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Several lines of evidence showed that apoptosis rate of cumulus cells in oocytes derived by assisted reproductive technologies could be used as an indicator of fertilizing gamete quality. Aim of the study was to investigate the effects of three different ovarian stimulation protocols on the biological and clinical outcome in hyporesponder patients. Collected data showed a higher significant rate of DNA fragmentation index (DFI) in U group (patients treated with Highly Purified human Menopausal Gonadotrophin) than in P group (treated with recombinant human Follicle Stimulating Hormone (r-hFSH) combined with recombinant human Luteinizing Hormone (r-hLH)). Both groups R (treated with r-hFSH alone) and P showed a significant increase in collected and fertilized oocytes number, embryo quality number. This study showed that combined r-hFSH/r-hLH therapy could represent the best pharmacological strategy for controlled ovarian stimulation and suggests to use DFI as a biomarker of ovarian function in hyporesponder patients.

Basandosi sui costrutti della ‘mentalizzazione’ e della ‘funzione riflessiva’ di Fonagy e colleghi come quadro teorico di riferimento, il presente articolo si propone di sviluppare il concetto di ‘mentalizzazione nelle organizzazioni’, inteso come processo di costruzione condivisa di significati all’interno dei contesti lavorativi, processo la cui assenza o compromissione può produrre significative esperienze di malessere. Si ipotizza che l’assenza o la compromissione di una competenza riflessiva, insieme ad una mancata simbolizzazione dell’esperienza di lavoro, determinino specifiche conseguenze sia sulla percezione della propria professione, sia sulle relazioni tra colleghi, sia sui processi di management, determinando insostenibilità nella vita professionale e organizzativa.

Il lavoro descrive un intervento di formazione realizzato negli Istituti di Pena e negli UEPE della Regione Sicilia. Il presupposto teorico su cui si è basato l’intervento è che esista una connessione tra il benessere organizzativo e gli spazi di mentalizzazione presenti in un contesto di lavoro. Tale connessione permette di accedere agli stati empatici della comunicazione e della relazione intersoggettiva e produce sostenibilità organizzativa. Dal coinvolgimento di tutti i livelli gerarchici dell’Istituzione Penitenziaria, si è attivato un processo di riflessione sulle specificità culturali di questa organizzazione, rendendo auspicabile lo sviluppo di politiche di ascolto organizzativo che non replichino modelli di lavoro fondati sulla logica dell’adempimento.

Objectives: We compared the outcome of anaemic patients undergoing transcatheter (TAVI) and surgical aortic valve replacement (SAVR) for severe aortic valve stenosis. Methods: Anaemic patients (haemoglobin

Study question Is there a difference in oocyte competence among patients with different gonadotrophin polymorphisms, after ovarian stimulation with r-FSH? Summary Answer Higher DNA Fragmentation Index and cleaved caspase-3 related to lower level of pAKT has been observed in patients with specific gonadotrophin polymorphism (FSHR and LHB). What is known already • In our experience, the DFI, the percentage of cleaved caspase-3 and the pAKT on cumulus cells can be used as molecular markers of oocyte competence; • The polymorphic variant of LHB is characterized by an extra glycosylation signal into the β subunit. This molecular variation influences the pharmacokinetic properties of v-betaLH, showing an elevated bioactivity in vitro, but a significantly shorter half-life in circulation if compared with the wild type LH. These patients show sub-optimal ovarian response after pharmacological ovarian stimulation with r-FSH; We know that FSH receptor (FSHR) variants, Thr307/Asn680 and Ala307/Ser680, are involved in the response to ovarian stimulation. Study design, size, duration The aim of the study was to determine the apoptosis levels (in terms of percentage of DNA fragmentation and percentage of cleaved caspase-3) and the pAKT levels as potential markers of oocyte competence in the cumulus cells of individual patients with specific FSHR and LHB polymorphisms. It was a retrospective study. It was included 36 patients. The duration of the study was 12 months. Participants/materials, setting, methods Patients were normo-responder patients with a normal basic level of FSH (

