Relationship between serum reproductive hormones and sperm parameters and surgical outcomes in Micro-TESE / 现代泌尿外科杂志

【Objective】 To investigate the relationship between serum reproductive hormones and sperm parameters and outcomes of micro-testicular sperm extraction (Micro-TESE). 【Methods】 Clinical data of 1 091 patients treated in our hospital during Jan. and Dec.2021 were retrospectively analyzed. According to the sperm concentration,the patients were divided into non-obstructive azoospermia (NOA) group (group A,n=418),normal sperm concentration group (group B,n=615),mild to moderate oligospermia group (group C,n=18),severe oligospermia group (group D,n=18),and obstructive azoospermia group (group E,n=22). In group A,244 cases treated with Micro-TESE were grouped into the sperm-acquired group (Micro-TESE positive group,n=82) and non-sperm-acquired group (Micro-TESE negative group,n=162),and according to the pathological types of testicular tissue,the patients were divided into normal testicular tissue with hypospermatogenesis group (HYPO group,n=129),maturation arrest group (MA group,n=10),and support-only cell syndrome group (SCO group,n=122). Differences in semen parameters and reproductive hormone levels were compared,and relationship between reproductive hormones and sperm parameters and Micro-TESE outcomes was determined with Pearson correlation analysis. 【Results】 In the sperm concentration subgroup,the testicular volume of group A was lower than that of group B and group E (P<0.05); the levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) in group A were the highest (P<0.05),but the level of testosterone (T) was the lowest (P<0.05); the levels of anti-mullerian hormone (AMH) and serum inhibin B (INHB) in group A were lower than those in group B and group E (P<0.05),the normal sperm morphology rate in group B was higher than that in group A and group E (P<0.05); the percentage of forward moving sperm in group B was the highest (P<0.05). Pearson correlation analysis revealed that sperm concentration,normal sperm morphology rate,and percentage of forward moving sperm were negatively correlated with age,FSH,LH (P<0.05),and positively correlated with testicular volume,T,AMH,and INHB (P<0.05). NOA patients were grouped according to testicular histology and pathology. The INHB in the SCO group was the smallest of the three groups (P<0.05); the FSH and LH levels in the SCO group were higher than those in the MA group (P<0.05),while the 17β-estradiol (E2) levels in the HYPO group were higher than those in the SCO group (P<0.05). NOA patients were grouped according to the results of Micro-TESE surgical treatment. There was a statistically significant difference in AMH and INHB levels between the Micro-TESE positive and negative groups (P<0.05). The binary logistic regression analysis of factors affecting the Micro-TESE outcomes of NOA patients showed AMH was negatively correlated with the Micro-TESE outcome (OR=0.904,95%CI:0.91-1.08,P<0.05). 【Conclusion】 Age,FSH,LH,AMH,and INHB are correlated with sperm concentration,normal sperm morphology rate,and percentage of forward moving sperm. The INHB level was the lowest in the SCO group. The results of Micro-TESE in patients with NOA can be predicted by serum AMH level.

Comparison of the Effects of Single Sperm Cryopreservation and Conventional Cryopreservation on Embryo Culture and Pregnancy in Patients Undergoing Micro-TESE / 中山大学学报(医学科学版)

ObjectiveTo compare the effects of single sperm cryopreservation and conventional cryopreservation on embryo culture and pregnancy in patients undergoing microdissection testicular sperm extraction （micro-TESE）. MethodsA retrospective analysis was done on the patients who underwent micro-TESE at the Reproductive Medicine Center in the Sixth Affiliated Hospital of Sun Yat-Sen University between January 2018 and December 2021. The single sperm cryopreservation group included 39 patients undergoing single sperm cryopreservation and 307 MII oocytes. The conventional cryopreservation group included 39 patients undergoing conventional cryopreservation and 410 MII oocytes. Propensity score matching （PSM） was performed to balance the selection bias. The fertility rate， embryo culture and pregnancy of these two groups were compared. ResultsThere was no statistical difference in age， body mass index （BMI）， years of infertility， basal FSH， basal LH， basal E2， AMH， AFC， number of oocytes retrieved and number of transferred embryos between the two groups （P>0.05）. No significant difference was found in fertilization rate （65.8% vs. 60.49%）， available embryo rate （67.82% vs. 58.87%） and high-quality embryo rate （70.80% vs. 75.34%）. The single sperm cryopreservation group had significantly lower clinical pregnancy rate than conventional cryopreservation group （45.45% vs. 70.0%， P=0.049）. ConclusionIf the patients undergoing micro-TESE have very few sperms， single sperm cryopreservation could be an effective choice to increase the utilization of each sperm and ensure the subsequent sperm retrieval after thawing， but the clinical pregnancy rate is decreased. Due to the limited number of cases， we need a large additional number of cases to observe and analyze.

