[Quality of life survey of 3,738 patients treated with intravitreal injections for age-related macular degeneration]

PURPOSE

To evaluate the peri- and post-intravitreal injection (IVI) symptoms reported by patients who have been repeatedly injected for age-related macular degeneration (AMD) and to analyze these according to the protocols of the injector.

MATERIALS AND METHODS

Multi-center, cross-sectional, consecutive, analytical survey.

RESULTS

The IVI protocols of 106 injectors differed in terms of the number of instillations of povidone-iodine, its contact time, and rinsing of the ocular surface post-injection. In total, 3,738 patients responded to the survey, 60.1% of whom were women; 36.4% had received more than 20 IVIs; 50.7% of patients reported irritation upon application of povidone-iodine. Post-IVI, depending on the symptom in question, between 44.8% and 57.4% of patients reported symptoms of ocular surface change. The number of instillations of povidone-iodine, its contact time with the ocular surface, and abundant rinsing post-IVI increased the immediate symptoms. Patients who received more IVIs were more prone to experiencing gritty eyes, and the incidence of acute pain increased in patients who had previously received over 20 IVIs. Women and patients previously treated for dry eye or glaucoma were at greater risk of worse symptoms.

CONCLUSION

Comparing injecting centers' practices with patients' self-assessments showed an aggravation of symptoms of ocular surface changes related to povidone-iodine. This survey contributes to providing data for the implementation of a protocol to improve the quality of life of patients injected repeatedly for AMD.

Investigation of relaxor and diffuse dielectric phase transitions of Ba1-XBixTi0.8Fe0·2O3 materials

Different doping elements have been used to enhance the dielectric properties of BaTiO₃ ceramic. In this work, the effect of substitution of Ba by Bi in A site and Ti by Fe in B site on structural, dielectric and electrical properties of Ba_1-xBi_xTi_0.80Fe_0·20O₃ ceramics at (x = 0.00, 0.05, 0.10 and 0.15) was investigated by X-ray diffraction, Raman spectroscopy, Scanning Electron Microscopy (SEM), Mössbauer spectroscopy as well as dielectric measurements. The Rietveld refinement results revealed that the prepared compounds crystallize in both tetragonal (P4mm) and hexagonal (P6₃/mmc) phases for x = 0.00 and 0.05 while at x = 0.10 and 0.15, the hexagonal phase disappears and only the tetragonal phase is fitted. The Raman spectra confirmed the disappearance of hexagonal phase in benefit of tetragonal phase as the Bi³⁺ substitution increases. Based on Mössbauer analyses results, all the samples are in paramagnetic state at room temperature and the Fe is oxidized under Fe³⁺ without the presence of Fe²⁺ or Fe⁴⁺ ions. The dielectric measurements as function of temperature are studied and tree broad and relaxor phase transitions were detected: from rhombohedral to orthorhombic phase T_R-O and to tetragonal ferroelectric phase T_O-T then to cubic paraelectric phase T_m. These phase transitions were displaced to the lower temperature with increasing of Bi³⁺ substitution. The values of ε'_r increase gradually with increasing of Bi³⁺contents which confirmed the enhancement of dielectric properties of BaTi_0·80Fe_0·20O₃ by Bi substitution on Ba site. The diffuse phase transitions were described by fitting the modified Uchino relation. The Cole-Cole analyses showed that both the grain and grain boundaries resistivity values are higher for Bi³⁺ substituted samples which are responsible to the dielectric properties improvement.

[Guidelines on the urological management of the adult patient with spinal dysraphism (spina bifida)]

INTRODUCTION

Improved life expectancy and prenatal screening have changed the demographics of spina bifida (spinal dysraphism) which has presently become a disease of adulthood. Urinary disorders affect almost all patients with spinal dysraphism and are still the leading cause of mortality in these patients. The aim of this work was to establish recommendations for urological management that take into account the specificities of the spina bifida population.

MATERIALS AND METHODS

National Diagnosis and Management Guidelines (PNDS) were drafted within the framework of the French Rare Diseases Plan at the initiative of the Centre de Référence Maladies Rares Spina Bifida - Dysraphismes of Rennes University Hospital. It is a collaborative work involving experts from different specialties, mainly urologists and rehabilitation physicians. We conducted a systematic search of the literature in French and English in the various fields covered by these recommendations in the MEDLINE database. In accordance with the methodology recommended by the authorities (Guide_methodologique_pnds.pdf, 2006), proposed recommendations were drafted on the basis of this literature review and then submitted to a review group until a consensus was reached.