Study question: Could pollution exposure play a key role on sperm quality, in terms of DNA fragmentation index (DFI)? Summary answer: Patients exposed to high level of pollution show an higher percentage of sperm DNA fragmentation index in contrast with patient from control group. What is known already: Taranto area is characterized by a number of steel factories and petrochemical industries. Data about the detrimental effects of environmental pollution are alarming. Pollution coming from the industrial plants causes health and fertility risks, mainly due to the exposure to several pollutant (PM10, heavy metals, etc). Toxic substances can affect DNA directly or indirectly, through oxidative stress, impairing sperm quality: high levels of sperm DNA fragmentation index has been summoned as possible cause of male infertility; it is known, in effect, that a spermatic DFI less than 15% is physiologic, while above 30% is related to fertility issues. Study design, size, duration: Case-control study: valuation of DFI in patients exposed to different level of environmental pollutants. A. Patients from the city of Taranto leaving far from industries B. Patients working in local steel factories in Taranto C. Patients from Palermo (control group) Duration of the study: 24 months, from January 2010 to December 2012. DFI assessed by in situ TUNEL assay. The fields of fixed semen samples were analysed, by fluorescence and light microscopy. Participants/materials, setting, methods: Three different groups of patients (tot. number of pts 152), afferent to an assisted reproduction clinic in Taranto: Group A) workers of local steel factories (pt. No: 28) and B) Taranto residents (pt. No: 61) and a Control group C) (pt. No: 63) afferent to an assisted reproduction clinic in Palermo with supposed fertility issues. Main results and the role of chance: Our study analyzed sperm samples from three patients groups: A) workers of local steel factories; B) Taranto residents; C) Controls. We observed a highly statistically significant increase of spermatic DNA fragmentation Index (DFI) in the “factory workers” group, constantly exposed to environmental pollutants for professional reasons” compared with control (DFI 31% vs 16.8% P ≤ 2.685 * 10−6) as well as in comparison with the Taranto resident (DFI 31% vs 25% P ≤ 2.9 * 10−3). We have also observed a statistically significant difference between Taranto resident and control group (DFI 25% vs 16.8% P ≤ 3.681*10−6). Limitations, reasons for caution: The limitation of this study is that it is a retrospective study and the size of cohort of patients. Wider implications of the findings: Our study supports the hypothesis that the level of dioxin exposition might be positively correlated with the sperm DFI. Interrupting the sperms damaging source might bring back the DFI level to normal values. So, moving away from the damaging source, patients from A and B groups could restore spermatogenesis. Trial registration number: The trial is an observational study and no registration is needed.

Background and aim of the study: The study aim was to determine the impact of prosthesis-patient mismatch (PPM) on early and late clinical outcomes, left atrial and ventricular remodeling, late tricuspid valve regurgitation and pulmonary hypertension (PH) in patients after mitral valve replacement (MVR). Methods: A total of 46 patients (mean age 66 ± 9.3 years) with mitral valve diseases and undergoing isolated MVR was enrolled in the study. The mitral valve effective orifice area (EOA) was determined using the continuity equation and indexed for the patient’s body surface area (EOAi). PPM was defined as EOAi ≤1.2 cm2/m2. PH was defined as a systolic pulmonary artery pressure (sPAP) >40 mmHg. Both, clinical and echocardiographic follow up were performed. Results: PPM was identified in 25% of patients, but no significant differences were observed in baseline and operative characteristics when comparing patients with and without PPM. The NYHA class was improved in most cases after surgery. Indeed, significant decreases in mean transvalvular gradient (from 8.6 ± 2.8 mmHg to 5 ± 1.3 mmHg, p = 0.001), left atrial dimension (LAD) (from 31.9 ± 9.8 mm to 29.5 ± 7 mm, p = 0.011), left ventricular end-systolic diameter (from 42.6 ± 18.1 mm to 35.5 ± 6.6 mm, p = 0.044) and left ventricular end-diastolic diameter (from 55.8 ± 19.2 mm to 48.7 ± 6.1 mm, p = 0.024) were observed over time when comparing preoperative and postoperative echocardiographic data. In addition, at follow up (mean 6.9 ± 1.8 years) there were significant decreases in LAD (from 31.9 ± 9.8 mm to 28 ± 11.1 mm, p = 0.001), left ventricular enddiastolic volume (from 106.9 ± 32.9 ml to 92.3 ± 21.9 ml, p = 0.024), tricuspid regurgitation (TR) (from 87% to 27%, p = 0.002) and PH (from 78.3% to 58.7%, p = 0.043) in all patients. No significant differences were observed in hemodynamic, clinical outcome and atrial natriuretic peptide levels of patients with and without PPM. Conclusion: Mitral PPM does not appear to have any negative effect on ventricular and atrial remodeling, TR and PH during the early and late postoperative periods.

