[Bacteriospermia: Effects on semen parameters]. / La bactériospermie : effets sur les paramètres spermatiques.

OBJECTIVES: Bacteriospermia may result in male hypofertlity. Indeed, 60% of patients treated by Assisted Reproductive Techniques had a local infection or inflammation of genital tract. However, direct effects of bacteriospermia on semen parameters remain controversial. The aim of our work was to explore the effect of bacteriospermia on sperm parameters among patients consulting for hypofertility. METHODS: A retrospective comparative study of two groups: a group of 70 patients with bacteriospermia (group 1) and a control group of 70 patients without bacteriospermia (group 2). For these groups, we studied the standard semen parameters (seminal volume and viscosity and spermatozoa count, initial and secondary mobility, vitality and morphology). Comparison of these parameters was made by the Chi2 test and the Fisher test. RESULTS: The mean age of our population was 40.4±6.7 years. There was no significant difference between ejaculate average volume in the 2 groups (group B: 2.78mL versus group A: 2.92mL with P=0.2). Similarly, for the viscosity no difference was noted (P=0,68). The altered parameters in the presence of bacteriospermia were mean concentration and sperm motility (P=0.001 and P=0.049 respectively). The prevalence of secondary asthenospermia was higher in the presence of bacterospermia (P=0.006). No statistically significant differences were observed for morphology and vitality of spermatozoa (P=0.276 and P=0.075 respectively). The leucospermia was associated with bacteriospermia in 10% patients. Ureaplasma urealyticum was the germ most found (45.7%) followed by Streptococcus and Staphylococcacae (20.3% for each), Gram negative rods accounted for 12.9%, while Corynebacterium spp was isolated only in 4,3% patients. U. urealyticum was associated with hypospermia in 33% of cases (P=0.031). Spermatozoa motility was significatively decreased not only in the presence of this bacteria (FT=0.002) but also when cultures were positive for Streptococcus (0.04) and Corynebacterium (P<0.001). Morphological abnormalities were also noticed with Streptococcus with index of teratozoospermia of 46% versus 19% in the 2nd group (P=0.046). CONCLUSION: Bacteriospermia may impair sperm parameters. The treatment of this affection seems to improve sperm fertilizing potential. In addition, it could prevent contamination of culture media.

[The usefulness of elastase measurement in the sperm for the diagnosis of urogenital male inflammation and infection]. / Intérêt du dosage de l'élastase dans le liquide séminal pour le diagnostic de l'inflammation et de l'infection du tractus urogénital masculin.

BACKGROUND: Genital tract inflammation is a frequent cause of infertility among men, usually clinically silent with only leukocytospermia defined as the presence of white blood cells (WBC)>1.106/ml in semen. During the inflammation process, granulocytes discharge large amounts of proteases such as elastase. The elastase linked to its inhibitor in the form of a complex the elastase α1-protease inhibitor in semen is suggested as a potential marker of genital tract inflammation. AIM: To assess the measurement of elastase as a biomarker of genital tract inflammation by comparing this technique with the detection of leukocytospermia according to the WHO guidelines. METHODS: This study interested 83 infertile men attending the andrology center for semen analysis. Leukocytospermia was assessed by a peroxydase test and elastase concentration by immunoassay in the seminal plasma. RESULTS: An elevated elastase was found in 38% of men. A similarity was found between leukocytospermia and elastase in 79% of cases, kappa coefficient concordance with leukocytospermia is good (0.78). The sensitivity of the elastase is 100%, the specificity= 75%. The positive predictive value is 47%, the negative predictive value is 100% with a Youden index=0.75. All patients with leukocytospermia>1.106/ml had an elastase>250ng/ml, 73% of them a concentration>1000 ng/ml. In the group of patients with no leucocytospermia, 75% had elastase<250ng/ml, 21% had concentration between 250 and 1000ng/ml and 4% (3 patients) a concentration>1000ng/ml. CONCLUSION: Seminal elastase is a more sensitive marker than leucocytospermia in the diagnosis of male urogenital inflammation and infection.

[Morphometric analysis of the human endometrium during the implantation window. Light and transmission electron microscopy study]. / Analyse morphométrique de l'endomètre humain en période d'implantation. Étude en microscopie optique et en microscopie électronique à transmission.