Outcomes of surgical sperm retrieval for non-obstructive azoospermia: A single-center experience

INTRODUCTION@#To evaluate the sperm retrieval rate and factors influencing its success among patients who undergo conventional or microsurgical testicular sperm extraction (TESE) for non-obstructive azoospermia.@*METHODS@#Data were from 223 consecutive patients who underwent conventional or microsurgical TESE from August 2011 to January 2021 under two urologists of the center. Data regarding age, follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, estradiol, testicular size, histopathology, surgical technique, and sperm retrieval were collected. Patients with obstructive azoospermia, repeated TESE procedure, and those who underwent TESE for oncofertility were excluded. Using simple logistic regression analysis, the relationship of the different factors to successful sperm retrieval was computed as odds ratio.@*RESULTS@#The overall surgical sperm retrieval rate was found to be 65.71%. The odds ratio of successful sperm retrieval were 1.04 (95% CI 1.00-1.09) for age, 0.94 (95% CI 0.91-0.97) for FSH, 0.93 (95% CI 0.87-0.99) for LH, 1.24 (95% CI 0.99-1.55) for testosterone, and 0.93 (95% CI 0.88-0.98) for estradiol. Decreased testicular size was also associated significantly with lower sperm retrieval rate (OR 0.22, 95% CI 0.09-0.56). Histopathologic pattern and surgical technique were also significantly associated with successful sperm retrieval.@*CONCLUSION@#The surgical sperm retrieval rate in this institution is comparable to the global surgical sperm retrieval rate. Age, FSH, LH, estradiol, testicular size, histopathologic pattern and surgical technique were found to have significant association to successful surgical sperm retrieval.

The relationship between performance and well-being at work: a systematic review of 20 years and future perspectives in Brazil / A relação entre desempenho e bem-estar no trabalho: uma revisão sistemática de 20 anos e perspectivas futuras / La relación entre desempeño y bienestar en el trabajo: una revisión sistemática de 20 años y perspectivas futuras

The pursuit of high levels of performance and well-being at work is a shared goal in societies nowadays. The happy-productive worker thesis (HPWT) proposes a positive relationship, where "happy" workers will perform better than "unhappy" workers. However, other relationships found in the literature have encouraged a revision of this thesis. This systematic review aims to understand better how the relationship between performance and well-being has been analyzed in Brazil during the last 20 years. Results obtained with the review of 26 studies, revealed that most of them reported a synergic or positive and unidirectional relationship consistent with the HPWT. However, we also found support for null and antagonist relationships and differences in the types of operationalizations studied. We discuss that this area of study should adopt a broader perspective to understand the complexity of the relationships between both constructs, and we propose future research directions.

A busca de altos níveis de desempenho e bem-estar no trabalho é um objetivo comum nas sociedades atuais. A tese do trabalhador feliz-produtivo (HPWT) propõe uma relação positiva, onde trabalhadores "felizes" terão um desempenho melhor do que trabalhadores "infelizes". No entanto, outras relações encontradas na literatura têm incentivado a revisão desta tese. Esta revisão sistemática visa entender melhor como a relação entre desempenho e bem-estar tem sido analisada no Brasil durante os últimos 20 anos. Os resultados obtidos com a revisão de 26 estudos, revelaram que a maioria deles relatou uma relação sinérgica, positiva e unidirecional consistente com o HPWT. Entretanto, também encontramos apoio para relações nulas e antagônicas e diferenças nos tipos de operacionalizações estudadas. Discutimos que esta área de estudo deveria adotar uma perspectiva mais ampla para entender a complexidade das relações entre os dois constructos, e propomos direções de pesquisa futuras.

La búsqueda de altos niveles de desempeño y bienestar en el trabajo es un objetivo compartido en las sociedades actuales, por lo que entender las relaciones entre esos constructos es clave en la investigación laboral. La tesis del trabajador feliz y productivo (HPWT) propone una relación positiva entre ellos, en que los trabajadores "felices" presentarán un mejor desempeño que los "infelices". Sin embargo, otras relaciones encontradas en la literatura han estimulado la revisión de esa tesis. Esta revisión sistemática tiene como objetivo comprender mejor cómo se ha analizado la relación entre el desempeño y el bienestar en Brasil durante los últimos 20 años. Los resultados obtenidos con la revisión de 26 estudios revelaron que la mayoría reportó una relación sinérgica, positiva y unidireccional consistente con la HPWT. Además, se encontró apoyo a la existencia de relaciones nulas y antagónicas, y diferencias en los tipos de operacionalización de los constructos. Se concluye que esta área de estudio debería adoptar una perspectiva más amplia para comprender la complejidad de las relaciones entre los dos constructos y se proponen caminos para la investigación futura.

Determining an optimal cut-off value for follicle-stimulating hormone to predict microsurgical testicular sperm extraction outcome in patients with non-obstructive azoospermia

ABSTRACT Objective To determine the optimal cut-off value for follicle stimulating hormone (FSH) to predict the outcome of microsurgical testicular sperm extraction (micro-TESE) in patients with nonobstructive azoospermia (NOA). Subjects and methods We included a total number of 180 patients with NOA. The serum level of FSH was determined and all the subjects underwent micro-TESE. We determined the optimal cut-off value for FSH and assessed whether the test could be effectively used as a successful predictor of sperm retrieval by calculating the Receiver Operating Characteristic (ROC) area under the curve. Results Overall we included a total number of 171 patients with mean age of 34.3 ± 8.6 years. The micro-TESE was considered to be successful in 79 (43.8%) while it failed in 92 (56.2%) patients. We found that the mean level of serum FSH was significantly higher in group those with failed micro-TEST compared to successful group (p < 0.001). The cut-off value for FSH was calculated to be 14.6 mIU/mL to predictive the outcome of micro-TESE with a sensitivity of 83.5% [73.5%-90.9%] and a specificity of 80.3% [69.5%-88.5%]. At this value, the other parameters were calculated to be PPV, 81.5%; NPV, 82.4; LR+, 4.23; and LR-, 0.21. Conclusions The results of the current study indicate that FSH plasma levels above 14.6 mIU/mL can be considered to be the failure predictor of the micro-TESE in NOA patients.

