Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility

Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.

Sperm chromatin and DNA integrity, methyltransferase mRNA levels, and global DNA methylation in oligoasthenoteratozoospermia / 대한생식의학회지

OBJECTIVE: To investigate sperm chromatin/DNA integrity, global DNA methylation, and DNMT mRNA transcription in men with oligoasthenoteratozoospermia (OAT) compared with normozoospermic men. METHODS: Semen samples from 32 OAT patients who comprised the case group and 32 normozoospermic men who comprised the control group were isolated and purified using a standard gradient isolation procedure according to World Health Organization criteria. DNMT1, DNMT3A, and DNMT3B transcripts were then compared between groups using real-time quantitative reverse-transcription polymerase chain reaction. Global DNA methylation in sperm was determined by an enzyme-linked immunosorbent assay. Protamine deficiency and the proportion of apoptotic spermatozoa were evaluated using chromomycin A3 (CMA3), aniline blue (AB), and toluidine blue (TB) staining, as well as the terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. The p-values < 0.05 were considered to indicate statistical significance. RESULTS: Significantly higher proportions of AB+, TB+, CMA3+, and TUNEL+ spermatozoa, as well as DNMT3A and DNMT3B transcription, were found in the OAT group. Positive correlations were detected between sperm parameters, DNA/chromatin damage, and DNMT3A and DNMT3B transcripts. Global DNA methylation was significantly higher in the OAT patients and had a significant correlation with abnormal results of all sperm chromatin integrity tests, but was not associated with DNMT1, DNMT3A, or DNMT3B expression. CONCLUSION: Oligoasthenoteratozoospermic men showed abnormal sperm parameters, abnormal chromatin/DNA integrity, and a higher global DNA methylation rate, as well as overexpression of DNMT mRNA.

Myocutaneous mucormycosis in a diabetic burnt patient led to upper extremity amputation; a case report

Mucormycosis is a rare opportunistic fungal infection that can implicate cranial sinuses, brain, lungs, gastrointestinal tract and skin. Although it can occur in patients with competent and incompetent immunity such as patients with diabetes mellitus, lymphoma, leukemia and burns, but it has an aggressive, malignant and lethal course in patients with incompetent immunity. To enforce the importance of burn in patients with underlaying diseases such as diabetes, we are going to report a rare case of diabetic burnt patient complicated by right upper extremity myocutaneous mucormycosis. We selected this case to emphasis the importance of underlying disease [diabetes mellitus] with cutaneous burn, aggressive treatment of fungal infection in these patients and referring such case to burn center to prevent catastrophic results. A 50-year-old woman was introduced to us after several days of medical and surgical care of right upper extremity and trunk split-thickness burn. Due to gross muscle necrosis of right upper extremity and poor general condition of the patient, she was taken to the operating room that led to right upper extremity amputation and several times of aggressive debridement to save her life. Pathologic report was indicative of mucormycosis. We can conclude from this case that: 1] Burn, even partially thickness and with little body surface area, should be referred to burn center for better care 2] No response to usual medical treatment should make us more sensitive to consider the unusual causes of infection such as fungi 3] Suspected dead tissues should be excised aggressively especially if suspiciousness to wound sepsis and fungal infection is present especially in an immunocompromised patient

Evaluation of sperm retrieval rate with bilateral testicular sperm extraction in infertile patients with azoospermia

Background: About 10% to 15% of infertile men have azoospermia, which could be obstructive or non-obstructive. Diagnostic biopsy from the testis and recently testicular sperm extraction [TESE] are the most precise investigations in these patients. Testicular biopsy can be done unilaterally or bilaterally. The worth of unilateral or bilateral testicular biopsy in men with azoospermia is controversial

Objective: To evaluate the necessity of bilateral diagnostic biopsy from the testis in new era of diagnosis and treatment of male infertility

Materials and Methods: In this retrospective study, we reviewed the results of testis biopsy in 419 azoospermic men, referred to Yazd Research and Clinical Center for Infertility from 2009-2013. Patients with known obstructive azoospermia were excluded from the study

