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Varaždin, Croatia

Fedder J.,Scientific Unit
Systems Biology in Reproductive Medicine | Year: 2011

Testicular volume, hormones, and growth factors are used as predictors of finding motile testicular sperm in azoospermic men. In this study, the possible predictive value of very simple parameters such as systematic history, clinical examination, and determination of ejaculate volume have been evaluated. Two-hundred and sixty-two consecutive non-vasectomized men with azoospermia/aspermia were evaluated by systematic history, clinical examination, ultrasonography of the scrotal content, and hormonal and genetic analyses. Hormonal analyses included, as a minimum, determination of follicular stimulating hormone (FSH), luteinizing hormone (LH), and testosterone, while genetic analyses included karyotyping and examination for cystic fibrosis transmembrane conductance regulator (CFTR) mutations and Y microdeletions. In seventy-six cases (29%) genetics was the most likely cause of azoospermia. For men with at least one CFTR mutation, motile sperm could be detected in 100% of 13 men with congenital bilateral absence of vasa deferentia (VD) but only in 44% of 18 with present VD. Ejaculate volumes were significantly lower (2.3mL versus 3.6mL) in 81 men with motile testicular sperm detected compared to 111 men without detectable motile sperm (p<0.001; Student's t-test), and the difference was still significant after exclusion of men carrying a CFTR mutation. Based on the present data, an ejaculate volume of 2.5mL was considered a useful threshold value. Furthermore, an inhomogeneous histological pattern with maturation of sperm in small islands isolated in tissue showing Sertoli cell only (SCO) pattern seems characteristic for men with a history of cryptorchidism (negative predictive value: 95%). In addition to FSH, testicular volume, and other endocrine factors, it is important to consider that very simple factors such as ejaculate volume and presence or absence of VD in men with CFTR mutations might be used as predictors according to the chance of finding motile testicular sperm. Evidence for a strong association between a history of cryptorchidism and an inhomogeneous histological pattern with maturation of sperm in islands in tissue presenting SCO pattern might indicate that multiple TESEs should be considered in men with a history of cryptorchidism. © 2011 Informa Healthcare USA, Inc. Source

Fedder J.,Scientific Unit | Fedder J.,University of Southern Denmark | Loft A.,Copenhagen University | Parner E.T.,University of Aarhus | And 2 more authors.
Human Reproduction | Year: 2013

Study Question Does neonatal outcome including congenital malformations in children born after ICSI with epididymal and testicular sperm [testicular sperm extraction (TESE)/percutaneous epididymal sperm aspiration (PESA)/testicular sperm aspiration (TESA) (TPT)] differ from neonatal outcome in children born after ICSI with ejaculated sperm, IVF and natural conception (NC)? Summary Answer Children born after TPT have similar neonatal outcome, including total malformation rates, as have children born after ICSI and IVF with ejaculated sperm. Testing for variance over the four groups may indicate smaller differences in specific malformation rates with TPT as the highest risk group. What is Known Already Regarding neonatal outcome as well as congenital malformations in children born after TPT, studies are few, with limited sample size, heterogeneous and often performed without relevant control groups. Study Design, Size, Duration Population-based cohort study including all Danish children born after TPT and fresh embryo transfer in Denmark from 1995 to 2009. Children born after transfer of frozen-thawed embryos were excluded. Control groups of children conceived by ICSI with ejaculated sperm, IVF and NC were identified by cross-linkage of the Danish IVF Register, Medical Birth Register (MBR) and National Hospital Discharge Register (HDR).PARTICIPANTS/MATERIALS, SETTINGThe study group consisted of 466 children born after TPT, while the control groups consisted of 8967 (ICSI with ejaculated sperm), 17 592 (IVF) and 63 854 (NC) children. Neonatal outcomes and congenital malformations were analysed for singletons and twins separately. Risk estimates for low birthweight (LBW, <2500 g) and preterm birth (PTB, <37 gestational weeks) were adjusted for maternal age, parity, child gender and year of childbirth. The study group was identified from the Danish national database on children born after TPT. Control groups were obtained from the IVF register and the MBR. All information included in the study was retrieved from the national registers. Main Results AND THE ROLE OF CHANCEConsidering singletons and twins as one group, the sex ratio (♂/♀) was significantly lower for children born after TPT (0.89) compared with conventional IVF (1.11; P = 0.017) but did not differ significantly when compared with ICSI with ejaculated sperm (0.94) and NC (1.05). The mean birthweight (BW) for singletons did not differ significantly between groups when including only first-born children. The mean gestational age (GA) in the TPT singletons (279 ± 12 days) was significantly higher compared with IVF (276 ± 18 days; P = 0.02), but similar to ICSI with ejaculated sperm and NC singletons when including only first-born children (277 ± 16 days and 279 ± 14 days, respectively). Rate of stillbirths, perinatal and neonatal mortality in the group of TPT singletons did not differ significantly from any of the control groups. Comparable results were found for the TPT twin group, except for perinatal mortality, which was significantly lower in the TPT group compared with naturally conceived twins. The adjusted risk of LBW was significantly higher for TPT versus NC singletons [adjusted odds ratio (AOR) = 0.67 (0.48-0.93)]; however AOR for PTB was similar in the two groups. Regarding twins, similar adjusted risks were observed for PTB and LBW between the TPT and all three control groups. Significantly more Caesarean sections were performed after IVF (27.3% for singletons) and ICSI (25.1% for singletons) with ejaculated sperm compared with the TPT group (16.4% for singletons). The total rate of congenital malformations in the TPT group was 7.7% and did not differ significantly from any of the control groups. However, singleton TPT boys showed an increased rate of cardiac malformations (3.6%) compared with singleton boys after IVF (1.4%; P = 0.04) and NC (1.1%; P = 0.02). Considering the level of male infertility as a continuum over the four groups, tests for variance in the rate of cardiac malformations in singleton boys, and undescended testicles for singleton as well as twin boys were each significantly increased from NC to IVF to ICSI to TPT (P < 0.001). The rate of hypospadias showed the same pattern, but the TPT group did not differ significantly compared with the control groups. Limitations , Reasons for Caution One of the Limitations is that the TPT group could not be classified according to testicular or epididymal sperm, as these data were not available in the IVF register. Another limitation is that registry-based studies are encumbered with the risk of reporting or coding errors or missing data due to insufficient coding. However, the quality of data on congenital malformations in HDR has, in other studies, been validated and found acceptable for epidemiological research, and furthermore, recordings on study and control groups are performed similarly. Wider Implications of the Findings Accumulating data show that TPT treatment is equally safe as conventional ICSI and IVF treatment and as NC with regard to neonatal outcome including congenital malformation. Study Funding/Potential Competing InterestsThis study is supported by Laboratory of Reproductive Biology, Scientific Unit, Horsens Hospital. No competing interests declared. © 2012 The Author. Source