Sperm fine-needle aspiration (FNA) mapping after failed microdissection testicular sperm extraction (TESE): Location and patterns of found sperm / 亚洲男科学杂志(英文版)

We sought to evaluate the ability of fine-needle aspiration (FNA) mapping to find sperm and to guide sperm retrieval after failed microdissection testicular sperm extraction (micro-TESE) in nonobstructive azoospermic men. In this study of consecutive male infertility cases, interventions included testicular FNA mapping and subsequent sperm retrieval. Outcomes included the frequency and location of found sperm on FNA maps after failed micro-TESE and the salvage sperm retrieval success. Among 548 patients undergoing FNA mapping from 2010 to 2016, 82 men with previous micro-TESE procedures were identified. The mean time between micro-TESE and FNA mapping was 2.2 years. A total of 2825 (1424 on right and 1401 on left) sites were mapped. At least one site revealed mature sperm in 24 (29.3%) of 82 men with prior failed micro-TESE procedures. There was an equal likelihood of detecting sperm in either testis (6.1% right; 5.7% left; P = 0.58). Digital 'heat maps' revealed differences in sperm findings within the testis with mature sperm more likely found in the testis periphery rather than centrally. Fifteen (62.5%) patients subsequently underwent sperm retrieval procedures guided by FNA maps. Sufficient sperm were retrieved in all cases, and in 10 (66.7%) of 15 cases, extra sperm were frozen for future use. In a significant proportion of failed micro-TESE procedures representing the largest study to date, sperm were detected by FNA mapping and could be reliably retrieved through FNA map-guided surgical sperm retrieval. When present, sperm were more likely to be found in the testis periphery rather than centrally with FNA mapping.

Predictive value of FSH, testicular volume, and histopathological findings for the sperm retrieval rate of microdissection TESE in nonobstructive azoospermia: A meta-analysis / 亚洲男科学杂志(英文版)

We performed this meta-analysis to evaluate the predictive value of different parameters in the sperm retrieval rate (SRR) of microdissection testicular sperm extraction (TESE) in patients with nonobstructive azoospermia (NOA). All relevant studies were searched in PubMed, Web of Science, EMBASE, Cochrane Library, and EBSCO. We chose three parameters to perform the meta-analysis: follicle-stimulating hormone (FSH), testicular volume, and testicular histopathological findings which included three patterns: hypospermatogenesis (HS), maturation arrest (MA), and Sertoli-cell-only syndrome (SCOS). If there was a threshold effect, only the area under the summary receiver operating characteristic curve (AUSROC) was calculated. Otherwise, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and the diagnostic odds ratio (DOR) were also calculated. Twenty-one articles were included in our study finally. There was a threshold effect among studies investigating FSH and SCOS. The AUSROCs of FSH, testicular volume, HS, MA, and SCOS were 0.6119, 0.6389, 0.6758, 0.5535, and 0.2763, respectively. The DORs of testicular volume, HS, and MA were 1.98, 16.49, and 1.26, respectively. The sensitivities of them were 0.80, 0.30, and 0.27, while the specificities of them were 0.35, 0.98, and 0.76, respectively. The PLRs of them were 1.49, 10.63, and 1.15, respectively. And NLRs were 0.73, 0.72, and 0.95, respectively. All the investigated factors in our study had limited predictive value. However, the histopathological findings were helpful to some extent. Most patients with HS could get sperm by microdissection TESE.

Evaluación de la eficacia de los laboratorios de embriología y anatomía patológica en el análisis de las biopsias testiculares de pacientes azoospérmicos / Evaluation of the Efficacy of the Laboratories of Embryology and Pathological Anatomy in the Analysis of Testicular Biopsies of Patients with Azoospermia

