Exposure by males to light emitted from media devices at night is linked with decline of sperm quality and correlated with sleep quality measures.

The last several decades have been characterized by the widespread usage of digital devices, especially smartphones. At the same time, there have been reports of both decline in sleep duration and quality and male fertility decline. The aim of this study was to assess the relationship between evening exposure to the light-emitting screens of digital media devices and measures of both sleep and sperm quality. Semen samples were obtained from 116 men undergoing fertility evaluation for the following sperm variables: volume (mL), pH, sperm concentration (million/mL), motility percentage (progressive% + non-progressive motility%), and total sperm count. Exposure to the screens of electronic devices and sleep habits was obtained by means of a questionnaire. Smartphone and tablet usage in the evening and after bedtime was negatively correlated with sperm motility (-0.392; -0.369; p < .05), sperm progressive motility (-0.322; -0.299; p < .05), and sperm concentration (-0.169; p < .05), and positively correlated with the percentage of immotile sperm (0.382; 0.344; p < .05). In addition, sleep duration was positively correlated with sperm total and progressive motility (0.249; 0.233; p < .05) and negatively correlated with semen pH (-0.349; p < .05). A significant negative correlation was observed between subjective sleepiness and total and progressive motility (-0.264; p < .05) as well as total motile sperm number (-0.173; p < .05). The results of this study support a link between evening and post-bedtime exposure to light-emitting digital media screens and sperm quality. Further research is required to establish the proposed causative link and may lead to the future development of relevant therapeutic and lifestyle interventions.

Fertility preservation in male patients with cancer.

Advances in the treatment of cancer in young patients have led to great improvements in life expectancy, which currently approaches 80% 5-year survival rate. As a result, fertility preservation and desire for paternity have become a significant issue in this group. However, a major concern is the negative impact of chemotherapy, radiotherapy, and the malignancy itself on fertility. Thus, men about to have treatment for malignant conditions may have sperm cryopreserved before commencing chemotherapy or radiotherapy. Ejaculated sperm cryopreservation is the most common technique used. Some patients with cancer may present initially with oligospermia or azoospermia. In cases when a sample is not produced due to medical, social, or religious reasons, sperm can be retrieved using penile vibratory stimulation, electroejaculation, or testicular sperm extraction. Fertility preservation in prepubertal boys presents a great challenge, as sperm banking is not possible. Alternative strategies have been developed, but all are currently experimental.

Outcomes from the first assisted reproduction program for HIV-serodiscordant couples in Australia.

OBJECTIVE: To describe the clinical outcomes for all HIV-serodiscordant couples attending an assisted reproduction program. DESIGN, SETTING AND PARTICIPANTS: Retrospective review of demographic, clinical and outcome data for all HIV-serodiscordant couples who attended an assisted reproduction program at a tertiary hospital in Melbourne, between its commencement in 2003 and June 2010. MAIN OUTCOME MEASURES: Pregnancies, miscarriages, births, HIV transmission to the HIV-negative partner, semen quality and detection of HIV (HIV RNA and HIV DNA) in semen. RESULTS: As of June 2010, 39 HIV-positive clients had proceeded to assisted reproduction after the initial consultation in the program. There were 162 completed cycles, with 26 pregnancies (clinical pregnancy rate per cycle, 16.2% for HIV-positive men with an HIV-negative partner, and 15.4% for HIV-positive women). Of all 222 tested semen samples, 18 (8%) had HIV RNA detected despite these men receiving antiretroviral therapy and having an undetectable HIV viral load in plasma. Sperm velocity was significantly lower in HIV-positive clients receiving combination antiretroviral therapy than in a control group of recipient-recruited sperm donors (P = 0.01); there were no other significant differences in sperm quality between the two groups. No HIV transmission to babies or HIV-negative partners occurred. CONCLUSION: Our findings show detectable HIV in 8% of semen samples from men with an undetectable HIV viral load in plasma, but confirm the safety of assisted reproduction for HIV-serodiscordant couples within a program with strict protocols for HIV treatment and testing of all semen before use.

Alveolar bone loss in liver transplantation patients: relationship with prolonged steroid treatment and parathyroid hormone levels.

