is associated with abdominal fat and physical activity in healthy young men.

Key messages

The semen quality is a sensitive marker of the health status and is predictive of disease occurrence. Our study suggests that semen quality is associated with lifestyle aspects in healthy young men.

Local Excision of Retinal Metastasis from Cutaneous Melanoma

The incidence of cutaneous melanoma is constantly rising. Ocular involvement is rare and the choroid is the most accessible structure to metastatic emboli.

The case described is noteworthy on account of several particular features:

1) the missed diagnosis of the primary malignancy. This might be because either cutaneous melanoma or cutaneous nevi show several common features;

2) the rarity of the retinal metastatic site. Unlike the choroid, the retina is an unusual metastatic site but, regardless of organ blood flow, the metastatic efficiency may be related to interactions between tumour cells and host tissue;

3) the treatment of the retinal metastasis, excised conservatively. As far as we know, this is the first report of a retinal metastasis being treated by local resection.

Iris Diaphragm Implantation in Post-Traumatic Aniridia and Tractional Retinal Detachment

The implantation of an artificial iris diaphragm is described in a case of aniridia and traumatic aphakia with a relapsed, tractional retinal detachment. The addition of heparin and dexamethasone to the infusion liquid is useful to reduce the fibrinous exudation which seems to be the main cause of diaphragm obliteration.

Intravitreal Triamcinolone in Cystoid Macular Edema Due to Uveitis and Repeated Surgery after a Penetrating Trauma

PURPOSE

To test the effectiveness of intravitreal triamcinolone acetonide in treating macular edema due to multiple vitreoretinal surgical procedures and uveitis after a penetrating trauma with metallic foreign body retention in a 37-year-old man.

METHODS

The patient received two intravitreal injections of triamcinolone acetonide-2 mg/0.05 mL and 4 mg/0.1 ml(-1) month apart. The 6-month follow-up included best-corrected visual acuity (BCVA) measurement and optical coherence tomography evaluation.

RESULTS

After the first injection (2 mg) the foveal thickness (685 microm, as compared to a normal value of <165 microm) and the BCVA (20/200) remained unchanged with respect to the preinjection values; 1 week after the second injection (4 mg), the foveal thickness went down to 130 microm and the BCVA improved (20/80). Such results were unchanged at the 6-month control. No complications occurred.

CONCLUSIONS

A 2 mg dose of triamcinolone acetonide did not improve the anatomic and functional status of the macula. A 4 mg dose markedly improved BCVA and reduced the macular thickness in this case of macular edema.

Randomised clinical study: gluten challenge induces symptom recurrence in only a minority of patients who meet clinical criteria for non-coeliac gluten sensitivity

BACKGROUND

It is unknown whether symptoms in non-coeliac patients (non-CD) meeting clinical diagnostic criteria for noncoeliac gluten sensitivity (NCGS) are specifically triggered by gluten.

AIM

To assess gluten sensitivity in patients diagnosed with NCGS.

METHODS

We studied 35 non-CD subjects (31 females) that were on a gluten-free diet (GFD), in a double-blind challenge study. Participants were randomised to receive either gluten-containing flour or gluten-free flour for 10 days, followed by a 2-week washout period and were then crossed over. The main outcome measure was their ability to identify which flour contained gluten. Secondary outcome measures were based upon Gastrointestinal Symptoms Rating Scale (GSRS) scores.

RESULTS

The gluten-containing flour was correctly identified by 12 participants (34%), who were classified as having NCGS. Their mean GSRS dimension scores were significantly higher following gluten challenge compared to baseline. The scores were: pain, 1.7 ± 0.8 vs. 2.6 ± 1.0; reflux, 1.6 ± 0.5 vs. 2.2 ± 0.9; indigestion, 1.9 ± 0.7 vs. 3.2 ± 1.1; diarrhoea, 1.6 ± 0.7 vs. 2.9 ± 1.5 and constipation, 1.9 ± 0.9 vs. 2.9 ± 1.3. Seventeen participants (49%) erroneously considered the gluten-free flour to contain gluten. Their mean GSRS dimension scores were significantly higher following gluten-free flour challenge compared to baseline. The scores were: pain, 1.6 ± 0.9 vs. 3.0 ± 0.9; reflux, 1.4 ± 0.5 vs. 2.3 ± 1.1; indigestion, 2.0 ± 1.1 vs. 3.7 ± 1.1; diarrhoea, 1.6 ± 0.7 vs. 3.0 ± 1.2 and constipation, 1.6 ± 0.9 vs. 2.6 ± 1.3. The other six participants (17%) were unable to distinguish between the flours.

