Evaluating the satisfaction and utility of social networks in medical practice and continuing medical education.

BACKGROUND: Digital health has surged during the Covid health crisis, and the use of social media, already prevalent in medicine, has significantly increased. There are Social Networks groups dedicated to physicians with an educational purpose. These groups also facilitate peer discussions on medical questions and the sharing of training materials. OBJECTIVES: The aim of our study was to assess the value of these new tools and their contribution to medical education. METHODS: An anonymous questionnaire was conducted among members of a Social Networks community group for physicians. The survey received responses from 1451 participants. RESULTS: The majority of participants believed they had enriched their medical knowledge and accessed documents they would not have accessed without the group. Subgroup analysis showed that the contribution of this tool is more pronounced for general practitioners and doctors practicing in limited healthcare access. CONCLUSION: It is essential to develop digital tools that enhance physician training, and social networks represent a valuable educational tool.

Human Sperm Morphology as a Marker of Its Nuclear Quality and Epigenetic Pattern.

Background: Human sperm chromatin condensation is a sum of epigenetic events that allows for the near-complete replacement of histones with protamines. Under high-magnification microscopy, nuclear vacuoles have been described as thumbprints with poor chromatin condensation. The objective of this study is to examine whether vacuolated spermatozoa carry specific epigenetic marks, which may influence embryo development. Methods: The presence and three-dimensional distribution of ten epigenetic marks (protamine-P2, histone-H3, H3K4me1/me2/me3, H3K9me1/me2/me3, H3K27me3, H4k20me2) were evaluated and compared in morphometrically normal spermatozoa according to the presence or absence of a large vacuole occupying more than 15% of the head surface (n = 4193). Results: Vacuolated spermatozoa were significantly more frequently labelled with H3 and H3K4me3 than normal spermatozoa (88.1% ± 2.7 and 78.5% ± 5.2 vs. 74.8% ± 4.8 and 49.1% ± 7.4, respectively; p = 0.009 and p < 0.001) and significantly less marked by P2 and H3K27me3 (50.2% ± 6.2 and 63.9% ± 6.3 vs. 82.1% ± 4.4 and 73.6% ± 5.1, respectively; p < 0.001 and p = 0.028). In three dimensions, vacuoles are nuclear concavities filled with DNA carrying the H3K4me3 marker. Conclusion: High-magnification microscopy is a simple tool to estimate in real time the sperm epigenetic profile. The selection of normal spermatozoa without vacuoles and the deselection of spermatozoa with vacuoles appear to be epigenetically favorable to embryo development and safe offspring.

For patients with non-obstructive azoospermia, the outcome of testicular sperm extraction correlates with self-esteem, sexual health and the quality of the couple's relationship.

BACKGROUND: A very small number of studies have indicated that azoospermia or negative testicular sperm extraction (TESE) outcomes are linked to depression or erectile dysfunction. However, the data are often weak, conflicting and gathered with non-validated questionnaires. Hence, we performed a cross-sectional study of 44 men with non-obstructive azoospermia. Levels of self-esteem and the quality of the couple's sex life and overall relationship were assessed with validated questionnaires before and after the TESE procedure as a function of the TESE outcome. RESULTS: A positive TESE outcome (n = 24) was associated with a statistically significant increase in self-esteem (particularly with regard to family aspects), sexual health and couples' adjustment quality. In contrast, a negative TESE outcome (n = 20) was associated with statistically significant decreases in self-esteem, erectile function, intercourse satisfaction, orgasmic function, couples' adjustment quality and all aspects of the couple's relationship (consensus, cohesion, satisfaction and affection). CONCLUSION: For men with non-obstructive azoospermia (NOA), negative TESE outcomes may have a negative impact on self-esteem and the quality of the couple's sex life and overall relationship. This should be borne in mind when counselling men with NOA and their partners to (ideally) help them to cope with and decrease the harmful impacts of azoospermia and negative TESE.

RESUME: INTRODUCTION: Quelques études concernant l'azoospermie ou les résultats négatifs de l'extraction de sperme testiculaire (TESE) montrent que ces résultats peuvent être liés à la dépression ou aux dysfonctions érectiles. Cependant, les données sont souvent faibles, contradictoires et recueillies à l'aide de questionnaires non validés. Nous avons donc réalisé une étude transversale auprès de 44 hommes atteints d'azoospermie non obstructive (ANO). Les niveaux d'estime de soi et la qualité de la vie sexuelle du couple et de la relation globale ont été évalués à l'aide de questionnaires validés avant et après la procédure TESE en fonction du résultat de la TESE. RéSULTATS: Un résultat positif de TESE (n = 24) a été associé à une augmentation statistiquement significative de l'estime de soi (en particulier en ce qui concerne les aspects familiaux), de la santé sexuelle et de la qualité de l'adaptation du couple. En revanche, un résultat négatif de TESE (n = 20) a été associé à une diminution statistiquement significative de l'estime de soi, de la fonction érectile, de la satisfaction des rapports sexuels, de la fonction orgasmique, de la qualité de l'adaptation du couple et de tous les aspects de la relation de couple (consensus, cohésion, satisfaction et affection). CONCLUSION: Chez les hommes atteints d'ANO, une TESE négative peut avoir un impact négatif sur l'estime de soi et la qualité de la vie sexuelle et de la relation globale du couple. Il convient de garder cela à l'esprit lors du conseil aux hommes atteints d'ANO et à leurs partenaires afin de les aider (idéalement) à faire face aux impacts néfastes de l'azoospermie et de la TESE négative et à les réduire.