Objetivos: El propósito de este estudio es evaluar la eficacia de los laboratorios de embriología y de anatomía patológica para hallar espermatozoides en las muestras de tejido testicular obtenido por biopsia testicular (testicular sperm extraction, TESE) en pacientes con azoospermia no obstructiva. Materiales y métodos: Se realizó un análisis retrospectivo y prospectivo de todos los pacientes con azoospermia no obstructiva atendidos en CRECER y en la Clínica Privada Pueyrredón, entre enero de 2006 y diciembre de 2016. En este estudio solo se incluyeron aquellos pacientes en los que la muestra obtenida con TESE fue enviada simultáneamente al anatomopatólogo y al laboratorio de embriología. Para el análisis de los resultados de las biopsias el estudio se detuvo a fines de 2016, pero el seguimiento de los pacientes continuó hasta el mes de octubre de 2017, registrándose todos aquellos casos que realizaron procedimientos de inyección intracitoplasmática de espermatozoides (intracytoplasmic sperm injection, ICSI) con muestras obtenidas de TESE y se anotó la obtención de embriones, embarazos y nacimientos. Resultados: El laboratorio de embriología halló espermatozoides en 36 de los 68 pacientes (52,9%), mientras que el laboratorio de patología solo informó presencia en 21 pacientes (30,88%). Hubo acuerdo en el hallazgo de espermatozoides entre ambos laboratorios en 20 de los 68 casos (29,41%), mientras que en 16 pacientes el laboratorio de embriología encontró espermatozoides donde el de patología no pudo hacerlo (23,53%). Al mismo tiempo, el laboratorio de patología halló espermatozoides solo en un caso en el que el de embriología informó su ausencia para la misma muestra analizada (1,47%) (p=0,0003). Conclusiones: El laboratorio de embriología es significativamente más eficaz para determinar la presencia de espermatozoides en las muestras de TESE, teniendo mejor rendimiento que el de patología, por lo que consideramos que, si las muestras fueran analizadas solo por el patólogo, se perdería la posibilidad de lograr muchos embarazos realizando ICSI más TESE.(AU)

Objectives: The purpose of this study is to evaluate the efficacy of embryology and pathological anatomy laboratories to find spermatozoa in testicular tissue samples obtained by testicular sperm extraction (TESE) in patients with non-obstructive azoospermia. Materials and methods: It was carried out a retrospective and prospective analysis of all the patients with non-obstructive azoospermia treated at CRECER and at Clínica Privada Pueyrredón, between January 2006 and December 2016. This study only includes patients in whom the sample obtained with TESE was sent at the same time to the pathology and embryology laboratory. For the analysis of the results of the biopsies, the study was stopped at the end of 2016, but the follow-up of the patients continued until October 2017, registering all those cases that performed intracytoplasmic sperm injection (ICSI) with samples obtained from TESE and wrote down the patients who´ve got embryos, pregnancies, and births. Results: The embryology laboratory found sperm in 36 of the 68 patients (52.9%), while the pathology laboratory only reported presence in 21 patients (30.88%). There was agreement in the finding of sperm between both laboratories in 20 of the 68 cases (29.41%), while in 16 patients the embryology laboratory found sperm where the pathology department could not do so (23.53%). At the same time, the pathology laboratory found sperm only in one case in which the embryology department reported its absence for the same sample analyzed (1.47%) (p=0.0003). Conclusions: The embryology laboratory is significantly more efficient to determine the presence of sperm in the samples of TESE, having better performance than the pathology one. Taking into account that, we believe that if the samples are only analyzed by the pathologist, the possibility of getting many pregnancies performing ICSI plus TESE would be lost. (AU)

Sperm fine-needle aspiration (FNA) mapping after failed microdissection testicular sperm extraction (TESE): location and patterns of found sperm / 亚洲男科学杂志(英文版)

We sought to evaluate the ability of fine-needle aspiration (FNA) mapping to find sperm and to guide sperm retrieval after failed microdissection testicular sperm extraction (micro-TESE) in nonobstructive azoospermic men. In this study of consecutive male infertility cases, interventions included testicular FNA mapping and subsequent sperm retrieval. Outcomes included the frequency and location of found sperm on FNA maps after failed micro-TESE and the salvage sperm retrieval success. Among 548 patients undergoing FNA mapping from 2010 to 2016, 82 men with previous micro-TESE procedures were identified. The mean time between micro-TESE and FNA mapping was 2.2 years. A total of 2825 (1424 on right and 1401 on left) sites were mapped. At least one site revealed mature sperm in 24 (29.3%) of 82 men with prior failed micro-TESE procedures. There was an equal likelihood of detecting sperm in either testis (6.1% right; 5.7% left; P = 0.58). Digital "heat maps" revealed differences in sperm findings within the testis with mature sperm more likely found in the testis periphery rather than centrally. Fifteen (62.5%) patients subsequently underwent sperm retrieval procedures guided by FNA maps. Sufficient sperm were retrieved in all cases, and in 10 (66.7%) of 15 cases, extra sperm were frozen for future use. In a significant proportion of failed micro-TESE procedures representing the largest study to date, sperm were detected by FNA mapping and could be reliably retrieved through FNA map-guided surgical sperm retrieval. When present, sperm were more likely to be found in the testis periphery rather than centrally with FNA mapping.

O que seria uma tese barthesiana? / What would be a barthesian thesis? / ¿Qué sería una tesis barthesiana?

A partir de textos inéditos de Roland Barthes (principalmente a dissertação sobre Ésquilo, os numerosos trabalhos doutorais inacabados e as anotações para o seminário sobre “Os problemas da tese e da pesquisa”), definimos as características de uma tese barthesiana: 1) ela não tem necessariamente um tema, seu objetivo é fabricar um objeto; 2) ela abandona seu método durante o percurso; 3) ela é desgraciosa, mas procura mesmo assim seduzir; 4) é uma maneira específica de orientar o desejo.