OBJECTIVES: To perform a morphometric and ultrastructural analysis of the various cellular components that constitutes the endometrial epithelium during the implantation window. METHODS: Endometrial biopsies of six patients in ageing to procreate were realized during the implantation window and analyzed using light and transmission electron microscopy (TEM). RESULTS: During the implantation window, four endometrial cell types are identified in distinct proportions: microvilli-rich cells, pinopode cells, ciliated cells and others without apical differentiation. We highlighted important differences between surface and glandular epitheliums. Pinopode cells are present in all biopsies; they are more frequent in glands than surface. Their maximum expression in the glandular epithelium is at the day 20 and in the surface epithelium at the day 22. The pinopodes are present since day 19, they appeared fully developed with a maximum at day 22. Using TEM for ultrastructural analysis, we showed images of endocytosis and numerous secretory vesicles in epithelial cells of the endometrium. Their plasmic membrane present apical differentiations in the form of microvilli covered with a very developed cell coat indicating a high activity of exchange with the extracellular compartment. The endometrial cells exhibit extensive signs of communication between neighboring cells appeared to be preserved. CONCLUSION: Our data suggest each cell type and each cell structure as a very precise function in order to prepare the endometrium to be receptive.

[Oocyte and embryo quality and outcome of ICSI cycles in patients with polycystic ovary syndrome (PCOS) versus normo-ovulatory]. / Qualité ovocytaire et embryonnaire et issue des cycles d'ICSI chez les patientes porteuses d'un syndrome des ovaires polykystiques (SOPK) versus normo-ovulantes.

OBJECTIVE: To compare the oocyte and embryo quality and outcomes in polycystic ovary syndrome (PCOS) patients and normo-ovulatory women undergoing intracytoplasmic sperm injection (ICSI) cycles. MATERIALS AND METHODS: We studied retrospectively 100 controlled ovarian stimulation cycles for ICSI in women with PCOS and 200 cycles in normo-ovulatory women. Every PCOS woman was paired according to age with two normo-ovulatory woman undergoing ICSI during the same study period. A long protocol of gonadotrophin releasing hormone (GNRH) agonist was carried out in all patients. The main outcome measures evaluated were: cancellation of the cycles, number of aspirated follicles, oocyte maturity, fertilization rate, embryo quality pregnancy and implantation rates, clinical abortion rate, multiple pregnancy rate and the "take-home baby" rate. Khi(2) test and Student t test were used for differences between normo-ovulatory and PCOS patients and the limit of significance was set at p<0,05. RESULTS: ICSI was performed for male infertility in most cases (79% in PCOS group vs 79,5%; NS). There was no significant difference in term of cancellation rate (5,5% in PCOS group vs 5%; NS). The mean number of follicles was higher in patients with PCOS (18,1+/-8,5 vs 9,4+/-5,5; p<0,001). Oocyte mature rate (67% vs 52%; p<0,001), fertilization rate (75% vs 63,7%; p<0,001) and grade 1 embryo rate (69% vs 53%; p<0,001) were significantly higher in PCOS group. The mean number of transferred embryos was similar in the two groups (2,46+/-0,5 vs 2,54+/-1,01; NS). Implantation rate (16,6% vs 12,1%; NS), clinical pregnancy rate per transfer (31,5% vs 24%; NS) and Live birth rate (22% vs 20%; NS) did not differ statistically in the two groups. Twin and triplet pregnancies rates were similar in the two groups (20% vs 16,7%; NS and 6,6% vs 7,1% ; NS respectively). Miscarriage rate was higher in PCOS group but this did not reach the statistical significance (26,6% vs 16,6%; NS). CONCLUSION: PCOS patients showed better global oocyte and embryo quality. However, pregnancy and live birth rates were similar in the two groups when number and quality of transferred embryos are equivalent.

[Histology of the larynx]. / Histologie du larynx.

