Critical evaluation of two models of flow cytometers for the assessment of sperm DNA fragmentation: an appeal for performance verification / 亚洲男科学杂志(英文版)

Lack of standardized, reproducible protocols and reference values is among the challenges faced when using new or upgraded versions of instruments in reproductive laboratories and flow cytometry. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay combined with flow cytometry routinely used for diagnostic measurement of sperm DNA fragmentation (SDF) is a unique example. Any change in the setting of the standard instrument, including upgrades of hardware or software, can lead to different results and may affect clinicians' decision for treatment. Therefore, we compared TUNEL results of SDF obtained from a standard (C6) flow cytometer with a newer version of the same instrument (C6 Plus) and examined the cutoff, sensitivity, and specificity without calibration (adjustment) and after adjustment. Identical sperm preparation and matched acquisition settings were used to examine the performance of two flow cytometers. The strength of agreement of the results between the two observers was also assessed. After adjustment of the settings, overall concordance became high and the two cytometers showed 100% positive and negative predictive value with 100% area under the curve. The overall correlation coefficient observed between C6 and C6 Plus was highly significant (P < 0.0001; r = 0.992; 95% confidence interval [CI]: 0.982-0.997). After adjustment, the two cytometers showed very high precision of 98% and accuracy of >99%. The interobserver agreement on C6 flow cytometer for the two observers was 0.801 ± 0.062 and 0.746 ± 0.044 for C6 Plus. We demonstrated a strong agreement between the samples tested on the two flow cytometers after calibration and established the robustness of both instruments.

Cor triatriatum sinistrum presenting as cyanotic congenital heart disease: a rare case report

Cor triatriatum is an acyanotic congenital heart disease. We present a rare case of cor triatriatum sinistrum in a 6-month-old female infant who was presented with cyanosis and failure to thrive. The 2D transthoracic echocardiography and the Doppler color flow imaging showed a proximal venous chamber communicating to the distal left atrium through restrictive opening to the low-pressure, distal left atrial chamber. The Saline Contrast Echocardiography confirmed a right-to-left atrial shunt due to a minor atrial septal defect. The defect was caused by a persistent pulmonary hypertension which had raised the right atrial pressure in the infant. To the best of our knowledge, barely any such cases have been reported in the literature so far. Our report highlights the clinical utility of the Saline Contrast Echo in other cases of congenital heart diseases