Results: In totally, 254 infertile men [60.6%] were underwent unilateral TESE, which in 175 patients [88.4%] sperm were extracted from their testes successfully. Bilateral testis biopsy was done in 165 patients [39.4%] which in 37 patients [22.4%], sperm were found in their testes tissues

Conclusion: Due to the low probability of positive bilateral TESE results especially when we can't found sperm in the first side, we recommend that physicians re-evaluate the risk and benefit of this procedure in era of newer and more precise technique of sperm retrieval like micro TESE

Phytochemical screening and in vitro evaluation of free radical scavenging activity of Dionysia revoluta L.

Dionysia revoluta L. a plant of Primulaceae family is used for treatment of ulcers and relieving pain in Iranian traditional system of medicine. The present study was aimed at preliminary phytochemical investigation and evaluation of antioxidant characteristics of D.revoluta L.ethanol extract and various fractions. Total phenolic content was determined by Folin-Ciocalteu method. Evaluation of total flavonoid was carried out by the use of an aluminium chloride/sodium carbonate colorimetric procedure. Anti lipid peroxidation effect was studied with ethanol extract. Radical scavenging properties of ethanolic extract and various fractions was determined by 2,2-diphenyl-l-picrylhydrazyl [DPPH] and Nitric Oxide [NO] methods. High phenolic and flavonoid content and significant radical scavenging properties were detected for the ethyl acetate and mainly n-butanol fraction. Comparisons were made with known reference antioxidant compounds including ascorbic acid, quercetin, and gallic acid. The radical scavenging effect of n-butanol fraction approached higher degree of effectiveness among all fractions. Acid hydrolysis of this fraction led to a significant enhancement in the phenolic and flavonoid contents and interestingly in DPPH scavenging efficacy of this fraction. As declared by the results, total phenolic content showed a good correlation with radical scavenging activity. The antioxidant activity found in the ethyl acetate and n-butanol fractions of D. revoluta L. may be attributed to the presence of flavonoids and other phenolic compounds. Among the various chemical constituents of this plant, the concentration of flavonoids seem to prevail remarkably as indicated by the inspection of thin layer chromatograms of various fractions and their responses to diagnostic colour reactions. Based on the results obtained in the present study, this plant bears a good radical scavenging and antioxidative character and is worth of further detailed phytochemical and antioxidative studies

Antimicrobial and cytotoxic activity of Ferula gummosa plant essential oil compared to NaOCl and CHX: a preliminary in vitro study

OBJECTIVES: The usage of medicinal plants as natural antimicrobial agents has grown in many fields including dental medicine. The aim of this in vitro study was three-fold: (i) to determine the chemical compositions of the Ferula gummosa essential oil (FGEO), (ii) to compare the antimicrobial efficacy of the oil with sodium hypochlorite (NaOCl) and chlorhexidine (CHX), (iii) to assess the toxic behavior of FGEO in different concentrations compared to 5% NaOCl and 0.2% CHX. MATERIALS AND METHODS: Gas chromatography/mass spectrometry (GC/MS) was used to determine the chemical compositions of the oil. The disk diffusion method and a broth micro-dilution susceptibility assay were exploited to assess the antimicrobial efficacy against Enterococcus faecalis, Staphylococcus aureus, Streptococcus mitis, and Candida albicans. The cytocompatibility of the FGEO was assessed on L929 fibroblasts, and compared to that of NaOCl and CHX. RESULTS: Twenty-seven constituents were recognized in FGEO. The major component of the oil was beta-pinene (51.83%). All three irrigants significantly inhibited the growth of all examined microorganisms compared to the negative control group. FGEO at 50 microg/mL was effective in lower concentration against Enterococcus faecalis than 5% NaOCl and 0.2% CHX, and was also more potent than 0.2% CHX against Candida albicans and Staphylococcus aureus. FGEO was a cytocompatible solution, and had significantly lower toxicity compared to 5% NaOCl and 0.2% CHX. CONCLUSIONS: FGEO showed a promising biological potency as a root canal disinfectant. More investigations are required on the effectiveness of this oil on intracanal bacterial biofilms.