RESULTS

Bladder dysfunctions induced by spinal dysraphism are multiple and varied and evolve over time. Management must be individually adapted and take into account all the patient's problems, and is therefore necessarily multi-disciplinary. Self-catheterisation is the appropriate micturition method for more than half of the patients and must sometimes be combined with treatments aimed at suppressing any neurogenic detrusor overactivity (NDO) or compliance alteration (anticholinergics, intra-detrusor botulinum toxin). Resort to surgery is sometimes necessary either after failure of non-invasive treatments (e.g. bladder augmentation in case of NDO resistant to pharmacological treatment), or as a first line treatment in the absence of other non-invasive alternatives (e.g. aponeurotic suburethral tape or artificial urinary sphincter for sphincter insufficiency; urinary diversion by ileal conduit if self-catheterisation is impossible).

CONCLUSION

Spinal dysraphism is a complex pathology with multiple neurological, orthopedic, gastrointestinal and urological involvement. The management of bladder and bowel dysfunctions must continue throughout the life of these patients and must be integrated into a multidisciplinary context.

Activation of 20-HETE Synthase Triggers Oxidative Injury and Peripheral Nerve Damage in Type 2 Diabetic Mice

Diabetic Peripheral Neuropathy (DPN), highly prevalent among patients with diabetes, is characterized by peripheral nerve dysfunction. Reactive Oxygen Species (ROS) overproduction has been suggested to orchestrate diabetic complications including DPN. Untargeted antioxidant therapy has exhibited limited efficacy, highlighting a critical need to explore ROS sources altered in a cell-specific manner in DPN. Cytochromes P450 (CYP) enzymes are prominent sources of ROS. Particularly, the 20-HETE synthase, CYP4A, is reported to mediate diabetes-induced renal, retinal, and cardiovascular injuries. This work investigates the role of CYP4A/20-HETE in DPN and their mechanisms of action. Non-obese type 2 Diabetic mice (MKR) were used and treated with a CYP4A-inhibitor (HET0016) or AMPK-activator (Metformin). Peripheral nerves of MKR mice reflect increased CYP4A and 20-HETE levels, concurrent with altered myelin proteins and sensorimotor deficits. This was associated with increased ROS production and altered Beclin-1 and LC3 protein levels, indicative of disrupted autophagic responses in tandem with AMPK inactivation. AMPK activation via Metformin restored nerve integrity, reduced ROS production, and regulated autophagy. Interestingly, similar outcomes were revealed upon HET0016 treatment whereby ROS production, autophagic responses, and AMPK signaling were normalized in diabetic mice. Altogether, the results highlight hyperglycemia-mediated oxidative injury in DPN through a novel CYP4A/20-HETE/AMPK pathological axis. PERSPECTIVE: To our knowledge, this is the first study to highlight the role of CYPs/20-HETE-induced oxidative injury in the pathogenesis of diabetic peripheral neuropathy. Targeting the identified pathological axis CYP4A/20-HETE/AMPK may be of clinical potential in predicting and alleviating peripheral nerve injury in patients with Type 2 Diabetes Mellitus.

AB0287 INFLUENCE OF COPING ON RHEUMATOID ARTHRITIS RELATED PAIN

Background

Most patients with rheumatoid arthritis (RA) have chronic pain. Nowadays dealing with pain is no more focused on traditional treatment only.

Objectives

Our study aimed to assess the impact of coping strategies on the chronic pain in RA subjects.

Methods

We performed a 6-month study including patients followed for RA according to ACR / EULAR 2010 criteria. The visual analogue scale (VAS) was used to assess the perception of pain. Coping was assessed by the Brief COPE questionnaire according to which five grouped strategies were identified: Problem solving that includes active coping and planning. Cognitive restructuring that combines humour, acceptance and positive reinterpretation. Support seeking that combines the search for instrumental support, the search for emotional support and religion. Avoidance that includes denial, blame, substance use and behavioural disengagement. Distraction that includes distraction and expression of feelings.

Results

We included 65 RA patients with 58 women and 7 men, the sex ratio was 0, 12 H/F. Mean age of the patients was 58, 6 [24 – 73 years]. Disease duration was superior to 10 years in 66, 2% of patients. RA was immunopositive in 87, 7% of cases and erosive in 83, 1 % of cases. The DAS28 (ESR) was on average 3, 4(IQR 25-75: 2, 8- 4, 6). The average of VAS was 5 ± 2,2. The perception of pain was positively associated with coping strategies based on problem solving, negatively associated to cognitive restructuring and distraction (Table 1).

Table 1.