From several unpublished texts (mainly the dissertation about Ésquilo, the numerous unfinished doctorals works and the notes for the seminary on "The problems of the thesis and research"), we defined the characteristics of a barthesian thesis: 1) it doesn't necessarily have a theme, it's objective is to fabricate an object; 2) it abandons it's method during the course; 3) it is ungraceful, but even so seeks to seduce; 4) it is a specific way to orient the desire.

A partir de diversos textos inéditos (principalmente la disertación sobre Esquilo, los numerosos trabajos doctorales inacabados y las anotaciones para el seminario sobre “Los problemas de la tesis y de la investigación”), definimos las características de una tesis barthesiana: 1) no tiene necesariamente un tema, su objetivo es fabricar un objeto; 2) abandona su método durante el recorrido; 3) es desgarbada, pero todavía busca seducir; 4) es una manera específica de orientar el deseo.

Passo a passo de sele‡Æo de componentes prot‚ticos / Step by step of abutment selection

Para as restaura‡ães prot‚ticas implantossuportadas alcan‡arem sucesso com longevidade e previsibilidade, ‚ de fundamental importƒncia a sele‡Æo adequada do sistema de reten‡Æo/conexÆo com o implante. O objetivo deste estudo foi esclarecer e fornecer embasamento cient¡fico aos cirurgiães dentistas para escolha adequada do tipo de restaura‡Æo implantossuportada nas mais variadas situa‡ães cl¡nicas. Segundo a revisÆo da literatura ‚ imprescind¡vel o conhecimento de fatores, como posicionamento do implante, aspectos oclusais, espa‡o interoclusal, requisitos est‚ticos, tecidos moles peri-implantares, necessidade de manuten‡Æo e reversibilidade da restaura‡Æo. Os profissionais da Implantodontia devem atentar para a enorme variedade de componentes prot‚ticos, bem como estarem aptos a realizar sua correta indica‡Æo e utiliza‡Æo.

In order to achieve success with predictability and longevity of implant restorations the proper selection of the retention system is extremely important. The objective of this study was to clarify and provide a scientific basis to guide dentists on the choice of the most appropriate type of implant supported restoration in different clinical situations. According to the literature it is essential to know factors, such as positioning of the implant, occlusal aspects, interocclusal space, aesthetic requirements, peri-implant soft tissues, maintenance and restoration of reversibility, prosthetic components and existing abutments. The professional must consider the variety of prsothetics components available, and be able to prescribe and utilize them properly.

Plastica gengival associada a laminados cerƒmicos para resolu‡Æo est‚tica / Periodontal plastic surgery in association with porcelain veneers for aesthetic resolution

Algumas vezes nos deparamos no consult¢rio com situa‡ães cl¡nicas, nas quais a falta de harmonia no sorriso encontra-se devido a uma grande exposi‡Æo de tecido gengival. Nestes casos o profissional deve ser capaz de realizar uma an lise detalhada dos componentes est ticos e dinƒmicos do sorriso, em busca de um planejamento e tratamento satisfat¢rios, que poder  englobar diferentes especialidades odontol¢gicas. Para estas situa‡ães, a associa‡Æo periodontia/pr¢tese ‚ uma alternativa vi vel a ser proposta ao paciente, que vem sendo utilizada de maneira positiva em busca de uma condi‡Æo est‚tica e funcional favor vel ao paciente, sem deixar de lado os princ¡pios de preserva‡Æo dos tecidos periodontais e da estrutura dent ria remanescente. Diante disso, o objetivo deste trabalho foi descrever um caso cl¡nico no qual a associa‡Æo periodontia/pr¢tese foi proposta para corre‡Æo de sorriso gengival e vestibulariza‡Æo dent ria. Atrav‚s do resultado cl¡nico obtido e a satisfa‡Æo do paciente, podemos entender que o tratamento multidisciplinar envolvendo a associa‡Æo de t‚cnicas periodontais e prot‚ticas em casos com comprometimento est‚tico gengival e dental, ‚ favor vel para alcan‡ar um resultado positivo.

Sometimes we face clinical situations in which the lack of harmony in the smile is caused by a major exhibition of the gingival tissue. In these cases the professional should be able to perform a detailed analysis of the static and dynamic components of the smile, in search of a satisfactory planning and treatment which may include different dental specialties. For these situations, the association of periodontics/prosthesis is a viable alternative that has been used positively in search of an aesthetic and functional condition that benefits the patient, without leaving aside the preservation of periodontal tissues and of the remaining structure of the tooth. Thus, the aim of this study was to describe a case in which the association between these two areas was proposed to correct gummy smile and dental vestibularization. Clinical results and the satisfaction of the patient indicate that this multidisciplinary treatment combining periodontal and prosthetic techniques is favorable to positive results in cases of compromised smile aesthetics due to excessive gum tissue.