The specific LH and FSH polymorphisms could influence the growth of follicles and oocytes.Some studies have shown that certain single nucleotide polymorphisms of FSHR are associated with changes in the ovarian activity, having functional implications in human reproduction. Carriers of polymorphic variant of betaLH show sub-optimal ovarian response to the standard long GnRH-agonist down-regulation protocol, when stimulated with recombinant FSH. No studies have been designed relating the polymorphic variants of FSHR and LHB with the oocyte competence. In previous studies, we demonstrated the correlation between the apoptosis rate and the expression level of some survival pathways molecules, as pAKT, in cumulus cells, as potential markers of oocyte competence. The aim of this study is to investigate the apoptosis levels of cumulus cells pool collected from the cumulus-oocyte complex of individual patients with specific FSHR and LHB polymorphisms. Cumulus cells, obtained from 36 selected patients, were used for in situ immunocytochemistry by cleaved caspase-3, pAKT and by TUNEL assays. Genomic DNA was extracted from whole blood samples. SNPs of FSHR and LHB gene was amplified by PCR using different primers. We found the following phenotypes: - for FSHR: A/T–S/N n=18; A/A–S/S n=6; T/T–N/N n=12 - for LHB: W/W–I/I n=23; W/R– I/T n=13 Cumulus cells of patients with phenotype A/T–S/N associated with W/R–I/T (double heterozygous) showed an higher level of apoptosis in terms of DNA Fragmentation Index (DFI) and percentage of active protein caspase-3 P

Introduction: We studied the apoptosis rate of the cumulus cells of individual cumulus-oocyte complex (COC), to verify a relationship with clinical outcomes, in terms of pregnancy and implantation rates. Usually oocytes are selected using morphological criteria. We tried to verify if cumulus cell apoptotic rate could be used as molecular criteria in selecting oocytes with higher implantation potentiality (1;2). Materials and Methods: The study design consisted in two different trials: in the first, we investigated apoptosis rate in cumulus cells of the three selected oocytes, to be fertilized by intracytoplasmic sperm injection (ICSI); in a second trial, average apoptosis rate of the cumulus cells coming from the three selected oocytes to be fertilized by ICSI and the pooled remaining oocytes were compared, when more than 5 COCs were aspirated. In a first trial we included 22 consecutive couples undergoing ICSI cycles, 20 in a second one, for a total of 42 patients. We selected the three oocytes for (ICSI) on the basis of the morphological appearance of the cumulus, according to Veek’s criteria. The cumulus cells of each COC were submitted to apoptotic assays (3). The patients were classified, on the basis of pregnancy success, in A Group (pregnant patients) and B Group (patients with negative βhCG). Results: Both trials showed that apoptosis in the cumulus cells was remarkably lower in the A Group if compared with B Group. The apoptosis rate in the selected COCs was similar to pooled COCs for each patient, confirming that apoptosis rate in cumulus cells is characteristic for patient. Out of 22 patients involved in the first trial, 8 were pregnant (36.3% A Group) and 14 were not pregnant (B Group). In the second trial 4 of a total of 20 patients were pregnant (20%). In the first trial a total of 58 metaphase II oocytes and 56 in the second trial were studied. In the second trial 38 oocytes where pooled to compare apoptosis rate with the three selected oocytes pools. In the first trial the incidence of DNA fragmentation, evaluated by TUNEL assay (fig. 1), of the cumulus cells from individual treated oocytes, was lower in A Group than in B Group (6.7% ranging between 2.2–13.3 vs 13.19% ranging between 6.2–34.9 respectively, p