Impact of coping strategies on chronic pain RA subjects

BpProblem solving0,4110,001Cognitive restructuring-0,3710,002Support seeking-0,0950,452Avoidance0,2430,252Distraction-0,2920,018

Conclusion

Our study revealed that having coping strategies based on problem solving increased the perception of pain whereas strategies based on distraction and cognitive restructuring decreased it.

Disclosure of Interests

None declared

High rate of autonomic neuropathy in Cornelia de Lange Syndrome

Background

Cornelia de Lange Syndrome (CdLS) is a rare congenital disorder characterized by typical facial features, growth failure, limb abnormalities, and gastroesophageal dysfunction that may be caused by mutations in several genes that disrupt gene regulation early in development. Symptoms in individuals with CdLS suggest that the peripheral nervous system (PNS) is involved, yet there is little direct evidence.

Method

Somatic nervous system was evaluated by conventional motor and sensory nerve conduction studies and autonomic nervous system by heart rate variability, sympathetic skin response and sudomotor testing. CdLS Clinical Score and genetic studies were also obtained.

Results

Sympathetic skin response and sudomotor test were pathological in 35% and 34% of the individuals with CdLS, respectively. Nevertheless, normal values in large fiber nerve function studies.

Conclusions

Autonomic nervous system (ANS) dysfunction is found in many individuals with Cornelia de Lange Syndrome, and could be related to premature aging.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13023-021-02082-y.

P–119 The correlation between sperm chromatin fragmentation and intrauterine insemination outcome

Study question

Does sperm genomic integrity affect the intrauterine insemination (IUI) outcomes in couples with unexplained infertility and young maternal age?

Summary answer

Spermatozoa with higher genomic integrity are correlated with higher clinical pregnancy rates in couples with unexplained infertility undergoing IUI.

What is known already

It is known that elevated sperm chromatin fragmentation (SCF) on the male gamete affects embryo development and implantation. This is particularly relevant in IVF as well as programmed intercourse and IUI. By complementing the standard semen analysis with an SCF assay, we can assess the competence of the male gamete and its ability to generate euploid embryos and healthy offspring. Elevated SCF has been used as a way to identify subtle male factor infertility in couples undergoing IUI with poor pregnancy outcomes in order to plan for further treatments.

Study design, size, duration

This is a retrospective cohort study of IUI outcomes of couples with young maternal age and a negative infertility workup treated at our center from 2016–2020. Terminal deoxynucleotidyl dUTP transferase nick-end labeling (TUNEL) assay was used to assess sperm genomic integrity. Couples were grouped based on SCF level: normal (≤15%) or abnormal (>15%). Rates of clinical pregnancy, defined as the presence of a fetal heartbeat, were compared between the groups following IUI.

Participants/materials, setting, methods

A total of 189 consenting couples, in which the female partner had a normal uterine cavity and patent fallopian tubes, underwent 454 IUI attempts. Only women ≤37 years old were included to control for age-related confounding factors. At least 500 spermatozoa were assessed per patient, and a threshold of ≤ 15% was considered normal. Women were either untreated for natural cycle IUI or stimulated with clomiphene citrate, gonadotropins, or Letrozole.

Main results and the role of chance

A total of 454 IUI cycles were reported at our center; 302 of these were carried out in 132 couples in which the male partner had normal SCF averaged at 9.29%. The average maternal age was 34.1±3 years, and the average paternal age was 37.1±5 years. These men had the following semen parameters: a concentration of 46.2±5x106/mL, 43.8±3% motility, and an average SCF of 9.3±3%. There were 45 documented clinical pregnancies (45/302, 14.9%) as confirmed by the presence of at least one fetal heartbeat detected by ultrasound; 26 delivered, 9 are ongoing, 5 were spontaneous abortions, and 5 were lost to follow-up. A total of 57 couples in which the male partner (37.2±5.9 years) had abnormal SCF underwent 152 IUI cycles (maternal age, 34.0±2.7 years). The men had the following semen parameters: an average SCF of 23.8±10 (p < 0.0001), a concentration of 26.0±10 x106/ml, and 40.1±4% motility. These IUI attempts yielded a clinical pregnancy rate of only 4.6% (7/152; P < 0.0001); 4 delivered and 3 were spontaneous abortions.

Limitations, reasons for caution

This study is a retrospective cohort analysis of a relatively small number of patients. Furthermore, most patients were screened for SCF due to at least one prior IUI failure. A prospective, randomized trial, in which men are concurrently screened for SCF levels at the first IUI attempt, would be ideal.

Wider implications of the findings: Assessment of SCF at the initial male infertility screening can be a useful tool to investigate the competence of the male gamete. Screening couples with idiopathic infertility for a subtle male factor would guide those with higher SCF toward alternative reproductive treatments to avoid unnecessary IUI treatments.

