[Predictors of fertility recovery in subfertile men after varicocelectomy].

INTRODUCTION: Varicocelectomy does not always lead to semen improvement and male fertility recovery. OBJECTIVES: Analysis of total progressive motile sperm count (TPMSC) predictive role in fertility recovery of subfertile man after varicocelectomy in combination with other predictors. MATERIALS AND METHODS: This prospective, open, multi-center study comprises 93 men from infertile couples with clinical varicocele who underwent microsurgical (inguinal or subinguinal) varicocelectomy. The changes in the standard semen analysis studied according to WHO 2010 Standards. We also evaluated spontaneous pregnancy rates. A discriminant analysis was carried out with step-by-step selection to identify reliable predictors of pregnancy after varicocelectomy. An increase in TPMSC by at least 12.5 million was considered as a good effect of varicocele repair (reference values for the number and progressive sperm motility according to WHO 2010: 39 million x 0.32 (32%) progressively motile). Patients were divided into 3 groups in regards of direction and degree of semen changes: group I included 48 patients with increase of TPMSC more or equal 12.5 million, group II comprised 20 patients with mild increase in TPMSC (0.1 - 12.5 million) and the III group comprised patients without any effect (TPMSC did not change, or became less than preoperative one) after varicocelectomy. The initial clinical characteristics of patients in the groups were compared. RESULTS: A significant effect was observed in 52% of cases (n=48), a mild favorable effect in 21% (n=20), and no effect in 27% (n=25). Spontaneous pregnancy rates (in 1 year after varicocele repair) were higher in patients of group I than that of groups II and III: 46%, 10% and 12%, respectively (p<0.05). The initial clinical characteristics between groups were comparable (p>0.05). In group I, the initial semen analysis parameters were significantly better than in group II and worse than in group III: the median and 25% -75% of the quartiles for TPMSC were 15 (1-44), 0 (0-8) and 54 (19-100) million, respectively (for all p<0.001). According to discriminant analysis significant predictors of pregnancy after varicocelectomy were an increase of TPMSC, male age and the initial total sperm motility. The predictive accuracy of the prognostic model with these three predictors was 84%, specificity was 87%, and sensitivity was 76%. CONCLUSIONS: The odds of fertility recovery after varicocelectomy has a U-shaped relationship: it is higher in patients with moderate semen quality impairment and it decreases in patients with initially low, and, conversely, high sperm count and motility. An increase in TPMSC by 12.5 million or more is a highly significant indicator of fertility recovery, because in this case the odds of spontaneous pregnancy can reach 50%. Predictors of fertility recovery after varicocelectomy are an increase of TPMSC, male age and the preoperative total motility.

[Experimental and clinical studies of the effect of pectin on the causative agents of acute intestinal infections]. / Eksperimental'noe i klinicheskoe izuchenie vliianiia pektina na vozbuditelei ostrykh kishechnykh infektsii.

The effect of alimentary pectin obtained from different raw materials (apple, tomato, cotton-wool) on the causative agents of infectious diarrheal diseases, belonging to the genera Shigella, Salmonella, Klebsiella, Enterobacter, Proteus and Citrobacter, was studied under experimental conditions and in clinical observations. The study revealed that pectin, irrespective of raw material used for its production, produced an inhibiting effect on these microorganisms. This effect was most pronounced, both under experimental and clinical conditions, when 5% pectin solution was used. A rapid suppress of diarrhea and other manifestations of the infectious syndrome was observed in patients. The patients treated with pectin stayed in the hospital, on the average, 2-3 days less than the control group of patients treated with antibiotics and other chemotherapeutic preparations.

[A plasma subunit vaccine against hepatitis B studied in field trials]. / Izuchenie sub''edinichnoi plazmennoi vaktsiny protiv gepatitia B v polevykh ispytaniiakh.

The work presents materials on the study of subunit plasma vaccine against hepatitis B (HB), developed in the USSR, in a controlled epidemiological trial. The study showed low reactogenicity and complete safety of the preparation, the level of anti-HBsAg antibodies in persons, formerly found to have no such antibodies, being 88% after three injections of the vaccine. To determine the prophylactic effectiveness of the vaccine, the test and control groups, each consisting of 500 children, were formed from children aged 1-3 years, i.e. belonging to the age group most frequently affected by HB, by the method of random choice. During 18 months from the time of immunization no cases of HB were registered among the vaccinees, while in the control group 5 cases of HB were registered (8.9 per 1000). These results indicate that the plasma vaccine against HB, newly developed in the USSR, is faintly reactogenic, safe and shows sufficiently high antigenic activity and protective potency correlating with this activity.

[Characteristics of viral hepatitis non-A, non-B with a fecal-oral mechanism of transmission of the infection in southern Uzbekistan]. / Kharakteristika virusnogo gepatita ni A ni B s fekal'no-oral'nym mekhanizmom peredachi infektsii v iuzhnom Uzbekistane.

An increase in the incidence of viral hepatitis was observed in the autumn of 1986 in one of the districts of southern Uzbekistan. The clinico-epidemiological data and highly sensitive tests for hepatitis A (HA) and B (HB) markers showed the absence of HB infection in most of the patients and prevalence of HA among children. In 68.7% of the patients, non-A-non-B hepatitis with fecal-oral mechanism of transmission of the infection was diagnosed. The bulk of HnAnB patients consisted of adults of 20-29 years. Pregnant women experience severe forms of the disease. Solid-phase enzyme-immunoassays and immune electron microscopy revealed in one fecal specimen from patients the antigen of non-A-non-B hepatitis serologically identical to that causing a rise in the incidence in northern Turkmenia in 1984-1985.