AIM: To evaluate the relationship among alveolar bone loss (ABL), bone status and calcium-regulating hormones in liver transplantees. PATIENTS AND METHODS: Twenty-one liver transplantees underwent a full oral examination. The correlations among bone densitometry, bone metabolic status and drug treatment were examined. RESULTS: Twelve patients had osteopenia, and six were osteoporotic. ABL was 4.33+/-2.32 mm (range 0.67-9.92). Parathyroid hormone (PTH) levels ranged from 14 to 106 (mean 55.2+/-26.4). The mean 25(OH)D(3) was 11.68+/-4.7, range 3.5-21.1 ng/ml. Nine patients were vitamin D deficient (<10 ng/ml); none of the patients had 25(OH)D(3) levels > or =30 ng/ml. No correlation was found between ABL and current or total glucocorticoids dose, although there was an inverse relation with the duration of treatment (r =-0.474, p=0.03). A positive correlation was found between ABL, PTH (r =0.419, p=0.059) and hip bone mineral density (BMD) (r=0.482, p=0.027). ABL correlated closely with age, PTH, glucocorticoid treatment (duration) and hip BMD (r =0.810, p=0.004). CONCLUSIONS: The majority of liver transplant patients had insufficient 25(OH)D(3) serum levels. Changes in calcium-regulating hormones and hip BMD were correlated with ABL. Therefore, therapeutic intervention aimed at treating vitamin D deficiency and secondary hyperparathyroidism should be considered in these patients. The benefits of vitamin D treatment in the management of secondary hyperparathyroidism and possible decrease in ABL deserve further evaluation in controlled trials.

The outcome and cumulative morbidity associated with the second and third postcesarean delivery.

The purpose of this study was to compare the outcome and cumulative morbidity among women who delivered twice after a cesarean delivery (CD), and who underwent in the second delivery either a trial of labor (TOL) or planned cesarean delivery (PCD). Eligible women (N = 399) were divided into two groups based on first post-CD: a TOL (n = 304) or PCD (n = 95). Women attempting a TOL were successful in 70 and 75% in the first and second post-CD, respectively. All participants undergoing a PCD subsequently had a third PCD. The overall morbidity was 8.4 and 5.3% among PCD and TOL groups, respectively ( P = 0.258). Women attempting a TOL after a previous CD had a 70 and 53% likelihood for at least one successful or two successful vaginal births in the two subsequent deliveries, respectively. No significant difference was documented between the groups regarding the cumulative morbidity.

Evidence of periopathogenic microorganisms in placentas of women with preeclampsia.

BACKGROUND: Periodontal disease is a chronic inflammatory infectious disease that may act as a focus of infection. Preeclampsia is a pregnancy-specific hypertensive disorder that often leads to maternal morbidity and mortality. Acute atherosis, the placental lesion of preeclampsia, shares many histopathological features with atherosclerosis. Recently, chronic infection was linked to the initiation of atherosclerosis. Oral pathogens have been detected in atherosclerotic plaques, where they may play a role in the development and progression of atherosclerosis. The purpose of the present study was to explore the possibility that periopathogenic bacteria may translocate into the placental tissues of women with preeclampsia. METHODS: Samples were taken from 16 placentas obtained from cesarean sections of women with preeclampsia and from 14 age-matched healthy pregnant women. Polymerase chain reaction was used to detect Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum ssp., Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, and Treponema denticola. RESULTS: Eight of the 16 (50%) placenta specimens were positive for one or more periopathogenic bacteria in the preeclampsia group, compared to only two of the 14 samples (14.3%) from controls. Bacterial counts were statistically significantly higher in the preeclampsia group for all of the periopathogenic bacteria examined (P

Maternal complications associated with multiple cesarean deliveries.

OBJECTIVE: The claim that a planned repeat cesarean delivery is safer than a trial of labor after cesarean may not be applicable to women who desire larger families. The aim of this study was to assess maternal complications after multiple cesarean deliveries. METHODS: The records of women who underwent two or more planned cesarean deliveries between 2000 and 2005 were reviewed. We compared maternal complications occurring in 277 women after three or more cesarean deliveries (multiple-cesarean group) with those occurring in 491 women after second cesarean delivery (second-cesarean group). RESULTS: Excessive blood loss (7.9% versus 3.3%; P < .005), difficult delivery of the neonate (5.1% versus 0.2%; P < .001), and dense adhesions (46.1% versus 25.6%; P < .001) were significantly more common in the multiple-cesarean group. Placenta accreta (1.4%) and hysterectomy (1.1%) were more common, but not significantly so, in the multiple-cesarean group. The proportion of women having any major complication was higher in the multiple-cesarean group, 8.7% versus 4.3% (P = .013), and increased with the delivery index number: 4.3%, 7.5%, and 12.5% for second, third, and fourth or more cesarean delivery, respectively (P for trend = .004). CONCLUSION: Multiple cesarean deliveries are associated with more difficult surgery and increased blood loss compared with a second planned cesarean delivery. The risk of major complications increases with cesarean delivery number. LEVEL OF EVIDENCE: II-2.