Oclusão em pr¢teses implantossuportadas – uma revisÆo de literatura / Occlusion on implant-supported prosthesis – a literature review

Embora a pr¢tese sobre implantes e a pr¢tese sobre dentes naturais compartilhem diversas caracter¡sticas devido ao diferente comportamento biomecƒnico entre os implantes e os dentes, alguns princ¡pios devem ser diferenciados, dentre eles a oclusÆo, pois esta ‚ um dos principais fatores respons veis pelo sucesso da osseointegra‡Æo. Considerando a quantidade de tratamentos poss¡veis de serem realizados com implantes e tendo em vista que ainda nÆo h  um consenso sobre o padrÆo oclusal ideal para essas pr¢teses, o objetivo deste trabalho foi realizar uma revisÆo de literatura, procurando abordar os aspectos oclusais relevantes para o sucesso do tratamento com pr¢teses sobre implantes.

Although implant-supported prosthesis and prosthesis over natural teeth share several characteristics some aspects should be distinguished due to the different biomechanical behavior between implants and teeth. Occlusion is one of these aspects and is one of the main factors responsible for the success of osseointegration. Considering the diversity of treatments that can be performed with implants and aware that there is still no consensus on the ideal occlusal pattern for these prostheses, the objective of the study was to conduct a literature review seeking to address the occlusal aspects relevant to the success of treatment with prosthetic implants.

Performance clínica utilizando implantes curtos: revisão de literatura / Clinical performance using short implants: Literature Review

A reabsor��o �ssea alveolar est� sempre presente ap�s a extra��o dent�ria, tornando invi�vel a utiliza��o de implantes longos em algumas situa��es cl�nicas, principalmente nas regi�es posteriores de maxila e mand�bula. Nos casos cl�nicos onde houve uma perda acentuada das estruturas �sseas, s�o utilizadas cirurgias pr�vias de enxerto �sseo para restabelecimento do volume anat�mico. No entanto, esse procedimento cl�nico proporciona ao paciente maior desconforto ap�s a cirurgia, maior custo econ�mico e maior tempo de tratamento. Uma alternativa para o tratamento visando menor morbidade para o paciente seria a utiliza��o de implantes curtos. O objetivo deste trabalho foi realizar uma revis�o de literatura sobre a utiliza��o dos implantes curtos no tratamento de reabilita��o bucal. Os resultados revelaram que a utiliza��o de implantes curtos � uma solu��o vi�vel para o tratamento dos pacientes que apresentam estruturas �sseas com reabsor��es, desde que sejam respeitados os princ�pios biomec�nicos da implantodontia.

Although bone resorption is always present after tooth extraction, in some clinical situations the use of long implants becomes unfeasible, especially in the posterior maxilla and mandible. In clinical cases with a marked loss of bone structures prior surgeries are needed for restoration of the anatomic volume. However, this clinical procedure gives the patient more discomfort after surgery, greater economic cost and longer duration of treatment. The alternative aimed at lower morbidity for the patient would be the use of short implants. The aim of this study was a literature review on the use of short implants in the treatment of oral rehabilitation. The results indicated that the use of short implants is a viable solution for the treatment of patients presenting bone resorption, whether the biomechanical principles of implantology is considered.

Effects of Y Chromosome Microdeletion on the Outcome of in vitro Fertilization / 대한불임학회지

OBJECTIVE: To determine whether the presence of Y-chromosome microdeletion affects the outcome of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) program. METHODS: Fourteen couples with microdeletion in azoospermic factor (AZF)c region who attempted IVF/ICSI or cryopreserved and thawed embryo transfer cycles were enrolled. All of the men showed severe oligoasthenoteratoazoospermia (OATS) or azoospermia. As a control, 12 couples with OATS or azoospermia and having normal Y-chromosome were included. Both groups were divided into two subgroups by sperm source used in ICSI such as those who underwent testicular sperm extraction (TESE) and those used ejaculate sperm. We retrospectively analyzed our database in respect to the IVF outcomes. The outcome measures were mean number of good quality embryos, fertilization rates, implantation rates, beta-hCG positive rates, early pregnancy loss and live birth rates. RESULTS: Mean number of good quality embryos, implantation rates, beta-hCG positive rates, early pregnancy loss rates and live birth rates were not significantly different between Y-chromosome microdeletion and control groups. But, fertilization rates in the Y-chromosome microdeletion group (61.1%) was significantly lower than that of control group (79.8%, p=0.003). Also, the subgroup underwent TESE and having AZFc microdeletion showed significantly lower fertilization rates (52.9%) than the subgroup underwent TESE and having normal Y-chromosome (79.5%, p=0.008). Otherwise, in the subgroups used ejaculate sperm, fertilization rates were showed tendency toward lower in couples having Y-chromosome microdeletion than couples with normal Y-chromosome. (65.5% versus 79.9%, p=0.082). But, there was no significance statistically. CONCLUSIONS: In IVF/ICSI cycles using TESE sperm, presence of Y-chromosome microdeletion may adversely affect to fertilization ability of injected sperm. But, in cases of ejaculate sperm available for ICSI, IVF outcome was not affected by presence of Y-chromosome AZFc microdeletion. However, more larger scaled prospective study was needed to support our results.