Study question: The aim of the research was to investigate the apoptosis rate of individual cumulus cell–oocyte complexes (COC), associated to the level of p-Akt, to verify the difference between oocytes who produce embryos able to reach the blastocyst stage compared with embryos arrested during the in vitro colture. Summary answer: It was demonstrated that DNA fragmentation in cumulus cells was remarkably lower in patients who achieved a pregnancy after ICSI cycles, related to the quality of oocytes and embryos. Akt pathway plays a critical role in the regulation of cell survival, and most growth factors activate this pathway. What is known already: Studies on oocyte maturation have shown the importance of LH-induced activation of the epidermal growth factor (EGF)-like growth factors. This can be a potential mechanism for transducing the LH signal to oocyte. It is known that LH is an anti apoptotic agent. It is unknown the relationship between apoptosis and Akt in cumulus cell. Akt has been reported to coexist in a multimolecular complex containing also ribosomal S6 kinase 1 and phosphoinositide-dependent kinase 1. Study design, size, duration: The study had the duration of 24 month. 53 patients were involved after informed consent. In this prospective and randomized study, it has been measured the DNA fragmentation rate and the level of p-Akt in cumulus cells of single cumulus-oocyte complex (COC) for each follicle containing a mature oocyte. Participants/materials, setting, methods: Normo-responder patients have been selected. DNA fragmentation rate in cumulus cells has been examined with the use of a TUNEL assay in situ. p-Akt has been examined by immunological assay in situ. Statistic of molecule expression and DNA fragmentation was tested through the repeated measures ANOVA test of log-transformed variables. Main results and the role of chance: Out of 255 MII oocytes, 197 were fertilized and the derived embryos had the following evolution: 117 completed the development to blastocyst (day 5or 6) and were transferred, 57 were vitrified at blastocyst stage and 23 were arrested during in vitro culture at different stage of cleavage. We found a statistical difference between the DNA fragmentation rate of cumulus cells between the arrested embryos compared to the transferred and vitrified blastocysts (p=0.004), confirming that cumulus apoptotic rate of the cumulus cells could be considered as a marker of oocyte competence. Likewise we a found statistical significance between oocytes resulting in transferred blastocyst and arrested embryos in the ratio p-AKT/TUNEL (p=0.043); Therefore, the ratio p-AKT/TUNEL could be considered also a marker of oocyte quality. Limitations, reasons for caution: More studies are needed to confirm these data and to determine the how these molecular pathways are involved on the oocyte competence. Wider implication of the findings: We found that in the cumulus cells of the oocytes able to produce blastocysts apoptosis is significantly lower and the p-AKT/TUNEL ratio is higher than in cumulus cells of arrested embryos, indicating that DNA fragmentation is lower when p-AKT is higher. Data seems to demonstrate that DNA fragmentation rate and p-AKT value in cumulus cells could be considered a molecular marker of oocyte competence, to evaluated as a prognostic pattern of blastocyst formation. Study funding/competing interest: Research awarded by “Grant for fertility innovation 2012” Trial registration number : The trial is an observational study and no registration is needed.