Uterine contractility and elastography as prognostic factors for pregnancy after intrauterine insemination.

OBJECTIVE: To determine the impact of the frequency and intensity of uterine contractions (UCs) at the time of IUI on subsequent fertility. DESIGN: Observational pilot study. SETTING: University hospital. PATIENT(S): One hundred volunteer women scheduled for IUI between April 2011 and July 2013, in whom UCs were assessed during the ultrasound before IUI. INTERVENTION(S): A two-dimensional sagittal uterus elastography was recorded for 5 minutes. The elasticity index, defined as the mean ratio of elastographic measurements between the subendometrial area (of interest) and the endometrial area (control), was computed. UC frequency, endometrial thickness and volume, and subendometrial vascularisztion were also measured. MAIN OUTCOME MEASURE(S): These parameters, along with characteristics of the IUI cycle, were entered into a logistic regression model for predicting ongoing pregnancy. RESULT(S): The elasticity index was significantly higher (2.4 ± 1.3 vs. 1.5 ± 0.7, i.e., with stiffer myometrium), and the endometrium was significantly less echogenic in future pregnant women. Factors closely reaching significance were age, previous fertility, day 3 hormonal assessments, number of inseminated spermatozoa, endometrial thickness, and UC count. In multivariate analysis, low UC frequency (<2.8/minute; odds ratio [OR] = 0.039), high elasticity index (>1.7; OR = 63.26), high endometrial thickness on the ovulation triggering day (>8 mm; OR = 28.21), and low patient age (<32 years; OR = 0.001) were predictive of pregnancy after IUI. CONCLUSION(S): A low frequency and high intensity of UCs at the day of IUI appears associated with a higher pregnancy rate. Elastography provides a promising innovative tool for IUI monitoring.

A novel quantitative PCR detects Babesia infection in patients not identified by currently available non-nucleic acid amplification tests.

BACKGROUND: Ticks transmit Babesia microti, the causative agents of babesiosis in North America and Europe. Babesiosis is now endemic in Northeastern USA and affects people of all ages. Babesia species infect erythrocytes and can be transmitted through blood transfusion. Whole blood and blood products, which are not tested for Babesia, can cause transfusion-transmitted babesiosis (TTB) resulting in severe consequences in the immuno-compromised patients. The purpose of this study was epidemiological evaluation of babesiosis in a tick-infested state. RESULTS: We examined blood samples from 192 patients who visited clinics during the active tick-borne diseases season, using a newly developed qPCR assay that uses the specific molecular beacon probe. Due to the absence of clear symptomology, clinical laboratories did not test 131 samples by IFA, FISH or microscopic examination of Giemsa-stained blood smears. Babesia infection was detected in all age groups by FISH and microscopy; notably patients >40 years of age represented 64% of tested samples and 13% were younger patients. We tested all samples using qPCR and found that 38% were positive for Babesia. Of 28 samples that were positive by FISH, 27 (96%) were also positive by qPCR indicating high congruency between nucleic acid based tests. Interestingly, of 78 asymptomatic samples not tested by FISH, 22 were positive by our qPCR. Direct detection of Babesia relies upon microscopic examination of patient blood smears, which is labor intensive, difficult to scale up, requires specific expertise and is hence, often not performed. In fact, a clinical laboratory examined only 23 of 86 blood samples obtained from two different counties by microscopy. By considering individuals positive for Babesia infection when results from currently available microscopy, FISH or serological tests were positive, we found that our qPCR is highly sensitive (96.2%) and showed a specificity of 70.5% for Babesia. CONCLUSION: Robust qPCR using specific probes can be highly useful for efficient and appropriate diagnosis of babesiosis in patients in conjunction with conventional diagnostics, or as a stand-alone test, especially for donated blood screening. The use of a nucleic acid amplification test based screening of blood and blood products could prevent TTB.

Treponema pallidum Lipoprotein TP0435 Expressed in Borrelia burgdorferi Produces Multiple Surface/Periplasmic Isoforms and mediates Adherence.