Trial registration number

Not applicable

P–118 A sperm selection technique to mitigate paternal contributions to embryo aneuploidy

Study question

Can microfluidic sperm selection (MFSS) select male gametes without sperm chromatin fragmentation (SCF) and double-stranded DNA breaks (dsDNA) in order to generate euploid conceptuses?

Summary answer

Couples treated by ICSI with MFSS had significantly improved embryo ploidy rates and pregnancy outcomes, demonstrating the efficacy of this novel selection method.

What is known already

SCF has been linked to infertility, specifically to embryo developmental and implantation failure. This damage can be both single-stranded (ssDNA) or double-stranded (dsDNA). Recent studies have shown that dsDNA in particular causes chromosomal aberrations and contributes to embryo aneuploidy, which leads to implantation failure.

Study design, size, duration

Consenting couples treated at our center by intracytoplasmic sperm injection (ICSI) with spermatozoa selected by MFSS were included. The majority of these couples had a medical history significant for elevated SCF, recurrent implantation failure, and embryo aneuploidy. ICSI clinical outcome, as well as preimplantation genetic testing for aneuploidy (PGT-A) and frozen embryo transfer (FET), was recorded and compared to the couples’ historical treatments following sperm selection by density gradient centrifugation (DGC).

Participants/materials, setting, methods

From 2016 to 2020, 51 consenting men had their ejaculates screened for SCF levels by terminal deoxynucleotidyl dUTP transferase nick-end labeling (TUNEL) using a commercially available kit. At least 500 spermatozoa were assessed per patient, with a normal threshold of ≤ 15%.

To screen for dsDNA, neutral Comet using a modified in-house protocol was also performed in a pilot study. At least 200 spermatozoa were assessed per patient, with a normal threshold of ≤ 3%.

Main results and the role of chance

A total of 51 men (average age, 41.0±8 years) had mean sperm concentrations of 39.0±33x106/mL, 38.4±12% motility, and 2.1±1% normal morphology. Following DGC and MFSS, the concentrations were 4.7±8 and 4.3±8x106/mL and the motility was 64.0±33 and 98.0±3%, respectively (P < 0.0001). The average SCF decreased from 20.1±18% in the ejaculate to 16±3% following DGC, but was 2.9±4% after MFSS. The dsDNA fell from 3.4±3% in raw specimens to 2.9±1% after DGC, and to only 0.5±0.7% following MFSS (P < 0.0001).

These men underwent ICSI with their female partners (average age, 37.3±4 years), with sperm selected by DGC; they achieved a fertilization rate of 56.4% (337/597) with 26.0% euploid embryos (36/139). FET cycles from these embryos yielded an implantation rate of 8.3% (2/24) and a clinical pregnancy rate (CPR) of 15.4% (2/13), but both miscarried.

These couples then underwent ICSI with MFSS, with a fertilization rate of 78.0% (588/754; P < 0.0001) and 50.0% (172/344; P < 0.0001) euploid embryos after PGT-A. A total of 37 embryos have been replaced, with an implantation rate of 67.6% (25/37; P < 0.0001) and a CPR of 73.5% (25/34; P < 0.001), with an ongoing/delivery rate of 70.6% (24/34; P < 0.0001).

Limitations, reasons for caution

While the oocyte contribution cannot be discounted, MFSS was able to yield spermatozoa that had the highest motility and ability to produce euploid embryos following ICSI.

Wider implications of the findings: The genome and epigenome of the spermatozoon, and their contribution to reproductive outcomes, are being vigorously explored and scrutinized. Alternative approaches to gamete selection, such as MFSS, in couples with elevated SCF and dsDNA provide the best chances for future pregnancies by mitigating embryo aneuploidy.

Trial registration number

Not applicable

O-101 Neospermatogenesis benefits from a three-dimensional culture system

Study question

Does a three-dimensional (3D) culture system increase the efficiency of male germline differentiation of mouse embryonic stem cells (mESC) over a bidimensional method?

Summary answer

Our 3D culture system based on direct spherification proves superior to the standard bidimensional plating in promoting neogametogenesis of mESC into post-meiotic male germ cells.