Literature data demonstrated that some environmental factors could have a key role in the remarkable and continuous decline of sperm quality observed in the last fifty years. Specifically, in the Taranto area, data about the detrimental effects of environmental pollution are alarming because of the high level of poisons released in the atmosphere. Pollution coming from the plant causes health and fertility risks, mainly due to the exposure to the dioxin. Our study analyzed sperm samples from three patients groups: i) workers of local steel factories; ii) Taranto residents; iii) Controls. Results demonstrate that patients from the “factory workers” group, constantly exposed to environmental pollutants for professional reasons, show a mean percentage of DNA fragmentation above 30%. In contrast, patients from group “Taranto residents” and patients coming from Palermo considered as “Controls” group show mean percentages of 25 and 16.8%, respectively. We observed an increase of spermatic DNA fragmentation (DFI) in the “factory workers” and “Taranto residents” groups, compared to “Controls”. These ones are patients of an in vitro fertilization clinic, with supposed fertility issues. It is known that a spermatic DFI less than 15% is physiologic, while above 30% is related to fertility issues. It is also known that interrupting the sperms damaging source might bring back the DFI level to normal values. So, moving away from the sperms damaging source, patients from “factory workers” and “Taranto residents” groups could restore spermatogenesis. The research methods employed in this study were found to be specific and valid for these analysis.

The aim of the research was to investigate the apoptosis rate of individual cumulus cell-oocyte complexes (COC), associated to the level of pAKT, to verify the difference between oocytes who produce embryos able to reach the blastocyst stage compared with embryos arrested during the in vitro culture. It was demonstrated that DNA fragmentation in cumulus cells was remarkably lower in patients who achieved a pregnancy after ICSI cycles, related to the quality of oocytes and embryos1,2. AKT pathway plays a critical role in the regulation of cell survival, and most growth factors activate this pathway3. The study focused on 53 patients, involved after informed consent. In this prospective and randomized study, it has been measured the DNA fragmentation rate and the level of pAKT in cumulus cells of individual COC for each follicle containing a mature oocyte. Normo-responder patients have been selected. DNA fragmentation rate in cumulus cells has been examined with the use of a TUNEL assay in situ . pAKT has been examined by immunological assay in situ . Statistic of molecule expression and DNA fragmentation was tested through the repeated measures ANOVA test of log-transformed variables. Out of 255 MII oocytes, 197 were fertilized and the derived embryos had the following evolution: 117 completed the development to blastocyst (day 5or 6) and were transferred in uterus, 57 were vitrified at blastocyst stage and 23 were arrested during in vitro culture at different stage of cleavage. In conclusion we found a statistical difference between the DNA fragmentation rate of cumulus cells between the arrested embryos compared to the transferred and vitrified blastocysts (p=0.004), confirming that apoptotic rate of the cumulus cells could be considered as a marker of oocyte competence. Likewise we a found statistical significance between oocytes resulting in transferred blastocyst and arrested embryos in the ratio pAKT/TUNEL (p=0.043). Therefore, the ratio pAKT/TUNEL could be considered also a marker of oocyte quality. More studies are needed to confirm these data and to determine the how these molecular pathways are involved on the oocyte competence.

Objective: Red blood cell distribution width (RDW), is a measurement of the size variation as well as an erythrocyte heterogeneity index (i.e., anysocytosis). used in combination with the mean corpuscular volume for anemia diagnosis. However, it is emerging as an useful predictor biomarker of mortality and morbidity of cardiovascular diseases. However, until now no literature data there are about the RDW role in predicting mortality after aortic valve replacement (AVR). Thus, in this pilot study biological significance of elevated RDW values in early outcome following AVR was evaluated Methods: We enrolled 75 patients (mean age 73.5 ±7.9 years) subjected to AVR and/ or not co temporally to other surgical procedures . Demographics, comorbidities, clinical presentations, and laboratory parameters were collected. The RDW values were considered elevated when more high than 48 fL. Multivariable and univariable examinations were performed in determine associations between preoperative high RDW values and postoperative outcome. Results: Preoperative higher RDW values had a prevalence of 41% (31 patients) in AVR cases studied. These 31 patients were older (76 ± 5.5 years vs 71.6± 8.9 years, p-value=0,02 ), low weight (69.7 vs. 74.1 Kg, p-value= 0,12) with higher platelet levels (p-value 0,005) than the other 44 cases. In addition, they represented the patients that should have likely required renal replacement therapy (13% vs 0%, p-value = 0.026), and prolonged ventilation (16% vs 0%, p-value =0.01). Multivariable adjustment analysis also demonstrated significant associations between higher preoperative RDW values with high BMI values (p-value= 0.05) and renal failure (p-value= 0,06 and p-value=0,02). Conclusions: Increased RDW values seem to be a good predictor biomarker of early outcome after AVR, particularly in patients with high BMI, renal impairment and postoperative prolonged ventilation

