Flow Cytometry and Sizing for Routine Andrological Analysis

Summary: Flow fluorometry and Coulter type sizing analysis of sperm have been applied separately in order to improve human semen analysis. Different methods of sample preparation were evaluated and a protocol involving prestaining pepsin treatment of sperm samples is proposed for fluorometric analysis. The data obtained with fluorometry and sizing analysis result in different kinds of information: Coulter counting allows to automate sperm counting and fluorometry yields more datailled information about normozoospermia and oligozoospermia by determining the proportion of mature spermatozoa and immature germ-cells. These two methods, together with light microscopy, may help to explore the correlation of fertility and pathology of spermatozoa. The aim of these investigations is to yield the preconditions for simultaneous two-parameter analysis of DNA content and cellular size distributions. Zusammenfassung: Durchflußcytophotometrie und Größenmessung für andrologische Routineuntersuchungen von Spermatozoen Durchflußanalyse und Größenanalyse nach dem Coulter-Prinzip wurden angewandt, um die Begutachtung menschlichen Spermas zu verbessern. Unterschiedliche Methoden der Probenaufbereitung wurden ausprobiert, und ein Protokoll mit Pepsinbehandlung der Spermatozoenproben für fluorometrische Analysen wird vorgeschlagen. Die mit der Cytofluorometrie und Größenanalyse erhaltenen Daten ergeben unterschiedliche Informationen: Das Coulter-Prinzip erlaubt die Automatisierung der Spermatozoenzählung, und die Fluorometrie ergibt detailliertere Erkenntnisse über Normozoo-spermie und Oligozoospermie, da die Unterscheidung von reifen Spermatozoen und unreifen Keimzellen ermöglicht wird. Diese beiden Methoden können in Kombination mit der Lichtmikroskopie helfen, die Korrelation zwischen Fertilität und Pathologie von Spermatozoen zu erkunden. Das Ziel dieser Untersuchungen ist es, die Voraussetzungen für gleich-zeitige Zweiparameteranalysen des DNA-Gehaltes und der zellulären Größenverteilungen zu liefern.     

Clinical Outcomes Following Percutaneous Coronary Intervention With Drug‐Eluting Stents Versus Bare Metal Stents in Patients on Chronic Hemodialysis

Background

Patients on chronic hemodialysis (HD) are recognized as a high‐risk group for adverse events after percutaneous coronary intervention, and whether drug‐eluting stents (DES) are associated with improved outcomes over bare metal stents (BMS) is still uncertain. The purpose of this study was to assess the efficacy of DES compared with BMS at short‐ and long‐term follow‐up (FU) in an unselected sample of HD patients.

Methods and Results

In the time period 2005–2010, consecutive patients on chronic HD treated with percutaneous coronary intervention (PCI) and stent implantation were retrospectively selected and analyzed. A total of 169 patients were selected, 77 treated exclusively with BMS and 92 exclusively with DES. Baseline clinical characteristics were similar in the 2 groups as well as the number of treated vessels, treated lesions, and the stent per patient ratio. At longest available FU, no difference between the 2 study groups was found in terms of cardiac death (18.2% vs 16.3%, P = 0.83), myocardial infarction (2.5% vs 8.6%, P = 0.09), cerebrovascular accidents (0% vs 1.1%, P = 0.98), and target vessel revascularization (TVR) (9.1% vs 16.3%, P = 0.17). Major adverse cardiac and cerebrovascular events‐free survival at 1,500 days in the BMS and DES groups was 57.6% and 50.9% (P = 0.11), respectively.

Conclusions

PCI in patients on chronic HD treatment is associated with a high incidence of adverse events at FU, mainly represented by death. In our study, the use of DES was not associated with a reduction of target lesion revascularization (TLR) and TVR.