CONCLUSION

Double-blind gluten challenge induces symptom recurrence in just one-third of patients fulfilling the clinical diagnostic criteria for non-coeliac gluten sensitivity.

Disruption of astrocyte-neuron cholesterol cross talk affects neuronal function in Huntington's disease

In the adult brain, neurons require local cholesterol production, which is supplied by astrocytes through apoE-containing lipoproteins. In Huntington's disease (HD), such cholesterol biosynthesis in the brain is severely reduced. Here we show that this defect, occurring in astrocytes, is detrimental for HD neurons. Astrocytes bearing the huntingtin protein containing increasing CAG repeats secreted less apoE-lipoprotein-bound cholesterol in the medium. Conditioned media from HD astrocytes and lipoprotein-depleted conditioned media from wild-type (wt) astrocytes were equally detrimental in a neurite outgrowth assay and did not support synaptic activity in HD neurons, compared with conditions of cholesterol supplementation or conditioned media from wt astrocytes. Molecular perturbation of cholesterol biosynthesis and efflux in astrocytes caused similarly altered astrocyte-neuron cross talk, whereas enhancement of glial SREBP2 and ABCA1 function reversed the aspects of neuronal dysfunction in HD. These findings indicate that astrocyte-mediated cholesterol homeostasis could be a potential therapeutic target to ameliorate neuronal dysfunction in HD.

Pitfalls in the detection of cholesterol in Huntington's disease models

Background Abnormalities in brain cholesterol homeostasis have been reported in Huntington’s disease (HD), an adult-onset neurodegenerative disorder caused by an expansion in the number of CAG repeats in the huntingtin (HTT) gene. However, the results have been contradictory with respect to whether cholesterol levels increase or decrease in HD models. Biochemical and mass spectrometry methods show reduced levels of cholesterol precursors and cholesterol in HD cells and in the brains of several HD animal models. Abnormal brain cholesterol homeostasis was also inferred from studies in HD patients. In contrast, colorimetric and enzymatic methods indicate cholesterol accumulation in HD cells and tissues. Here we used several methods to investigate cholesterol levels in cultured cells in the presence or absence of mutant HTT protein. Results Colorimetric and enzymatic methods with low sensitivity gave variable results, whereas results from a sensitive analytical method, gas chromatography-mass spectrometry, were more reliable. Sample preparation, high cell density and cell clonality also influenced the detection of intracellular cholesterol. Conclusions Detection of cholesterol in HD samples by colorimetric and enzymatic assays should be supplemented by detection using more sensitive analytical methods. Care must be taken to prepare the sample appropriately. By evaluating lathosterol levels using isotopic dilution mass spectrometry, we confirmed reduced cholesterol biosynthesis in knock-in cells expressing the polyQ mutation in a constitutive or inducible manner. *Correspondence should be addressed to Elena Cattaneo: elena.cattaneo@unimi.it

A rare case of giant papillary adenoma of the breast

The authors present a case of giant papillary adenoma of the breast and discuss their therapeutic strategy. The patient subsequently returned due to a local recurrence, which was treated with oncoplastic surgery, with satisfactory aesthetic results. The authors conclude by stressing the considerable rarity of this disease and the need for effective cooperation between surgeons and pathologists.