Cumulus cells apoptosis rate an adjunct to morphology evaluation for the embryo selection on day 3 could be considered a new tool, compared with embryo selection by morphology alone, to select the embryos with higher implantation potential to increase the clinical outcomes after ICSI. Several studies have demonstrated a lower cumulus cell apoptotic rates in women who achieved pregnancy compared with women who did not become pregnant after ICSI. A prospective randomized observational study on 76 ICSI patients was performed before Ovum Pick-Up. Patients were randomized into either the control group (embryo selection by morphology only, A group: 48 patients) or the treatment group (morphology plus cumulus cell apoptosis evaluation, B group: 28 patients). On Day 3, embryo transfer of a maximum of 3 embryo of grade A was performed. Patient demographics and baseline characteristics were distributed equally over the two groups. No statistical differences were found between the group A vs group B in terms of FSH units for ovarian stimulation (1833 ± 754 vs 1927 ± 826), E2 at hCG administration (1872 ± 788 vs 1787 ± 796), the numbers of oocytes collected (6.4 ± 2.1 Vs 6.7 ±3.7), the number of transferred embryos (A group: 126; B group: 69), the grade A transferred embryos (126 vs 69). No differences was found in the cumulative DNA fragmentation rate in the cumulus cells (16.39 ±12.9 vs 15.7 ± 11.3). Significative differences were found in ongoing pregnancy rate (33.3 vs 57.1) and implantation rate (12.6 vs 23.1). Embryos selection according to cumulus cells apoptosis rate could help to identify competent embryos with higher implantation potential, suggesting a new diagnostic tool in IVF laboratories to increase the clinical outcomes reducing the number of embryos to transfer.

In order to identify the embryos with higher implantation potential to increase the clinical outcomes after ICSI, the apoptotic rate in human cumulus cells for the embryo selection on day 3, as an adjunct to morphology evaluation, could be considered a new tool compared with embryo selection by morphology alone. Several studies have demonstrated a lower cumulus cell apoptotic rate in women who achieved pregnancy compared with women who did not become pregnant after ICSI. A prospective randomized observational study on 76 ICSI patients was performed before Ovum Pick-Up. Patients were randomized into either the control group (embryo selection by morphology only, A group: 48 patients) or the treatment group (morphology plus cumulus cell apoptosis evaluation, B group: 28 patients). On Day 3, embryo transfer of a maximum of 3 embryo of “grade A” was performed. Patient demographics and baseline characteristics were distributed equally over the two groups. No statistical differences were found between the A group vs B group in terms of FSH units for ovarian stimulation (1833 ± 754 vs 1927 ± 826), E2 at hCG administration (1872 ± 788 vs 1787 ± 796), the numbers of oocytes collected (6.4 ± 2.1 Vs 6.7 ±3.7), the number of transferred embryos (A group: 126; B group: 69), the “grade A” transferred embryos (126 vs 69). No differences was found in the cumulative DNA fragmentation rate in the cumulus cells (16.39 ±12.9 vs 15.7 ± 11.3). Significant differences were found in ongoing pregnancy rate (33.3 vs 57.1) and implantation rate (23.1 vs 12.6). Embryo selection according to cumulus cells apoptosis rate could help to identify competent embryos with higher implantation potential, suggesting a new diagnostic tool in IVF laboratories to increase the clinical outcomes reducing the number of embryos to transfer.