Comparison of reactive oxygen species in neat and washed semen of infertile men

Male are involved in near 50% of cases of infertility and reactive oxygen species [ROS] playing an important role in decreasing fertility potential. Accurate measurement of ROS seems to be important in evaluation of infertile male patients. To compare ROS measurement in neat and washed semen samples of infertile men and define the best method for evaluation of ROS in these patients. We measured the level of ROS in semen samples of thirty five non-azoospermic men with infertility. The semen samples were divided into two parts and the semen parameters and ROS levels in neat and washed samples were evaluated. We also evaluated the presence of pyospermia using peroxidase test. The differences regarding sperm count and quick motility were significant in neat and washed semen samples. The mean ROS level was significantly higher in neat samples compared with washed spermatozoa [7.50 RLU vs. 1.20 RLU respectively]. Difference in ROS levels was more significant in patients with pyospermia compared to whom with no pyospermia [378.67 RLU vs. 9.48 RLU respectively]. Our study confirmed that neat or unprocessed samples are better index of normal oxidative status of semen samples. Because we do not artificially add or remove factors that may play an important role in oxidative equilibrium status

sensitivity of ultrasonography in detecting renal cortical defects in pyelonephritic patients with or without vesicoureteral reflux

The presence of renal scarring has been documented in 5% to 15% of febrile urinary tract infections. The main aim of this study was to compare the value of renal ultrasonography and cortical scintigraphy with technetium-99m dimercaptosuccinic acid [DMSA] in detecting renal cortical defects in acute pyelonephritis. Between June 2003 and February 2012 a prospective cohort study of patients aged 1 month to 14 years of age was conducted. Pediatric patients with documented urinary tract infections were evaluated with renal ultrasonography, voiding cystoureterography [VCUG] and DMSA scintigraphy. Statistical test was two-tailed and was considered significant when P< 0.05. The results of DMSA scans showed 70.2% of cases as being abnormal. Renal ultrasonographies were reported to be normal in 72.45 and showed mild hydronephrosis in 37.7% of cases, moderate to severe hydronephrosis in 40.62%, stone formation in 13.66% and scar formation or decreased cortical thickness in 8.2%. There was a significant difference in ultrasonography reports between patients with normal and abnormal DMSA scans [P< 0.012] but there was no significant difference in detection of scar formation between DMSA scan results and those of ultrasonography in our patients. Among patients with severe abnormalities on DMSA scintigraphy the percent of cases with vesicoureteral reflux was significantly higher than those with normal scans or mild to moderate changes on DMSA scintigraphy. [46.3% vs 26.9%]. We concluded that ultrasonography is a sensitive method for detection of renal cortical defects and ultrasonography can also predict the presence of vesicoureteral reflux in pyelonephritic patients

Prevalence of second-eye cataract surgery and time interval after first-eye surgery in Iran: a clinic-based study

To determine the prevalence of second-eye senile cataract surgery [SECS] as a proportion of all senile cataract surgeries and the trend in the interval between first and second cataract operations in a main referral and academic eye hospital. In this cross-sectional study, a list of patients who underwent senile cataract surgery over four consecutive years [2006-2009] was retrieved from hospital computer-based records as the sampling frame. With a systematic random method, 15% of records were selected [1, 585 out of 10, 517 records]. First- and second-eye operations were performed in 1, 139 [71.9%; 95% confidence interval [CI], 69.5-74.1] and 446 eyes [28.1%; 95% CI, 25.9-30.35], respectively. The proportion of SECS procedures increased from 24.3% in 2006 to 33.4% in 2009 [P- 0.017]. The median [interquartile range] interval between the two operations was 9 [4-24] months, which remained stable during the study period. The SECS rate was 10.4% higher [P - 0.0l] and the time interval was 13 months shorter [P- 0.007] in patients who underwent phacoemulsification than extracapsular cataract extraction. The number of cataract operations in this tertiary eye care setting increased 1.5 fold over the study period. The proportion of second-eye operations also rose from 1/4 to 1/3 during the same time