What is known already

Two-dimensional monolayer cell cultures are common in stem cell research. However, this method does not replicate a physiological 3D spatial relationship and may provide an inaccurate replication of in vivo environments. A 3D spherical structure allows us to mimic the seminiferous tubule, the site of in vivo spermatogenesis. By using spheroids as a scaffold to replicate cell culture systems, we can study spermatogenesis in a controlled setting. Direct spherification, a technique commonly used in molecular gastronomy, provides an opportunity to create spheroids that mimic in vivo events that materialize in the lab

Study design, size, duration

mESCs were initially cultured on a 6-well plate coated with fibroblasts and inserted into sodium alginate spheres. To coax differentiation, spheres (3 to 6 mm in diameter) were plunged directly into differentiation medium (DM) while the control mESC in 6-well dishes were layered with it. Cells obtained from both culture systems were tested by biomarkers for different germ cell stages

Participants/materials, setting, methods

Bidimensional mESC at 80% confluence were differentiated either on a plate or spherified for a 3D culture. Both systems underwent the same timeline of exposure to EpiLC medium with Activin A, bFGF and KSR for 3 days and PGCLC medium with BMP4, LIF, SCF and EGF for 7 days. Differentiated cells were retrieved from each method at day 3 and day 10 to assess for germ line differentiation markers, DAZL, VASA and BOULE

Main results and the role of chance

Under optic visualization through the sphere wall, cellular aggregation was seen on day 2 of culturing in EpiLC medium while this phenomenon was not observed on bidimensional plating. In the conventional method, cells expressed 7% DAZL (spermatogonium cell stage) and 1% VASA (pre-spermatid cell stage) whereas in direct spherification, cells expressed 20% DAZL (P < 0.001) and 15% VASA positivity (P < 0.0001).

To further compare the different methods in later stages of germ-line differentiation, the remaining spheres were cultured in PGCLC medium for 7 days. At day 10, isolated cells were assessed for VASA and DAZL again. In the conventional method, 23% of cells expressed positivity for VASA and 29% DAZL whereas direct spherification achieved a positivity rate of 43% for VASA (P < 0.005) and 45% for DAZL (P < 0.005). This increased expression in both VASA and DAZL signify the increased number of cells undergoing germline differentiation.

Additionally, BOULE was assessed for the presence of meiotic cells such as the spermatocyte. The conventional method yielded < 1% BOULE positivity whereas in direct spherification, there was 10% positivity (P < 0.005).

Direct spherifcation result shows that differentiation almost doubled in comparison to the conventional method, yielding more post-meiotic cells in the same amount of time

Limitations, reasons for caution

Despite a higher differentiation rate in direct spherification, these cells would still need to be tested for their fertilization potential. The ability to achieve fertilization, blastocysts and live pups would provide final proof and reliability of this method of neogametogenesis

Wider implications of the findings

Differentiating ESCs through direct spherification provides an alternative to studying intercellular relationships. This provides an opportunity to study spermatogenesis in more detail by replicating the microenvironment of the seminiferous tubule. Once embryo developmental competence of the de novo gamete is confirmed, this may open a new chapter in human reproduction

Trial registration number

N/A

P–120 Selecting spermatozoa with the highest genomic integrity in order to enhance clinical outcomes in men with high DNA fragmentation levels

Study question

What are the best methods of selecting spermatozoa with the highest genomic integrity in order to improve embryo implantation and term pregnancy rates with ICSI?

Summary answer

Testicular or ejaculate spermatozoa isolated by microfluidic sperm selection (MFSS) were characterized by superior genomic integrity with improved clinical pregnancy and delivery rates.

What is known already

In couples with unexplained infertility, a subtle male factor can often be identified. Both single-strand (ss) and double-strand (ds) DNA nicks and breaks hinder the ability of the male gamete to support embryonic development. Surgical retrieval of spermatozoa from the proximal male genital tract can prevent their exposure to oxidative stress. Moreover, use of membrane-based microfluidics chips has been shown to allow for selection of the most progressively motile spermatozoa with higher genomic integrity.

Study design, size, duration

Over the course of 48 months, 86 consenting men presenting with high sperm chromatin fragmentation (SCF) in their ejaculate with prior ART failure underwent a subsequent cycle with specimens retrieved by testicular biopsy or ejaculate processed by MFSS. A concurrent TUNEL assay was performed on samples collected or selected by each method. Sperm specimens of both origins were utilized for ICSI cycles. Semen parameters, chromatin integrity, and pregnancy outcomes were compared between the two methods.

Participants/materials, setting, methods

Fresh ejaculates from consenting men were collected for standard semen analysis (WHO 2010). Testicular biopsy and MFSS were used to isolate spermatozoa with a higher genomic integrity after previous ART failure. SCF was assessed by terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) on at least 500 spermatozoa under a fluorescent microscope with a threshold of ≥ 15%. MFSS was carried out by Zymot® chips. ICSI was performed in the standard fashion.