Transcatheter mitral valve implantation for mitral valve regurgitation is in the very early phase of development because of challenging anatomy and device dimensions. We describe the procedure of a transfemoral-transseptal implantation of the second-generation CardiAQ mitral valve bioprosthesis and 30-day follow-up.The procedure was performed percutaneously, without any left extracorporeal circulatory support. The patient had severe mitral regurgitation with severely depressed ventricular function and other comorbidities. The patient was deemed extreme high risk for conventional cardiac surgery by a multidisciplinary team. The main procedural steps were the creation of an arteriovenous loop with an exchange nitinol wire, and the use of a customised "steerable snare system" to facilitate the catheter delivery system into the mitral annulus. Transoesophageal echocardiography and fluoroscopy were utilised for device positioning and deployment. The mitral valve prosthesis was implanted with mild mitral regurgitation. The postoperative course was uneventful and at 30-day follow-up the patient is in NYHA Class I, with good function of the mitral valve bioprosthesis.This procedure shows that percutaneous transfemoral transcatheter mitral valve implantation is feasible, safe and successful. Further experience is needed to render this procedure clinically available.

Background— The proven efficacy of transcatheter aortic valve implantation (TAVI) in high-risk patients is leading to the expansion of its indications toward lower-risk patients. However, this shift is not supported by meaningful evidence of its benefit over surgical aortic valve replacement (SAVR). This analysis aims to describe outcomes of TAVI versus SAVR in low-risk patients. Methods and Results— We compared the outcome after TAVI and SAVR of low-risk patients (European System for Cardiac Operative Risk Evaluation II [EuroSCORE II] P =0.82). Cardiac tamponade, permanent pacemaker implantation, major vascular damage, and moderate-to-severe paravalvular regurgitation were significantly more frequent after TAVI compared with SAVR. Stroke rates were equal in the study groups. SAVR was associated with higher risk of cardiogenic shock, severe bleeding, and acute kidney injury. At 3 years, survival was 83.4% after SAVR and 72.0% after TAVI ( P =0.0015), whereas freedom from major adverse cardiac and cerebrovascular events was 80.9% after SAVR and 67.3% after TAVI ( P Conclusions— In patients with low operative risk, significantly better 3-year survival and freedom from major adverse cardiac and cerebrovascular events were observed after SAVR compared with TAVI. Further studies on new-generation valve prostheses are necessary before expanding indications of TAVI toward lower-risk patients.

Background There are scarce data on outcomes after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in patients with renal failure. Methods We evaluated the impact of renal failure on outcomes after TAVI and SAVR and compared the results of these procedures in patients with chronic kidney disease stages 3b to 5 from the Observational Study of Effectiveness of AVR-TAVI Procedures for Severe Aortic Stenosis Treatment (OBSERVANT) study. Results Chronic kidney disease (CKD) stages 3b to 5 was associated with an increased risk of mortality after either TAVI or SAVR compared with CKD stages 1 to 3a. Among 170 propensity score–matched pairs with CKD stages 3b to 5, patients who underwent TAVI had a significantly higher rate of permanent pacemaker implantation, vascular damage, and mild to moderate paravalvular regurgitation, and tended to have a higher 30-day mortality (7.1% versus 2.9%; p = 0.09). Thirty-day mortality after transapical TAVI was 7.1%. SAVR had a significantly higher rate of blood transfusions, stroke, and acute kidney injury. At 2 years, patients undergoing TAVI had somewhat higher all-cause mortality (31.2% versus 23.4%; p = 0.118), major cardiac and cerebrovascular events (37.2% versus 31.0%; p = 0.270), and a lower risk of dialysis (12.4% versus 21.2%; p = 0.052) compared with SAVR. Conclusions CKD stages 3b to 5 increases the risk of mortality after TAVI and SAVR. In this subset of patients, SAVR was associated with somewhat better early and late survival. The risk of acute kidney injury was higher after SAVR. These findings suggest that CKD stages 3b to 5 does not contraindicate SAVR. Strategies to prevent severe acute kidney injury should be implemented with either SAVR or TAVI.