Fertilization, Embryonic Development, and Pregnancy Rate using Fresh and Frozen Testicular Sperm in Hypospermatogenesis / 대한남성과학회지

PURPOSE: This study was performed to assess the fertilization, embryonic development and pregnancy rate using fresh and frozen-thawed testicular sperm from hypospermatogenic patients. MATERIALS AND METHODS: A total of 84 cycles of ICSI were performed with fresh or frozen-thawed testicular sperm frm hypospermatogenesis patients. Of these, 55 cycles(65.5%) were performed with fresh sperm, and 29 cycles(34.5%) were performed with frozen-thawed sperm. Testicular tissue was frozen with the programmed cell freezer(Cryomagic I, Miraebiotech, Seoul, Korea). Fertilization was checked 18-20 hrs after ICSI. Embryo grade was assessed based on the day 2 and day 3 embryo morphology. Embryo grade was scored five groups, and good embryos were classified as grade I to grade II. RESULTS: The total percentage of fertilized embryos was 62.4%, the development of good embryos was 58.8%(290/493), and pregnancy rate was 39.2%(29/74). For fresh sperm, the percentage of fertilized embryos was 65.7%, the percentage of good embryos was 57.6%(204/354) and the pregnancy rate was 34.8%(16/46). For thawed sperm, the percentage of fertilized embryos was 54.4%, the percentage of good embryos was 61.9%(86/139), and pregnancy rate was 46.4%(13/28). Thawed sperm showed a higher percentage of good embryos and higher pregnancy rate than fresh sperm. CONCLUSIONS: In this study we obtained acceptable rates of fertilization and good embryos after ICSI with testicular sperm from hypospermatogenesis patients. Frozen sperm showed higher rates of good embryos and pregnancy than fresh sperm. Therefore both fresh and frozen testicular sperm are effective in ICSI for embryonic development and pregnancy in patients with hypospermatogenesis.

Fertilization, Embryonic Development, and Pregnancy Rate using Fresh and Frozen Testicular Sperm in Hypospermatogenesis / 대한남성과학회지

PURPOSE: This study was performed to assess the fertilization, embryonic development and pregnancy rate using fresh and frozen-thawed testicular sperm from hypospermatogenic patients. MATERIALS AND METHODS: A total of 84 cycles of ICSI were performed with fresh or frozen-thawed testicular sperm frm hypospermatogenesis patients. Of these, 55 cycles(65.5%) were performed with fresh sperm, and 29 cycles(34.5%) were performed with frozen-thawed sperm. Testicular tissue was frozen with the programmed cell freezer(Cryomagic I, Miraebiotech, Seoul, Korea). Fertilization was checked 18-20 hrs after ICSI. Embryo grade was assessed based on the day 2 and day 3 embryo morphology. Embryo grade was scored five groups, and good embryos were classified as grade I to grade II. RESULTS: The total percentage of fertilized embryos was 62.4%, the development of good embryos was 58.8%(290/493), and pregnancy rate was 39.2%(29/74). For fresh sperm, the percentage of fertilized embryos was 65.7%, the percentage of good embryos was 57.6%(204/354) and the pregnancy rate was 34.8%(16/46). For thawed sperm, the percentage of fertilized embryos was 54.4%, the percentage of good embryos was 61.9%(86/139), and pregnancy rate was 46.4%(13/28). Thawed sperm showed a higher percentage of good embryos and higher pregnancy rate than fresh sperm. CONCLUSIONS: In this study we obtained acceptable rates of fertilization and good embryos after ICSI with testicular sperm from hypospermatogenesis patients. Frozen sperm showed higher rates of good embryos and pregnancy than fresh sperm. Therefore both fresh and frozen testicular sperm are effective in ICSI for embryonic development and pregnancy in patients with hypospermatogenesis.

Outcome of Preimplantation Genetic Diagnosis in Patients with Klinefelter Syndrome / 대한불임학회지

OBJECTIVES: Klinefelter syndrome is the most common genetic cause of male infertility and presents with 47, XXY mainly or 46, XX/47, XXY mosaicism. It is characterized by hypogonadism and azoospermia due to testicular failure, however, sporadic cases of natural pregnancies have been reported. With the development of testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI), sperm can be retrieved successfully and ART is applied in these patients for pregnancy. It has been suggested that the risk of chromosome aneuploidy for both sex chromosome and autosome is increased in the sperms from 47, XXY germ cells. Considering the risk for chromosomal aneuploidy in the offspring, preimplantation genetic diagnosis (PGD) could be applied as a safe and more effective treatment option in Klinefelter syndrome. The aim of this study is to assess the outcome of PGD cycles by using FISH for sex chromosome and autosome in patients with Klinefelter syndrome. MATERIALS AND METHODS: From Jan. 2001 to Dec. 2003, PGD was attempted in 8 cases of Klinefelter syndrome but TESE was failed to retrieve sperm in the 3 cases, therefore PGD was performed in 8 cycles of 5 cases (four 47, XXY and one 46, XY/47, XXY mosaicism). In one case, ejaculated sperm was used and in 4 cases, TESE sperm was used for ICSI. After fertilization, blastomere biopsy was performed in 6~10 cell stage embryo and the chromosome aneuploidy was diagnosed by using FISH with CEP probes for chromosome X, Y and 17 or 18. RESULTS: A total of 127 oocytes were retrieved and ICSI was performed in 113 mature oocytes. The fertilization rate was 65.3+/-6.0% (mean+/-SEM) and 76 embryos were obtained. Blastomere biopsy was performed in 61 developing embryos and FISH analysis was successful in 95.1% of the biopsied blastomeres (58/61). The rate of balanced embryos for chromosome X, Y and 17 or 18 was 39.7+/-6.9%. The rate of aneuploidy for sex chromosome (X and Y) was 45.9+/-5.3% and 43.2+/-5.8% for chromosome 17 or 18, respectively. Embryo transfer was performed in all 8 cycles and mean number of transferred embryos was 2.5+/-0.5. In 2 cases, clinical pregnancies were obtained and normal 46, XX and 46, XY karyotypes were confirmed by amniocentesis, respectively. Healthy male and female babies were delivered uneventfully at term. CONCLUSION: The patients with Klinefelter syndrome can benefit from ART with TESE and ICSI. Considering the risk of aneuploidy for both sex chromosome and autosome in the sperms and embryos of Klinefelter syndrome, PGD could be offered as safe and more effective treatment option.