1-D and 2D-NMR assignments of nigricin from iris imbricata

Ethanolic crude extract of I. imbricata Lindl. [Iridaceae] was subjected to column chromatography on silica gel with varying portions of MeOH: CHCl[3]. Nigicin [irisolone] was isolated and its identification carried out by IR, UV, MS, 1-D and 2-D NMR spectroscopy

effect of oral administration of Pentoxifylline on sperm motility of asthenozoospermic ejaculates from men with or without testicular varicoceles

Pentoxifylline [PX] is a methyxanthin derivative that influences the sperm motion characteristics. In general, PX has been reportedly effective in preserving sperm motility in vitro, also when administered orally to the asthenozoospermic patients. The main objective of this prospective clinical trial study was to rule out the effect of oral administration of PX on sperm progressive motility of asthenozoospermic ejaculates obtained from men with or without mild testicular varicoceles. In addition, the role of patient's age on sperm motility following PX administration was investigated. A total of 68 infertile men with asthenozoospermia were allocated to this study. Following physical examination, 20 cases were found with mild varicocele of testis. A dosage of 400 mg PX/ twice daily for duration of 3 months was administered to each patient. Two semen samples [one before and one after the PX therapy] were evaluated under blind condition. Semen parameters of sperm concentration, total and fast progressive motility [%] and morphology [%] were analyzed for each sample. Also, the sperm motion characteristics of asthenozoospermic patients with testicular varicocele were compared with cases lacking varicocele. The subjects were divided into two age groups of <30 and >/= 30 years old. PX was significantly effective on the fast progressive motility of sperm [p<0.01]. Also, total progressive motility was enhanced from 26.82 +/- 16.8 to 29.60 +/- 22.2 with PX therapy. However, PX did not have any negative effect on other semen parameters. Oral therapy of PX was also effective in improving the fast progressive motility of sperm of samples from cases with or without mild testicular varicocele [p<0.01]. Fast progressive motility was also significantly enhanced in ejaculates of men from both age groups. Our results demonstrate that low dose of oral therapy of PX is significantly useful in enhancing fast progressive motility of sperms from infertile men with asthenozoospermia. Also, testicular varicocele did not interfere with enhancing effect of PX on sperm motility

Two isoflavones from itis songarica schrenk

Two isoflavone, irilin A and irisone B were isolated from Iris songarica and their structures were determined by 1 and 2 D-NMR, IR, UV and MS. The effect of solvent on 1H-NMR spectra of irisone B have been studied

Anti - pseudomona and anti - bacilli activity of some medicinal plants of Iran

The use of plants in treatment of burns, dermatophytes, and infectious diseases is common in traditional medicine of Iran. Based on ethno pharmacological and taxonomic information, antibacterial activities of methanol extracts of some medicinal plants of Iran were determined by In Vitro bioassays using agar diffusion-method against standard strains of Pseudomonas aeruginosa, P. fluorescens, Bacillus subtilis, B. cereus and B. pumilis at 20 mg/ml. From 180 plant species of 72 families, 78 species [43.3%] in 42 families [58.3%] showed antibacterial activities against B. cereus [88.4%], B. subtilis [39.7%], B. pumilis [37.1%], P. fluorescens [37.1%] and P. aeruginos [10.2%]. The most active plant families were Apiaceae, Compositae and Labiatae with 9, 8 and 7 active plant species respectively. Minimum inhibitory concentrations [MIC] of the active plants were determined using two fold serial dilutions. Most active plant against Bacilli was Myrtus communis L. with MIC of 1.87 mg/ml. For Pseudomonas species, Dianthus caryophyllus L. and Terminalia chebula [Gaertner] Retz. were more active with the MIC of 0.46 mg/ml for P. fluorescens and of 1.87 mg/ml for P. aeruginosa respectively