A few studies recently reported controversial results with transfemoral transcatheter aortic valve replacement (TF-TAVR) versus transapical transcatheter aortic valve replacement (TA-TAVR), often without adequate adjusted analysis for baseline differences. Data on patients who underwent TF-TAVR and TA-TAVR from the Observational Study of Effectiveness of avR-tavI procedures for severe Aortic stenosis Treatment study were analyzed with propensity score 1-to-1 matching. From a cohort of 1,654 patients (1,419 patients underwent TF-TAVR and 235 patients underwent TA-TAVR), propensity score matching resulted in 199 pairs of patients with similar operative risk (EuroSCORE II: TF-TAVR 8.1 ± 7.1% vs TA-TAVR, 8.4 ± 7.3%, p = 0.713). Thirty-day mortality was 8.0% after TA-TAVR and 4.0% after TF-TAVR (p = 0.102). Postoperative rates of stroke (TA-TAVR, 2.0% vs TF-TAVR 1.0%, p = 0.414), cardiac tamponade (TA-TAVR, 4.1% vs TF-TAVR 1.5%, p = 0.131), permanent pacemaker implantation (TA-TAVR, 8.7% vs TF-TAVR 13.3%, p = 0.414), and infection (TA-TAVR, 6.7% vs TF-TAVR 3.6%, p = 0.180) were similar in the study groups but with an overall trend in favor of TF-TAVR. Higher rates of major vascular damage (7.2% vs 1.0%, p = 0.003) and moderate-to-severe paravalvular regurgitation (7.8% vs 5.2%, p = 0.008) were observed after TF-TAVR. On the contrary, TA-TAVR was associated with higher rates of red blood cell transfusion (50.0% vs 30.4%, p = 0.0002) and acute kidney injury (stages 1 to 3: 44.4% vs 21.9%, p

[P-057] HPV infection in male partners of infertile couples seems to not affect seminal parameters A.M. Brucculeri1, G. Ruvolo1, L. Giovannelli2, R. Schillaci3, E. Cittadini1, G. Scaravelli4, A. Perino3. 1Centro di Biologia della Riproduzione, Centro di Biologia della Riproduzione, Palermo, Italy; 2University of Palermo, Dipartimento di Scienze per la Promozione della Salute, Palermo, Italy; 3University of Palermo, Dipartimento Materno Infantile, Palermo, Italy; 4Istituto Superiore di Sanità, Istituto Superiore di Sanità, Roma, Italy Introduction: Human papilloma viruses (HPV) are agents of the most common sexually transmitted disease. This small DNA viruses induce epithelial cell proliferation and high risk HPV types have been associated with cancers of the anogenital mucosa in men and women. Since it was demonstrated the presence of the virus in semen (Rintala M.A. et al., 2004), there is a growing interest on impact of HPV infection on male fertility and reproductive function. While data from recent studies suggest a possible role of HPV as a cause of miscarriage in couples undergoing assisted reproduction techniques cycles (Perino A. et al. 2011), the effect of infection on semen parameters is still a controversial topic. Some authors reported that seminal HPV infection was associated with reduced sperm motility (Lai Y.M. et al. 2007; Foresta C. et al. 2010) while other authors did not find any effects on sperm quality (Rintala M.A. et al., 2004). The purpose of this study was to investigate the role of human papillomavirus on semen quality parameters in patients who attended our fertility clinic. Matherial and Methods: A cohort of 316 male partner of couple undergoing IVF/ICSI were investigated for HPV infection and seminal samples were collected to evaluate semen parameters according to WHO (2010) manual. The presence of HPV DNA was researched by the combined use of two HPV assays, namely, the INNO-LiPA HPV Genotyping kit (Innogenetics N.V., Ghent, Belgium), based on the combined use of SPF10 PCR and LiPA hybridisation (Kleter, 1999); and a highly sensitive nested PCR assay, with the PGMY09/11 and GP05 + /GP06 + primer pairs, followed by direct sequencing of PCR products for HPV genotyping (Giovannelli, 2004). HPV types were considered as low-risk (LR)- or high-risk (HR) oncogenic types, according to two recently published classifications of HPV types (Munoz, 2003; de Villiers, 2004). Statistical analysis of data was performed by Chi Square test using Pearson's Product Moment Coefficient and a p value