Brain-derived neurotrophic factor in patients with Huntington's disease

Reduced Brain-Derived Neurotrophic Factor (BDNF) levels have been described in a number of patho-physiological conditions, most notably, in Huntington's disease (HD), a progressive neurodegenerative disorder. Since BDNF is also produced in blood, we have undertaken the measurement of its peripheral levels in the attempt to identify a possible link with HD prognosis and/or its progression. Here we evaluated BDNF level in 398 blood samples including 138 controls, 56 preHD, and 204 HD subjects. We found that BDNF protein levels were not reliably different between groups, whether measured in plasma (52 controls, 26 preHD, 105 HD) or serum (39 controls, 5 preHD, 29 HD). Our experience, and a re-analysis of the literature highlighted that intra-group variability and methodological aspects affect this measurement, especially in serum. We also assessed BDNF mRNA levels in blood samples from 47 controls, 25 preHD, and 70 HD subjects, and found no differences among the groups. We concluded that levels of BDNF in human blood were not informative (mRNA levels or plasma protein level) nor reliable (serum protein levels) as HD biomarkers. We also wish to warn the scientific community in interpreting the significance of changes measured in BDNF protein levels in serum from patients suffering from different conditions.

Expressed Alu repeats as a novel, reliable tool for normalization of real-time quantitative RT-PCR data

Expressed Alu repeats are a reliable, accurate and universal reference for use in RT-qPCR normalization of human genes

We describe a novel strategy for mRNA normalization in quantitative real-time PCR that is based on expressed Alu repeat amplification as a measure for the mRNA fraction. We show that expressed Alu repeat amplification is a fast, accurate normalization tool that can be successfully used for quantification of selected mRNA in the human transcriptome. This result is particularly important for clinical diagnosis and biomarker validation studies based on mRNA detection in human blood.

Analysis of the repressor element-1 silencing transcription factor/neuron-restrictive silencer factor occupancy of non-neuronal genes in peripheral lymphocytes from patients with Huntington's disease

We have previously demonstrated that the transcription of neuronal repressor element-1/neuron-restrictive silencer element (RE1/NRSE)-regulated genes is reduced in the brain of subjects with Huntington's disease (HD) as a result of increased binding of the repressor element-1 silencing transcription factor/neuron-restrictive silencer factor (REST/NRSF) to its RE1/NRSE targets. As specific non-neuronal REST/NRSF-regulated genes have been identified in the human genome, we exploited the possibility that the binding of REST/NRSF to its target RE1/NRSE sites may also be altered in the peripheral tissues of HD patients. Our results show that REST/NRSF occupancy is increased in lymphocytes from HD subjects, thus indicating for the first time that the activity of the RE1/NRSE sites is dysfunctional in vivo. Chromatin immunoprecipitation (ChIP) of the RE1/NRSE sites in lymphocytes may therefore be a reproducible, sensitive and specific means of searching for candidate markers of HD onset and progression.

Systematic assessment of BDNF and its receptor levels in human cortices affected by Huntington's disease

One cardinal feature of Huntington's disease (HD) is the degeneration of striatal neurons, whose survival greatly depends on the binding of cortical brain-derived neurotrophic factor (BDNF) with high-affinity (TrkB) and low-affinity neurotrophin receptors [p75 pan-neurotrophin receptor (p75(NTR))]. With a few exceptions, results obtained in HD mouse models demonstrate a reduction in cortical BDNF mRNA and protein, although autopsy data from a limited number of human HD cortices are conflicting. These studies indicate the presence of defects in cortical BDNF gene transcription and transport to striatum. We provide new evidence indicating a significant reduction in BDNF mRNA and protein in the cortex of 20 HD subjects in comparison with 17 controls, which supports the hypothesis of impaired BDNF production in human HD cortex. Analyses of the BDNF isoforms show that transcription from BDNF promoter II and IV is down-regulated in human HD cortex from an early symptomatic stage. We also found that TrkB mRNA levels are reduced in caudate tissue but not in the cortex, whereas the mRNA levels of T-Shc (a truncated TrkB isoform) and p75(NTR) are increased in the caudate. This indicates that, in addition to the reduction in BDNF mRNA, there is also unbalanced neurotrophic receptor signaling in HD.

[Merkel cell tumor: a case report and literature review]

Merkel cell tumor (MCT) is extremely rare, being discovered so far about 400 cases in literature. It is classified among neuroendocrine tumors. We report a case of MCT in the subclavicular region in a 93 years old woman. We confirm the efficacy of radiotherapy associated with octreotide, which these tumours express specific receptors for.