Fetal heart rate patterns and neurodevelopmental outcome in very low birth weight infants.

BACKGROUND: To evaluate the validity of fetal heart rate monitoring during the last hour prior to birth, as a predictor of long term neurodevelopmental outcome of very low birth weight infants. METHODS: A total of 111 very low birth weight infants were included in the study. Fetal heart rate tracings were obtained during the last hour prior to delivery. A perinatologist, blinded to the neonatal outcome, evaluated the tracings and divided them into three groups: reassuring, nonreassuring, and pathological. Neurodevelopmental status was evaluated at age 2 years. The relationship between fetal heart rate monitoring results and the neurodevelopmental outcome at 2 years of age was assessed with a chi-square test and the Student's t-test. RESULTS: At 2 years of age 97 (87.4%) of the children had normal neurodevelopmental function, while 14 (12.6%) had variable degrees of neurodevelopmental impairment. The fetal heart rate monitoring results were classified as reassuring (normal) in 35 cases (31.5%), nonreassuring in 56 cases (50.5%), and pathological in 20 cases (18.0%). Both normal and pathological fetal heart rate patterns were associated with similar incidence of abnormal neurodevelopmental outcome, 14.3% and 15.0% of cases, respectively (p=0.778). Pathological fetal heart rate patterns as a predictor of neurodevelopmental outcome had a sensitivity of 27%, specificity of 74%, positive predictive value of 15%, and negative predictive value of 86%. CONCLUSION: Electronic fetal heart rate monitoring prior to delivery is not a reliable tool for the prediction of neurodevelopmental impairment in premature infants of very low birth weight, at 2 years of age.

Early versus late initiation of epidural analgesia in labor: does it increase the risk of cesarean section? A randomized trial.

OBJECTIVE: To determine whether early initiation of epidural analgesia in nulliparous women affects the rate of cesarean sections and other obstetric outcome measures. STUDY DESIGN: A randomized trial in which 449 at term nulliparous women in early labor, at less than 3 cm of cervical dilatation, were assigned to either immediate initiation of epidural analgesia at first request (221 women), or delay of epidural until the cervix dilated to at least 4 cm (228 women). RESULTS: At initiation of the epidural the mean cervical dilatation was 2.4 cm in the early epidural group and 4.6 cm in the late group (P < 0.0001). The rates of cesarean section were not significantly different between the groups--13% and 11% in the early and late groups, respectively (P = 0.77). The mean duration from randomization to full dilatation was significantly shorter in the early compared to the late epidural group--5.9 hours and 6.6 hours respectively (P = 0.04). When questioned after delivery regarding their next labor, the women indicated a preference for early epidural. CONCLUSION: Initiation of epidural analgesia in early labor, following the first request for epidural, did not result in increased cesarean deliveries, instrumental vaginal deliveries, and other adverse effects; furthermore, it was associated with shorter duration of the first stage of labor and was clearly preferred by the women.

Pregnancy tumor occurring twice in the same individual: report of a case and hormone receptors study.

A case of 2 pregnancy tumors in the same individual and at the same site within 2 years, during 2 consecutive pregnancies, despite complete eradication of the first lesion, is described. A 27-year-old woman at 32 weeks gestation was referred for gingival swelling. Gingival enlargement was pronounced on her maxillary right side, and a hemangioma was present on the lip adjacent to this mass. Despite preventive periodontal treatment the lesion continued to grow, interfering with speech and mastication, and became painful; it was therefore removed surgically. Sixteen months later, during a subsequent pregnancy, the woman returned at 20 weeks gestation for treatment of a recurrent lesion at the same site, and the lesion was excised. The roles of female sex hormones, multiplicity of vascularity, and local irritants in the development of pregnancy tumors are examined.