The mucous membrane lining the interior of the larynx was studied in autopsy specimens taken from 21 infant larynxes, with ages ranging from 1 to 15 years. Only those larynxes in which the epithelial mucosal structures were preserved were set aside for study. A standard histological technique was applied. Paraffin sections were stained with haematoxylin-eosin, PAS, Masson's triple stain and orcine. The epithelium of the ventricles, ventricular bands and subglottis was found to be of respiratory type. On the vocal folds, the lining was non-keratinising squamous epithelium. These findings are consistent with those found in the literature. Findings that differed were as follows: the laryngeal surface of the epiglottis is classically described as having a respiratory type of epithelium, whereas we found it to be of non-keratinising stratified squamous type. The literature describes the epithelium of the ventricular bands as respiratory. While in our series we found stratified squamous in 56% and respiratory in 44%. Other findings are imprecise in the literature, and need definition; the finding of taste papillae in six cases without age correlation; and the richness of follicles in the lymphoid tissue at the epiglottis and ventricles of children aged more than 3 months.

Inflammatory response in induced sputum mononuclear cells from patients with acute exacerbation of asthma.

Examination of sputum provides a direct method to investigate airway inflammation non-invasively in particular Th1 (IL-2, IFN-gamma) and Th2 (IL-4, IL-10) cytokine production. IL-2, IL-4, IL-10 and IFN-gamma cytokine were studied in induced sputum mononuclear cells of asthmatic patients. Sputum induction was performed on 10 patients and 10 normal controls. Basal and mitogen-stimulated cytokine production was determined in induced sputum T-cell culture. Supernatants were collected and assayed not only with specific ELISA but also with polymerase chain reaction (PCR) techniques. Data showed a significantly higher production of IL-10 by both the ELISA and the RT-PCR techniques in asthmatic patients compared with sputum mononuclear cells from healthy controls. IL-4 production was detected at a low level using the ELISA method in asthmatic patients. The RT-PCR analysis detected a significantly IL-4-mRNA expression in all asthmatic patients, compared with controls. Results of IL-10 and IL-4 mRNA expression were reproducible. We did not find any alteration in the expression of the type 1 derived cytokines (IL-2 and IFN-gamma) in asthmatic patients or in healthy controls. Our study showed a tendency of induced sputum mononuclear cells to express a Th2-like cytokine pattern in acute exacerbation of asthmatic patients, where IL-10 and IL-4 are synthesized in larger amounts. The combination of sputum induction as a non-invasive tool to explore the lung and the identification of disease-associated cytokine expression and of specific cytokine mRNA should help elucidate mechanisms of the immunologically mediated inflammatory responses in asthma.

Bone histomorphometry in 50 normal Tunisian subjects.

Quantitative bone histomorphometry was done on undecalcified sections of iliac crest bone specimens obtained at autopsy from 50 normal subjects (24 males and 26 females). The following parameters were measured: cortical thickness (Ct.Th), trabecular bone volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), osteoid volume (OV/BV), osteoid surfaces (OS/BS), osteoid thickness (O.Th) and eroded surfaces (ES/BS). There was a significant age-related decrease in BV/TV in both sexes which followed a x3 polynomial regression. A significant decrease of Tb.Th was noted in males after the fifth decade. In males, bone loss was 1.5% per decade, but in females it was 0.36% before menopausal period and 2% after. Other parameters were unrelated to age and sex.

[Biomaterials for bone filling: comparisons between autograft, hydroxyapatite and one highly purified bovine xenograft]. / Biomatériaux de comblement osseux: comparaisons entre autogreffe, hydroxyapatite et une xénogreffe bovine hautement purifiée.

Bone grafts are becoming increasingly common in orthopaedics, neurosurgery and periodontology. Twenty one New Zealand rabbits were used in the present study comparing several materials usable as bone substitutes. A 4.5 mm hole was drilled in the inner femoral condyles. Holes were filled with either an autograft (from the opposite condyle), an hydroxylapatite (Bioapatite), or a highly purified bovine xenograft (T650 Lubboc). Animals were sacrificed at 1, 3 and 6 months post implantation and a quantitative analysis of newly-formed bone volume (BNF/IV) and remaining biomaterials (BMAT/IV) was done. In addition, some holes were left unfilled and served as controls. At 6 months, there was no tendency for spontaneous repair in the control animals. The autografted animals have repaired their trabecular mass and architecture within the first month. Hydroxylapatite appeared unresorbed at six months and only thin and scanty new trabeculae were observed. The xenograft induced woven bone trabeculae formation on the first month. This was associated with resorption of the material by two multinucleated cell populations. At six months, the epiphyseal architecture was restored and the biomaterial has disappeared in most cases. Xenografts appear a promising alternative to autografts and allografts, whose infectious risks and ethical problems should always be borne in mind.