[Treatment of single hepatic metastasis from surgically treated breast carcinoma. (Report of a clinical case and review of the literature)]

In the natural history of the breast cancer, the liver metastatic location represents a clear element of an advanced stage of the disease, because it is often accompanied to multiple locations in the same organ and/or in different organs and tissues. The finding into two years after the primary intervention, during the ordinary follow-up, of an insulated metastasis in the 3rd hepatic segment in a patient operated for breast carcinoma, and the following surgical treatment of the metastasis, have suggested us to draft this note. The finding of a single metastasis in the liver in patients operated for breast carcinoma imposes a revaluation of the stage of sickness to highlight the contemporary presence of subsequent distance metastatic location; the negativity of the instrumental investigations performed has triggered the question about the type of therapeutic treatment to do to the patient. The range of therapeutic hypothesis spaces from the ultrasound guided mini-invasive techniques (alcoholization, infusion of LAK cells, use of radio frequencies), to the chemotherapy, so general that local one, by means of super selective catheterization of the hepatic artery, up to the, finally, minus usual (in these cases) surgical therapy. In the patient observed we have chosen the surgical treatment, consisting of a segmentary resection, we haven't any complication, neither intra- nor post-operative, and the patient was discharged in 8th day. Our choice of the surgical approach has bean consequence of an attentive evaluation so of the clinical indicators of the patient (good general conditions, bulk of the injury and surgical treatableness) that of the biological parameters of the neoplasm. The results of our experience, in line with whet indicated from the other AA., encourage the choice of the surgical treatment of the insulated hepatic metastasis from breast carcinoma, with the awareness of the concept of "adjuvant" that it necessarily engages in such circumstances, and, however, after an accurate selection of the patients.

[Pseudo-thrombophlebitic syndrome of the leg caused by cyst in the inner popliteal hamstrings. A case report]

The Authors present a clinical case of pseudo-thrombophlebitic syndrome caused by a cyst of the inner popliteal hamstrings. Pointing out anatomic characteristics of the area involved together with the physiopathology and etiology of the formation that fill the space of the inner popliteal hamstrings, in agreement with the observations reported in literature, and intervene in determining a great number of venous blockage observed in the leg. In conclusion, they observe how a correct clinical-anamnestic approach is important in the diagnosis and consequent prompt and aimed therapy, and how this approach should use the modern instruments available today for a definite diagnosis in the presence of a syndrome of venous stasis of the lower limbs.

[Treatment of rectal carcinoma: our experience]

Authors' experience with 53 patient operated on for adenocarcinoma of the rectum in Oncologic Surgery Department--University of Messina (Italy) was analysed. The development of mechanical devices has allowed surgeons to perform sphincter-saving in patients with medium-lower tumors of the rectum. In this experience abdominoperineal amputation was performed in cases of distal rectal tumors, local transanal excision was performed in 6 cases. There were no statistically significant differences between low anterior resection and abdomino-perineal resection with respect to local (17% vs 16.6%) and distant (16% vs 16%) recurrence.

[Carcinomas of the digestive system in patients under 20 years old]

Gastrointestinal cancers are very scarce for the people under twenties. Such a rarity, as misguides diagnostic trend, is responsible, in the greater part of cases, of the lag in the recognizing these neoplasm and, consequently, reduces the expectations of surviving whether medium or long term. Authors report their experience as regards to observation of two cases of malignant neoplasm of the stomach and of the recto-sigmoid joint in young patients of fourteen and nineteen years old and they emphasize the importance of a complete diagnostic route which, in spite of age, does not exclude the possibility of a neoplastic pathology in the presence of suggestive persistent symptomatology. It is underlined the importance of early diagnosis in fact survival yield is always and however dependent on a disease stage and not on age. Furthermore it is underlined that the young patient is subject to a rate of postoperative complications which is marginal compared with intervention yield, this is translated in a better responsiveness of young patient to radical and, if it is necessary, extended interventions.

[A case of vascular leiomyosarcoma of the superficial soft tissues]

The authors report a case of vascular leiomyosarcoma of the superficial soft tissues, and point out its epidemiologic (rareness of the report), biologic (high degree of malignancy, trend to local relapse and remote conversion into metastases), histopathologic aspects. They consider significant as to prognostic value the appraisal of the "mitotic index" and the opportunity of a radical intervention, followed by radiotherapy. They, moreover, think it useful, in consideration of the frequency of the relapses, to perform a periodic checking of the patient.