Results of a well-defined protocol for a trial of labor after prior cesarean delivery.

OBJECTIVE: It has been claimed that a trial of labor after cesarean carries higher maternal and fetal risks than planned cesarean delivery. Because the management of such patients in our department differs from that described in some studies, and is perhaps more cautious, we hypothesized that the outcome may be better. METHODS: We identified women with 1 previous low uterine segment cesarean who had delivered a cephalic singleton infant at gestational age 34 weeks or more from January 2000 through May 2005. Our policy is to encourage such women to undergo a trial of labor unless cesarean delivery is indicated. Unless otherwise indicated, our policy is to wait for spontaneous labor. We do not use prostaglandins, and recommend cesarean delivery if the cervix is unripe.(Bishop score < 6). We compared the outcome between women who underwent a trial of labor and women who underwent planned cesarean delivery. RESULTS: A trial of labor was attempted by 841 women (80% successful), and 467 underwent planned cesarean delivery. Uterine rupture was observed in 1 woman 18 hours after vaginal delivery. There was no difference in major or minor maternal morbidity. There was no serious neonatal morbidity. Among the planned cesarean patients, hospital stay was longer, and there were more admissions to the neonatal intensive care unit. CONCLUSION: With our well-defined protocol, a trial of labor after cesarean seems to be as safe for the mother and infant as planned cesarean delivery, and the hospital stay is shorter. LEVEL OF EVIDENCE: II-2.

Severe pregnancy complication (preeclampsia) is associated with greater periodontal destruction.

BACKGROUND: Preeclampsia is a pregnancy-specific disease which is one of the leading causes of maternal and fetal morbidity and mortality. The etiology of preeclampsia remains elusive. The underlying pathology may be related to a generalized intravascular hyperinflammatory state. Since the placental histopathologic lesions of acute atherosis, seen in preeclampsia, bear resemblance to those seen in atherosclerosis, and recent evidence links atherosclerosis with chronic infection, we decided to investigate a possible link between preeclampsia and chronic periodontal infection. METHODS: Thirty primigravidas, 15 suffering from preeclampsia, had full mouth periodontal examinations. Gingival crevicular fluid samples were taken for laboratory immunological assessment. Similar examination and sampling were performed in 15 age- and maternal status-matched controls. RESULTS: Significantly higher periodontal probing depth and clinical attachment level scores were found in the preeclamptic group compared with controls (2.98 versus 2.11 and 3.33 versus 2.30, respectively). Plaque index, gingival index, and mean gingival overgrowth scores were very similar in both groups. Furthermore, prostaglandin E2 (PGE2), tumor necrosis factor (TNF)-alpha, and interleukin (IL)-1beta levels were all significantly higher in the preeclamptic group (247.4 ngr/sample versus 89.1 ngr/sample, 8.03 pgr/sample versus 4.03 pgr/sample, and 175.7 pgr/sample versus 62.2 pgr/sample, respectively). CONCLUSION: The above results suggest a possible association between periodontal inflammation and preeclampsia.

Subcutaneous implantation of pure crystalline estradiol pellets for conception control.

OBJECTIVES: Assessment of the contraceptive effectiveness of pure estradiol pellets implanted annually under the skin, thus avoiding the 'first passage phenomenon' through the liver, using a modification of Emperaire and Greenblatt's method. STUDY DESIGN: 228 women wishing birth control for 1 year or more were included. 5 pellets of estradiol (25 mg each) were implanted initially. At each subsequent annual treatment, 4 pellets were implanted. Withdrawal bleeding was induced monthly with oral norethindrone acetate 5 mg taken for 7 days. Our experience encompassed 8,136 cycles, or 678 women years. The study obtained approval of the local Ethical Committee. RESULTS: Annual continuation rates were 51 per 100 women in the second year, 65 in the third, 72 in the fourth and 84 +/- 10.1 annually over the next 6 years. Through 12 years of our study, 2 accidental pregnancies occurred. The annual net cumulative pregnancy rates were 0.44 and 0.48 per 100 women at 1 and 2 years, and reduced to 0.29 at the end of 10 years. Return of fecundity after discontinuing treatment was 53% after 12 months, 81% after 24 months and 89% after 36 months. The mean estradiol levels were 1,413 +/- 161 pmol/l one week following the pellet installation. The mean serum estradiol level of the 43 women who were assayed arbitrarily or a year following last insertion was 1,207 pmol/l (range 462-2,904 pmol/l); 22% had serum estradiol levels <1,000 pmol/l and 6.3% (3 women) had levels >1,750 pmol/l. A total of 28 endometrial biopsies were obtained -19 were proliferative, 6 showed slight simple hyperplasia, and three, benign cystic glandular hyperplasia. CONCLUSION: Subcutaneous implantation of pure estradiol pellets offers excellent birth control, has minimal untoward effects, is simple to insert and can serve as a possible alternative for conception control. It could be considered for 3 indications: for women who have completed family planning; for women in older age group (above 35 years) who are approaching the climacteric; and for women at any age, who need prolonged periods of contraception.