Embryonic Developmental Capacity and Pregnancy Rates of Fertilized Oocytes in IVF, ICSI and TESE-ICSI Cycles / 대한불임학회지

OBJECTIVE: This study was performed to evaluate and compare the embryonic developmental capacity and pregnancy rates in conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) with ejaculated sperm or testicular sperm cycles. MATERIALS AND METHODS: Fertilization was examined in the following morning after IVF (group I), ICSI (group II) or TESE-ICSI cycles (group III). Fertilized oocytes were co-cultured with Vero cells until embryo transfer (ET). On day 2 and 5~7, grades of embryos ( or =4-cell) and blastocysts (BG1, 2, 3 or early) were evaluated. Clinical pregnancy rate was determined by detecting G-sac with transvaginal ultrasonogram. We analyzed the results bychi2 and Student's t-test and considered statistically significant when P value was less than 0.05. RESULTS: Fertilization rate was significantly higher (p<0.05) in group I (79.0+/-21.2%) than in group II and III (56.8+/-21.6% and 36.7+/-25.3%). Cleavage and blastulation rate of group I (95.8+/-13.8% and 59.5+/-25.3%) were significantly higher (p<0.05) than those of group III (83.4+/-18.6% and 40.4+/- 36.5%). Clinical pregnancy rate was significantly higher (p<0.05) in group I and II (40.7% and 41.7%) than that in group III (12.5%). No differences were found in the rates of multiple pregnancy and abortion among three groups. Embryonic implantation rate was higher in group I (15.1+/-20.2%, p<0.05) and II (14.7+/-20.6%, NS) than that in group III (5.1+/-15.6%). However, embryonic implantation rate was increased in ET with blastocyst(s) among three groups. CONCLUSIONS: Fertilized oocytes obtained from TESE-ICSI were harder to be successfully cultured to blastocyst stage for 5~7 days than that from IVF cycles. However, all blastocyst(s) ET increased the embryonic implantation rate equally in IVF, ICSI and TESE-ICSI cycles.

Pregnancy Outcomes after Transfer of Frozen-thawed Embryos following ICSI with Ejaculated, Fresh and Frozen-thawed Testicular Sperm / 대한산부인과학회잡지

OBJECTIVES: This study was performed to evaluate the pregnancy rate following the transfers of frozen- thawed embryos which was derived from intracytoplasmic sperm injection (ICSI) using sperm obtained by ejaculated, testicular sperm extraction (TESE), and frozen-thawed testicular sperm extraction (t-TESE). METHODS: Frozen-thawed embryos were successfully transferred to the patients in 664 cycles among 695 cycles from January 1998 to December 2002, where ICSI was done with various origins of sperm. Subjects were divided into three groups according to the origin of sperm; ejaculated sperm group as a control (n=535), TESE group (n=98) and t-TESE group (n=62). After conventional ICSI, the supernumerary PN stage or developing embryos were cryopreserved by slow freezing protocol with 1, 2-propanediol as cryoprotectant. RESULTS: The survival rate of frozen-thawed embryos was 77.7% (2515/3236) in ejaculated sperm group, 76.6% (441/576) in TESE group and 83.9% (292/348) in frozen-thawed TESE group, respectively. The difference of survival rate of between t-TESE group and other two groups was statistically significant (p<0.01). The good embryo formation rate and positive beta-hCG rate was 46.3% (1164/2515), 28.8% (148/513) in ejaculated sperm group, 49.2% (217/441), 36.6% (34/93) in TESE group and 46.2% (135/292), 34.9% (22/63) in frozen-thawed TESE group, respectively. CONCLUSION: This study demonstrates that comparable pregnancy rate and implantation rate could be achieved after the transfer of frozen-thawed embryos following ICSI using various sources of sperm. As there was no statistically significant difference in pregnacy rate between ICSI with fresh testicular sperm and with frozen-thawed testicular sperm, the sequential cryopreservation of supernumerary testicular sperm and embryos may be a useful method for increasing pregnancy outcome in infertile couples with male factor.