Main results and the role of chance

A total of 86 men (36.5±5 years) had the following semen parameters: volume of 2.6 ±1mL, concentration of 27.0±33 x 106/mL, 35.6±15% motility, and high SCF (24.1±10%). They underwent 146 ICSI cycles with their partners (maternal age, 33.7±3) resulting in a high incidence of pregnancy loss (100%; 13/13). Of those who failed to conceive, 22 couples used surgically retrieved spermatozoa (SRS) with a concentration of 1.8 ± 4 x 106/mL (P < 0.01), 5.0±11% motility (P < 0.01), and an SCF of 12.6 ± 6% (P < 0.0001). SRS was used in 37 ICSI cycles, yielding a fertilization rate of 61.6% (204/331, P < 0.01), an implantation rate of 10.6% (9/85, P < 0.01), a CPR of 23.5% (8/34, P < 0.01), and a delivery rate of 17.6% (6/34, P < 0.01). Another 24 couples underwent ICSI cycles with ejaculated spermatozoa processed by MFSS with a concentration of 1.8±3 x 106/mL (P < 0.01), but an increased motility of 99±1% (P < 0.01) and an SCF of 1.2 ±1%, lower than both the raw and testicular specimens (P < 0.0001). MFSS-processed specimens resulted in a fertilization rate of 76% (335/441, P < 0.01), an implantation rate of 26.3% (15/57, P < 0.05), and a CPR of 67.9% (19/28, P < 0.01), of which 15 patients delivered and 2 pregnancies are ongoing (89.5%; P < 0.01).

Limitations, reasons for caution

This is a preliminary study on a small number of subjects. A randomized prospective study conducted on a larger cohort would be required to confirm our findings.

Wider implications of the findings: SCF severely affects pregnancy by impairing embryonic development, consequently promoting implantation failure. While retrieving spermatozoa from the germinal epithelium is a viable option, MFSS provides an alternative. Although MFSS requires an adequate number of sperm with good kinetic characteristics, it provides a more palatable option, reducing surgical risk and costs.

Trial registration number

Not applicable

Targeting the NADPH Oxidase-4 and Liver X Receptor Pathway Preserves Schwann Cell Integrity in Diabetic Mice

Diabetes triggers peripheral nerve alterations at a structural and functional level, collectively referred to as diabetic peripheral neuropathy (DPN). This work highlights the role of the liver X receptor (LXR) signaling pathway and the cross talk with the reactive oxygen species (ROS)-producing enzyme NADPH oxidase-4 (Nox4) in the pathogenesis of DPN. Using type 1 diabetic (T1DM) mouse models together with cultured Schwann cells (SCs) and skin biopsies from patients with type 2 diabetes (T2DM), we revealed the implication of LXR and Nox4 in the pathophysiology of DPN. T1DM animals exhibit neurophysiological defects and sensorimotor abnormalities paralleled by defective peripheral myelin gene expression. These alterations were concomitant with a significant reduction in LXR expression and increase in Nox4 expression and activity in SCs and peripheral nerves, which were further verified in skin biopsies of patients with T2DM. Moreover, targeted activation of LXR or specific inhibition of Nox4 in vivo and in vitro to attenuate diabetes-induced ROS production in SCs and peripheral nerves reverses functional alteration of the peripheral nerves and restores the homeostatic profiles of MPZ and PMP22. Taken together, our findings are the first to identify novel, key mediators in the pathogenesis of DPN and suggest that targeting LXR/Nox4 axis is a promising therapeutic approach.

Ruthenium-Catalyzed, Microwave-Mediated [2+2+2] Cycloaddition: A Useful Combination for the Synthesis of 2-Aminopyridines

A ruthenium-catalyzed [2+2+2] cycloaddition between α,ω-diynes and cyanamides is reported under microwave irradiation to access 2-aminopyridines. In contrast to the classical thermal conditions, this atom-economical sustainable protocol allows access to diverse functionalized 2-aminopyridine derivatives with high yields and excellent regioselectivities in MeTHF with short reaction times.

Decreased amplitude of surface electromyo- graphic recordings of muscle activation along the posterior myofascial kinematic chain in subjects with chronic nonspecific low back pain compared to healthy subjects

BACKGROUND

The concept of myofascial continuity suggests that muscles activate along kinematic chains with common fascial coverings. Yet, the literature lacks evidence in regards to the function of anatomical chains in populations suffering from low back pain (LBP).

OBJECTIVE

To examine muscle activations along the superficial back line in LBP patients compared to healthy controls.

