Pathogenesis of Autoimmune Male Infertility: Juxtacrine, Paracrine, and Endocrine Dysregulation.

According to global data, there is a male reproductive potential decrease. Pathogenesis of male infertility is often associated with autoimmunity towards sperm antigens essential for fertilization. Antisperm autoantibodies (ASAs) have immobilizing and cytotoxic properties, impairing spermatogenesis, causing sperm agglutination, altering spermatozoa motility and acrosomal reaction, and thus preventing ovum fertilization. Infertility diagnosis requires a mandatory check for the ASAs. The concept of the blood-testis barrier is currently re-formulated, with an emphasis on informational paracrine and juxtacrine effects, rather than simple anatomical separation. The etiology of male infertility includes both autoimmune and non-autoimmune diseases but equally develops through autoimmune links of pathogenesis. Varicocele commonly leads to infertility due to testicular ischemic damage, venous stasis, local hyperthermia, and hypoandrogenism. However, varicocelectomy can alter the blood-testis barrier, facilitating ASAs production as well. There are contradictory data on the role of ASAs in the pathogenesis of varicocele-related infertility. Infection and inflammation both promote ASAs production due to "danger concept" mechanisms and because of antigen mimicry. Systemic pro-autoimmune influences like hyperprolactinemia, hypoandrogenism, and hypothyroidism also facilitate ASAs production. The diagnostic value of various ASAs has not yet been clearly attributed, and their cut-levels have not been determined in sera nor in ejaculate. The assessment of the autoimmunity role in the pathogenesis of male infertility is ambiguous, so the purpose of this review is to show the effects of ASAs on the pathogenesis of male infertility.

Thyroid gland and brain: Enigma of Hashimoto's encephalopathy.

The versatile clinical manifestations of the Hashimoto's chronic autoimmune thyroiditis often include psycho-neurological disorders. Although hypothyroidism disturbs significantly the ontogenesis and functions of central nervous system, causing in severe cases of myxedema profound impairment of cognitive abilities and even psychosis, the behavioral, motor and other psychoneurological disorders accompany euthyroid and slightly hypothyroid cases and periods of Hashimoto's disease as well, thus constituting the picture of so called "Hashimoto's encephalopathy". The entity, although discussed and explored for more than 50 years since its initial descriptions, remains an enigma of thyroidology and psychiatry, because its etiology and pathogenesis are obscure. The paper describes the development of current views on the role of thyroid in ontogeny and functions of brain, as well as classical and newest ideas on the etiology and pathogenesis of Hashimot's encephalopathy. The synopsis of the world case reports and research literature on this disorder is added with authors' own results obtained by study of 17 cases of Hashimoto's thyroiditis with schizophrenia-like clinical manifestations. The relation of the disease to adjuvant-like etiological factors is discussed. Three major mechanistic concepts of Hashimoto's encephalopathy are detailed, namely cerebral vasculitis theory, hormone dysregulation theory and concept, explaining the disease via direct action of the autoantibodies against various thyroid (thyroperoxidase, thyroglobulin, and TSH-receptor) and several extrathyroid antigens (alpha-enolase and other enzymes, gangliosides and MOG-protein, onconeuronal antigens) - all of them expressed in the brain. The article demonstrates that all above mentioned concepts intermingle and prone to unification, suggesting the unified scheme of pathogenesis for the Hashimoto's encephalopathy. The clinical manifestations, criteria, forms, course, treatment and prognosis of Hashimoto's encephalopathy and its comorbidity to other diseases - are also discussed in brief. The relation between Hashimoto's encephalopathy and non-vasculitis autoimmune encephalomyelitides of paraneoplastic and non-paraneoplastic origin is emphasized [1 figure, bibliography - 200 references].

Hyperventilation Hypocapnia as The Leonardo da Vinci's Syndrome.

The paper in early history of pulmonary medicine deals with studies of hypocapnia as a result of hyperventilation. Hyperventilation hypocapnia provokes respiratory alkalosis, subsequent ion changes in blood may cause disorders of myocardium conductivity and excitability resulted in arrhythmiae and even heart failure. Besides, hypocapnia limits the cerebral circulation which may be manifested in euphoria and even loss of consciousness. It is dangerous component of high altitude disease. Earliest medical descriptions of hyperventilation hypocapnia and its cardiac consequences are traditionally related with publications by an American physician of XIX age J.M. Da Costa and British doctor A.B.R. Myers. There exists a generally accepted eponym of "Da Costa syndrome". Hereby the authors for the first time coin data that disorders related to hyperventilation were described more than 360 years prior to Da Costa - by an Italian polymath of Renaissance epoch Leonardo da Vinci and suggest new eponym of "Leonardo da Vinci's syndrome". The article also briefly analyzes the medical studies of Leonardo da Vinci and his early contribution into Human Anatomy and Thyroidology.

Integration of Educational and Research Activities of Medical Students (Experience of the Medical Faculty of Saint Petersburg State University).

The article is devoted to the role of research activity of the medical students in higher education of physicians. The teaching of physicians in classical universities and specialized medical schools is compared. The history of physicians' training in Russia in imperial, Soviet and post-Soviet periods is reviewed and compared to development of higher medical education in other countries. Article gives the the description of all failed attempts to establish a Medical Faculty within oldest classical university of Russia, crowned by history of last and successful attempt of its establishment. Authors' experience of adjoining education and research in curriculum and extra-curricular life of this Medical Faculty is discussed. The problems of specialization and fundamentalization of medical education are subjected to analysis. Clinical reasoning and reasoning of scholar-experimentalist are compared. The article reviews the role of term and course papers and significance of self-studies and graduation thesis in education of a physician. The paper gives original definition of interactive learning, and discusses the methods and pathways of intermingling the fundamental science and clinical medicine in medical teaching for achievement of admixed competencies of medical doctor and biomedical researcher.