Darabos N.,University of Zagreb | Haspl M.,Special Hospital for Orthopaedics and Traumatology Akromion | Moser C.,Witten/Herdecke University | Darabos A.,Scientific Unit | And 2 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2011

Pro-inflammatory cytokines play a pivotal role in osteoarthritis, as well as in bone tunnel widening after ACL reconstructive surgery. A new treatment option is to administer autologous conditioned serum (ACS) containing endogenous anti-inflammatory cytokines including IL-1Ra and growth factors (IGF-1, PDGF, and TGF-β1, among others) in the liquid blood phase. The purpose of this trial was to establish whether the postoperative outcome could be affected by intraarticular application of ACS. Methods In a prospective, randomized, double-blinded, placebo-controlled trial with two parallel groups, 62 patients were treated. Bone tunnel width was measured by CT scans, while clinical efficacy was assessed by patientadministered outcome instruments (WOMAC, IKDC 2000) up to 1 year following the ACL reconstruction in patients receiving either ACS (Group A) or placebo (Group B). We compared the levels and dynamics of IL-1β concentrations in the synovial liquid and examined the correlation between the levels of IL-1β at three different postoperative points. Results Bone tunnel enlargement was significantly less (6 months: 8%, 12 months: 13%) in Group A than in Group B (6 months: 31%, 12 months: 38%). Clinical outcomes (WOMAC, IKDC 2000) were consistently better in patients treated with ACS at all data points and for all outcome parameters, and there were statistically significant differences in the WOMAC stiffness subscale after 1 year. The decrease in IL-1β synovial fluid concentration was more pronounced in the ACS group, and values were lower, to a statistically significant degree, in the ACS group at day 10. Conclusion The intraarticular administration/injection of ACS results in decreased bone tunnel widening after ACL reconstructive surgery. Level of evidence Therapeutic study, Randomized controlled trial (significant differences and narrow confidence intervals), Level I. © Springer-Verlag 2011. Source

Fedder J.,Scientific Unit
Danish medical bulletin | Year: 2011

As we found no recent published reports on the amount and kind of research published from Danish hospitals without university affiliation, we have found it relevant to conduct a bibliometric survey disclosing these research activities. We retrieved all scientific papers published in the period 2000-2009 emanating from all seven Danish non-university hospitals in two regions, comprising 1.8 million inhabitants, and which were registered in a minimum of one of the three databases: PubMed MEDLINE, Thomson Reuters Web of Science and Elsevier's Scopus. In 878 of 1,252 papers, the first and/or last author was affiliated to a non-university hospital. Original papers made up 69% of these publications versus 86% of publications with university affiliation on first or last place. Case reports and reviews most frequently had authors from regional hospitals as first and/or last authors. The total number of publications from regional hospitals increased by 48% over the 10-year period. Publications were cited more often if the first or last author was from a university hospital and even more so if they were affiliated to foreign institutions. Cardiology, gynaecology and obstetrics, and environmental medicine were the three specialities with the largest number of regional hospital publications. A substantial number of scientific publications originate from non-university hospitals. Almost two thirds of the publications were original research published in international journals. Variations between specialities may reflect local conditions. not relevant. not relevant. Source

Zinther N.B.,Horsens Regional Hospital | Zinther N.B.,Scientific Unit | Wara P.,Aarhus University Hospital | Friis-Andersen H.,Horsens Regional Hospital
Hernia | Year: 2010

Purpose Current hernia literature shows that the use of mesh in ventral hernia repair reduces the risk of recurrence signifieantly. In laparoscopic repair, the mesh is placed intraperitoneally. Accordingly, the close contact between mesh and viscera involves a risk of adhesion formation. In this experimental study, we examined the degree of de novo adhesion formation over time to currently available meshes. Methods Sixteen sheep each received laparoscopic placement of four (10 × 10 cm) meshes on intact peritoneum. Two different mesh materials (coated vs. non-coated) and two different Wxation devices (absorbable/non-absorbable) were investigated. (Parietex®Composite, DynaMesh®IPOM, ProTack™ and AbsorbaTack™). After 3, 6, 12 and 18 months, four animals, respectively, underwent a new laparoscopy to determine the extent of adhesions to the mesh. Results Parietex®Composite signifieantly reduced the formation of intraabdominal adhesions compared to Dyna-Mesh®IPOM. The mean extent of adhesions increases over time without reaching a steady state within the Wrst 12 months after laparoscopic placement. Conclusions This is the Wrst long-term (18 months) experimental study on adhesion formation in sheep after laparoscopic placement of mesh and may serve as a template for future studies on meshes before marketing. © Springer-Verlag 2010. Source

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