METHODS

The sample study included 20 males with chronic LBP (mean age 28.7 (± 3.05) years, mean BMI 24.91 (± 2.76)) and 17 healthy controls (mean age 31.06 (± 7.76) years, mean BMI 23.46 (± 3.43)). Muscle activation (gastrocnemius, hamstrings, erector spine, and upper trapezius) along the superficial back line was measured using surface EMG. All subjects underwent five test conditions: Conditions 1-3 involved passive movement, active movement and active movement against maximum isometric resistance of the right gastrocnemius muscle. Conditions 4 and 5 involved neck extension without and with isometric resistance from the prone position. The main outcome was relative muscle activation amplitude between research and control subjects.

RESULTS

Muscle activation along the posterior anatomical chain was observed during distal movement (plantar flexion or neck extension). LBP patients showed significant lower muscle activation in the erector spine of lower back region compared with the control group during active plantar flexion and active neck extension (p< 0.05). Lower muscle activation in other regions (gastrocnemius, hamstrings, erector spine level T6) was observed in the research group (although not significant).

CONCLUSION

LBP may cause or result in a lower muscle activation of the posterior kinematic myofascial chain muscles.

Endoscopic injection of bulking agent around the ejaculatory ducts at the verumontanum for recurrent paediatric epididymitis

INTRODUCTION

Paediatric recurrent epididymitis is frequently observed in several urogenital conditions, and may result in deterioration of long-term fertility. The management of recurrent epididymitis is still a therapeutic challenge for paediatric urologists, and as yet there is no consensus for treatment.

OBJECTIVE

To present a minimally invasive endoscopic approach for the treatment of recurrent epididymitis (more than three episodes).

PATIENTS AND METHODS

Eleven boys were referred with a history of recurrent epididymitis in a context of urogenital malformations. All children underwent endoscopic transurethral injection. Dextranomer/hyaluronic acid was injected around the ejaculatory ducts at the verumontanum (Summary Fig.). The medical records and outcomes of the patients were retrospectively reviewed.

RESULTS

Of the 11 boys, two (18%) had a history of bladder exstrophy, three (27%) anorectal malformation, two (18%) peno-scrotal hypospadias, two (18%) posterior urethral valves, one (9%) seminal vesicle cyst, and one (9%) urethral stricture. The median age at injection was 3.75 years (range 8 months-14.7 years). Endoscopic injection effectively prevented recurrence in eight patients (73%) with a mean follow-up of 3 years (range 6 months-8.8 years). The mean injected volume was 0.7 ml/session. No perioperative complications were recorded. Vas clipping was performed in three patients after unsuccessful injections.

DISCUSSION

The current discussion for management of recurrent epididymitis is mainly based on vas clipping. Endoscopic injection in the verumontanum could offer several potential advantages over vas clipping; moreover, it is easy to perform for an urologist who usually uses endourological approaches. It is believed that only Kajbafzadeh et al. have reported their experience with endoscopic injection in the verumontanum in seven patients with structural anomalies, and they had a 42% success rate. Similarly, the current study did not observe perioperative or postoperative complications.

CONCLUSION

In this series, endoscopic injection of the verumontanum was considered to be a safe and effective treatment in almost 73% of children with recurrent epididymitis. It did not result in perioperative complications and not contraindicate a subsequent surgical procedure such as vas clipping.

A Practical Access to Functionalized Alkyl Sulfinates

We describe herein a three-step synthesis of aliphatic sulfinates. This cost-effective method involves the use of 2-mercaptobenzothiazole under mild conditions and exhibits good yields (up to 78% over three steps). This approach provides an access to a wide range of functionalized sulfinates. A good tolerance with respect to diverse functional groups (alkene, alkyne, ether, acetal) was also noted.

Exploring avenues for best use of cytotechnologists in non-gynaecological cytology: Double screening or independent sign-out

OBJECTIVE

Cytotechnologist (CT) screening workload has been decreasing due to the falling number of Papanicolaou tests. This continuing trend has prompted exploration of ways to best employ the CT skillset. One potential way of more effective use is by having two CTs double screen non-gynaecological (NGC) cases to assess whether this improves screening quality and concordance with pathologists. Another is evaluating the CT's performance on low-complexity negative NGC cases for a potential independent CT sign-out without pathologist review.

METHODS

In total, 1119 NGC cases were reviewed; 577 screened by two CTs and 542 screened by one CT. All cases were signed out by a pathologist and all CT interpretations were compared to the pathologist final diagnoses. The disagreements were classified based on degree of discrepancy. The extra workload by adding the second screener was assessed.

RESULTS

The agreement rate between the CT's screening interpretation and pathologist's interpretation did not improve by adding a second CT compared to a single screener (91.5% vs 92.9%, respectively). CT to pathologist concordance was very high on low complexity NGC cases (voided urine, fluid, sputum) whether screened and interpreted as negative by one CT (97.3%) or two CTs (99.3%).