     

The significance of a positive cutaneous immunofluorescence test in systemic lupus erythematosus

Direct cutaneous immunofluorescence microscopical examination of uninvolved skin is an important diagnostic test in systemic lupus erythematosus. Its prognostic significance is undetermined. In twenty-four patients there was an increased incidence of leukopenia, hypocomplementaemia, and LE cells in patients with positive skin immunofluorescence. Positive cutaneous immunofluorescence of uninvolved skin was correlated with the most severe forms of lupus renal disease, membranous glomerulonephritis, and diffuse proliferative glomerulonephritis.     

Effect of Steroid Eluting Versus Conventional Electrodes on Propafenone Induced Rise in Chronic Ventricular Pacing Threshold

The aim of this study was to evaluate chronic ventricular pacing threshold increase after oral propafenone therapy. Eighty-three patients affected by advanced atrioventricular hJock and sick sinus syndrome were studied at least 3 months after pacemaker implantation, before and after oral propafenone therapy (450–900 mg/day based on body weight). The patients were subdivided into three groups according to the type of unipolar electrode that was implanted: group I (41 patients)Medtronic CapSure 4003, group II(30 patients)Medtronic Target Tip 4011, and group III (12 patients)Osypka Vy screw-in lead. In all cases a Medtronic unipolar pacemaker was implanted: 30 Minix, 23 Activitrax, 14 Elite, 12 Legend, and 4 Pasys. Propafenone biood level was measured in 75 patients 3–5 hours after propafenone administration. The pacing autothreshoid was measured at 0.8 V, 1.6 V, and 2.5 V by reducing puise width. At the three different outputs before and after propafenone, threshold increments were significantly lower in group I in comparison with group II and group III (propafenone ranging from < 0.001 to < 0.05). No significant difference was found in pacing impedance or in propafenone plasma concentration in the three groups. Strength-duration curves were drawn for each group at baseline and after propafenone administration. Before propafenone, in group I, the knee was markedly shifted to the left and downward as compared to the classic curve, so that the steep part was predominant; in group II and group III this shift was progressively less evident. After propafenone we found the curve shifted to the right with the flat part progressively more evident in group II and group III as compared to group I. We conclude that steroid eiuting leads cause less threshold increase than conventionol and screw-in ones after oral propafenone, thus leading to safer chronic pacing. Chronic pacing at 2.5-V amplitude and 0.6-msec width was feasible in 97% of group I patients and in 80% of group II patients, but not in group III due to an insufficient safety margin. propafenone, pacing threshold     

Low Energy Intracardiac Cardioversion of Persistent Atrial Fibrillation

The aims of the study were to verify the efficacy and safety of low energy internal Cardioversion (LEIC) in patients with persistent at rial fibrillation (AF) and to identify the factors affecting the at rial defihrillation threshold (ADT). Forty-nine patients with persistent (lasting ≥ 10 days) AF underwent LEIC. In each patient, two 6 Fr custom-made catheters with large active surface areas were positioned in the coronary sinus (cathode) and the lateral right wall (anode), respectively, for shock delivery, and a tetrapolar lead was placed in the fight ventricular apex for R wave synchronization. Truncated, biphasic (3 ms+3 ms). exponential shocks were used, beginning at 50 V and increasing in steps of 50 V until sinus rhythm had been restored. Mild sedation (diazepam 5 mg IV) was administered to 12 patients. Sinus rhythm was restored in all the subjects with mean voltage and energy levels of 352.0 ± 80.3 V and 8.2 ± 3.4 J, respectively. The ADT in patients pretreated with amiodarone (6.4 ± 1.8 J) was lower than that of patients who had not received any antiarrhythmic drugs (9.2 ± 3.7) (P = 0.04). No ventricular arrhythmias were induced by any of the atrial shocks, and no other complications were observed. During a mean follow-up of 162.9 ± 58.7 days, AF recurred in 21 (43%) patients; 71% of these occurred in the first week after Cardioversion. LEIC is effective in restoring sinus rhythm in patients with persistent AF. The technique seems to be safe and does not require general anesthesia or, in most cases, sedation. Patients pretreated with amiodarone have lower ADTs.