The ability of Treponema pallidum, the syphilis spirochete to colonize various tissues requires the presence of surface-exposed adhesins that have been difficult to identify due to the inability to culture and genetically manipulate T. pallidum. Using a Borrelia burgdorferi-based heterologous system and gain-in-function approach, we show for the first time that a highly immunogenic lipoprotein TP0435 can be differentially processed into multiple isoforms with one variant stochastically displayed on the spirochete surface. TP0435 was previously believed to be exclusively located in T. pallidum periplasm. Furthermore, non-adherent B. burgdorferi strain expressing TP0435 acquires the ability to bind to a variety of host cells including placental cells and exhibits slow opsonophagocytosis in vitro similar to poor ex vivo phagocytosis of T. pallidum by host macrophages reported previously. This phenomenon of production of both surface and periplasmic immunogenic lipoprotein isoforms has possible implications in immune evasion of the obligate pathogen T. pallidum during infection.

Disruption of bbe02 by Insertion of a Luciferase Gene Increases Transformation Efficiency of Borrelia burgdorferi and Allows Live Imaging in Lyme Disease Susceptible C3H Mice.

Lyme disease is the most prevalent tick-borne disease in North America and Europe. The causative agent, Borrelia burgdorferi persists in the white-footed mouse. Infection with B. burgdorferi can cause acute to persistent multisystemic Lyme disease in humans. Some disease manifestations are also exhibited in the mouse model of Lyme disease. Genetic manipulation of B. burgdorferi remains difficult. First, B. burgdorferi contains a large number of endogenous plasmids with unique sequences encoding unknown functions. The presence of these plasmids needs to be confirmed after each genetic manipulation. Second, the restriction modification defense systems, including that encoded by bbe02 gene lead to low transformation efficiency in B. burgdorferi. Therefore, studying the molecular basis of Lyme pathogenesis is a challenge. Furthermore, investigation of the role of a specific B. burgdorferi protein throughout infection requires a large number of mice, making it labor intensive and expensive. To overcome the problems associated with low transformation efficiency and to reduce the number of mice needed for experiments, we disrupted the bbe02 gene of a highly infectious and pathogenic B. burgdorferi strain, N40 D10/E9 through insertion of a firefly luciferase gene. The bbe02 mutant shows higher transformation efficiency and maintains luciferase activity throughout infection as detected by live imaging of mice. Infectivity and pathogenesis of this mutant were comparable to the wild-type N40 strain. This mutant will serve as an ideal parental strain to examine the roles of various B. burgdorferi proteins in Lyme pathogenesis in the mouse model in the future.

The nature of human sperm head vacuoles: a systematic literature review.

Motile sperm organelle morphology examination (MSOME) involves the use of differential interference contrast microscopy (also called Nomarski contrast) at high magnification (at least 6300x) to improve the observation of live human spermatozoa. In fact, this technique evidences sperm head vacuoles that are not necessarily seen at lower magnifications - particularly if the vacuoles are small (i.e. occupying <4% of the sperm head's area). However, a decade after MSOME's introduction, it is still not clear whether sperm head vacuoles are nuclear, acrosomal and/or membrane-related in nature. In an attempt to clarify this debate, we performed a systematic literature review in accordance with the PRISMA guidelines. The PubMed database was searched from 2001 onwards with the terms "MSOME", "human sperm vacuoles", "high-magnification, sperm". Out of 180 search results, 21 relevant English-language publications on the nature of human sperm head vacuoles were finally selected and reviewed. Our review of the literature prompted us to conclude that sperm-head vacuoles are nuclear in nature and are related to chromatin condensation failure and (in some cases) sperm DNA damage.

Le MSOME (motile sperm organelle morphology examination) est une technique d'observation des spermatozoïdes mobiles à fort grossissement (>6300x) à l'aide du contraste interférentiel différentiel de Nomarski. Avec cette technique, des anomalies de la tête spermatique comme les vacuoles peuvent être observées alors qu'elles demeurent souvent invisibles à plus faible grossissement, notamment quand elles sont petites et qu'elles occupent moins de 4% de la surface de la tête. Depuis l'introduction du MSOME dans les années 2000, plusieurs études se sont intéressées à la nature des vacuoles. Sont-elles de nature nucléaire ? de nature acrosomique ? de nature membranaire ? Pour répondre à ces questions, nous avons réalisé une revue de la littérature en suivant les règles PRISMA. Les études publiées sur le sujet entre 2001 et aujourd'hui ont été recherchées dans la base Pubmed en utilisant les mots clés : "MSOME", "human sperm vacuoles" et "high-magnification, sperm". Parmi les 180 études retrouvées, 21 publications écrites en langue Anglaise et traitant de la nature des vacuoles spermatiques ont été sélectionnées et étudiées. Au total, cette revue de la littérature conclut que les vacuoles sont de nature nucléaire, en lien avec une moindre condensation de la chromatine spermatique. Cette moindre condensation chromatinienne représentant un facteur de susceptibilité aux dommages de l'ADN (fragmentation, dénaturation par exemple), les spermatozoïdes vacuolés peuvent aussi présenter plus de dommages de l'ADN que les spermatozoïdes sans vacuole.