CONCLUSION

Double screening of NGC cases by two cytotechnologists prior to pathologist sign-out does not improve screening quality and is not cost-effective. The high concordance between the CTs and pathologists in this limited group of low complexity negative cases suggests that such cases could be signed out independently by cytotechnologists.

Field Hospital Concept Is Rooted in Relevancy

Since the very beginning of his papacy, Pope Francis has provided a field day for the media. With well over 10 million people following him on Twitter, it is no wonder that many of his statements have become quotable quotes. One in particular has garnered much attention: “I see clearly that what the Church needs today is the ability to heal wounds and to warm the hearts of the faithful; it needs nearness, proximity [to the people]. I see the Church as a field hospital after a battle.”

The diagnostic yield of ultrasound of the head in healthy infants presenting with the clinical diagnosis of benign macrocrania

AIM

To investigate the frequency of sonographic findings that required neurosurgical consultation for all referred outpatients suspected to have benign macrocrania (BMC).

MATERIALS AND METHODS

A retrospective review was performed from September 2011 until June 2015 for all outpatients referred to the ultrasound (US) department for BMC. Electronic medical records, US images, and reports were reviewed in conjunction with follow-up imaging. Each review consisted of gender, specialty of referring physician, first head circumference, head circumference at or closest to the time of the head US, the last head circumference, and any neurological issue prior to the US, at the time of US, or following the US, and clinical outcomes. Statistical analysis employed the Kruskal-Wallis rank sum test and Fischer's exact test (chi square test of independence) that compared normal/BMC patients from the patients requiring a neurosurgical consultation.

RESULTS

One hundred and thirty (40.9%) had a normal head US, 181 patients (56.9%) had sonographic findings of BMC, and seven (2.2%) patients had an abnormal head US that required a neurosurgical consultation. Of the 181 patients with BMC, 23 underwent follow-up imaging with 22 patients having unchanged BMC or a normal head US and one patient developing mild ventriculomegaly that was stable on follow-up imaging. Three of the seven patients (1%) aged 1.8, 2.3, and 13.1 months with abnormal head US requiring neurosurgical consultation, had mild ventriculomegaly that was stable on follow-up imaging. Four of the seven patients (1.2%) that required neurosurgical consultation needed a neurosurgical procedure. Between the two US subgroups (normal and BMC), no statistical significance was noted regarding age of patient at US, head circumference at clinical and radiological presentation (p>0.05) except for the first head circumference clinically documented which demonstrated statistical significance (p<0.03).

CONCLUSION

Short interval surveillance including head circumference and assessment for the development of bulging anterior fontanelle and neurological abnormalities may be more cost effective than US in the initial evaluation of patients clinically suspected to have BMC.

Greater effects of high- compared with moderate-intensity interval training on cardio-metabolic variables, blood leptin concentration and ratings of perceived exertion in obese adolescent females

This study examined the effects of high- vs. moderate-intensity interval training on cardiovascular fitness, leptin levels and ratings of perceived exertion (RPE) in obese female adolescents. Forty-seven participants were randomly assigned to one of three groups receiving either a 1:1 ratio of 15 s of effort comprising moderate-intensity interval training (MIIT at 80% maximal aerobic speed: MAS) or high-intensity interval training (HIIT at 100% MAS), with matched 15 s recovery at 50% MAS, thrice weekly, or a no-training control group. The HIIT and MIIT groups showed improved (p < 0.05) body mass (BM), BMI Z-score, and percentage of body fat (%BF). Only the HIIT group showed decreased waist circumference (WC) (p = 0.017). The effect of exercise on maximal oxygen uptake (VO2max) was significant (p = 0.019, ES = 0.48 and p = 0.010, ES = 0.57, HIIT and MIIT, respectively). The decrease of rate-pressure product (RPP) (p < 0.05, ES = 0.53 and ES = 0.46, HIIT and MIIT, respectively) followed the positive changes in resting heart rate and blood pressures. Blood glucose, insulin level and the homeostasis model assessment index for insulin decreased (p < 0.05) in both training groups. Significant decreases occurred in blood leptin (p = 0.021, ES = 0.67 and p = 0.011, ES = 0.73) and in RPE (p = 0.001, ES = 0.76 and p = 0.017, ES = 0.57) in HIIT and MIIT, respectively. In the post-intervention period, blood leptin was strongly associated with %BF (p < 0.001) and VO2max (p < 0.01) in the HIIT and MIIT groups, respectively, while RPE was strongly associated with BM (p < 0.01) in the HIIT group. The results suggest that high-intensity interval training may produce more positive effects on health determinants in comparison with the same training mode at a moderate intensity.