Frozen section examination of endometrial curettings in the diagnosis of ectopic pregnancy.

BACKGROUND: The aim of our study was to determine the accuracy and validity of frozen section analysis of endometrial curettings in differentiating between abnormal intrauterine and ectopic pregnancies. METHODS: A retrospective analysis of the database of the Department of Obstetrics and Gynecology in our institute was performed from January 1998 to September 1999. In 70 women with a suspected ectopic pregnancy a diagnostic curettage was sent for frozen section examination because products of conception could not be identified macroscopically in the curettings. Routine paraffin fixation specimens were also prepared from the endometrial curettings. A frozen section diagnosis was considered correct if it concurred with the final pathologic diagnosis, and incorrect if it differed. The sensitivity, specificity, positive predictive value and negative predictive value of a frozen section in identification of conception products were calculated. RESULTS: Of the 70 frozen section studies the diagnosis was correct in 63 (90%), and incorrect in 7 (10%) cases. Of 50 specimens interpreted as negative on frozen sections (no products of conception noted), 6 (12%) were found to contain conception products on final pathologic review. One of the 20 (5%) specimens interpreted as positive by a frozen section failed to demonstrate products of conception on a final pathologic section. The sensitivity of frozen sections in the diagnosis of ectopic pregnancy was 76%, specificity 97.8%; positive predictive value 95%; negative predictive value 88% and accuracy 90%. CONCLUSIONS: Frozen section examination is a rapid and accurate method for identifying products of conception in endometrial curettings, and may reduce delay in the diagnosis of an ectopic pregnancy and in the institution of therapy.

Common oral manifestations during pregnancy: a review.

UNLABELLED: Pregnancy has far-reaching systemic effects extending beyond the reproductive system. Oral and masticatory changes during pregnancy have been documented for many years; however, their magnitude and frequency have not been stressed. This review highlights the major oral complications during pregnancy. Pregnancy gingivitis and pregnancy tumor are described and presented, and possible preventive strategies are suggested. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to summarize the major oral complications during pregnancy, to outline the etiologic factors associated with each of these conditions, and to explain the role of dental treatment during pregnancy.

Periodontal changes in liver cirrhosis and post-transplantation patients. II: radiographic findings:.

BACKGROUND: Liver disease and transplantation affect bone turnover. The role of cylosporin A (CsA) in aggravating bone loss is controversial. The aim of the present study was to examine the effect of liver cirrhosis, transplantation, and immunosuppressive therapy with either CsA or tacrolimus on alveolar bone height. METHODS: The experimental group consisted of 13 liver cirrhosis (LC) patients. A second experimental group included 24 post-liver transplantation patients (PT) receiving CsA or tacrolimus. Seventeen healthy subjects formed a control group. Panoramic x-rays were taken and digitized using a computer-based measurement software to assess alveolar bone height of all available teeth. RESULTS: Bone loss in the PT group (4.57+/-0.56 mm) was significantly higher than the control (C) (2.73+/-0.38 mm); however, it was significantly lower (P = 0.0005) than the LC (6.47+/-0.75 mm). Likewise, alveolar bone loss showed a trend for negative correlation (R = 0.404, P = 0.06) with the duration of immunosuppressive therapy post-liver transplantation. CONCLUSIONS: Liver cirrhosis patients demonstrated greater bone loss compared to healthy controls. Restoration of liver functions following transplantation seems to have the potential to reverse some of these radiographic changes. Further longitudinal studies will be necessary to substantiate these findings.