GynePro Medical

Summary of the May 2025 ESHRE Journal Club discussion focused on the study by Sandhu et al. (2024) which assessed the role of an online decision aid to support the elective egg freezing decision-making process, exploring key dimensions such as the decision-making moment, biomarkers, risks management, and realistic communication in clinical counselling.

Background: Previous literature has suggested an important association between a history of anterior cruciate ligament (ACL) reconstruction (ACLR) and future thigh muscle injuries, but more and larger studies are needed, particularly for quadriceps muscle injuries. Purpose: To determine the incidence of hamstring and quadriceps muscle injuries after return to play (RTP) from ACLR using patellar tendon (PT) and hamstring tendon (HT) autografts in professional male soccer players. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 5447 players from 74 clubs were followed prospectively from July 2001 to May 2022. The injury incidence (number of injuries per 1000 hours) was compared between players with ACLR and those without ACL injuries as well as for players with ACLR between a 2-year period before the ACL injury and a 2-year period after RTP. The rate ratio (RR) was calculated with the 95% confidence interval (CI) and examined for significance with Z statistics. Results: There were 110 ACLR cases (76 PT and 34 HT grafts) in 107 players included. Players with ACLR had a 60% higher thigh muscle injury incidence (RR, 1.6 [95% CI, 1.3-2.0]) within 2 years after RTP compared with players without ACL injuries. Players with ACLR had a doubled thigh muscle injury incidence (RR, 2.0 [95% CI, 1.4-2.9]) in the 2 years after RTP compared with 2 years before their ACL injury. Players with a PT autograft had a higher quadriceps muscle injury incidence (RR, 3.5 [95% CI, 1.4-8.8]) in the 2 years after RTP compared with 2 years before their ACL injury, whereas there was no difference in the hamstring muscle injury incidence in players with an HT autograft (RR, 1.7 [95% CI, 0.5-5.8]). Conclusion: ACLR in professional male soccer players was associated with an increased thigh muscle injury incidence, particularly quadriceps muscle injuries in players with a PT autograft.

Arteriovenous fistula (AVF) thrombosis is a major vascular access complication in hemodialysis (HD) patients, contributing to increased morbidity. Statins, known for their pleiotropic effects, may reduce AVF thrombosis risk, but evidence on dose-dependent effects is limited. This study evaluated the association between statin use, dose intensity, and AVF thrombosis in HD patients. Methods. A multicenter, retrospective cohort study was conducted using data from 562 HD patients with native AVFs across 10 dialysis clinics (May 2021–April 2025). Patients were categorized by statin use (users vs. non-users) and dose intensity (moderate vs. high vs. none). The primary outcome was AVF thrombosis; death was treated as a competing event. Kaplan-Meier survival curves and Fine and Gray subdistribution hazard models, adjusted for age, diabetes, dialysis vintage, Kt/V, glucose, calcium, blood flow, and pre-HD cardiovascular disease, were used to assess thrombosis risk. Results. Of 562 patients (median follow-up 59 months), 212 (37.7%) were statin users. AVF thrombosis occurred in 54 (9.6%) patients, with 11 (7.1%) in statin users vs. 43 (10.6%) in non-users (p = 0.006). Kaplan-Meier analysis showed lower thrombosis probability in statin users (log-rank p = 0.001), with high-intensity users having the lowest risk (p = 0.004). In the unadjusted Fine and Gray model, high-intensity statins were associated with reduced thrombosis risk (sHR 0.61, 95% CI 0.59–0.97, p = 0.03), with a significant dose-dependent trend (p = 0.018). The adjusted model showed no significant association (moderate: sHR 0.67, p = 0.16; high: sHR 0.57, p = 0.26). Conclusions. Statin use, particularly high-intensity, may reduce AVF thrombosis risk in HD patients, with a dose-dependent trend in unadjusted analyses. However, adjusted results were non-significant, possibly due to limited events. Larger prospective studies are needed to confirm these findings and optimize statin therapy for vascular access preservation.

Climbing has grown into a grassroots participation sport and Olympic discipline. The high loads expressed through the upper limb may increase the risk of injury in this population. This may also affect rehabilitation and return to sport (RTS) considerations after injury. Treatment, management, rehabilitation and RTS parameters after injury are poorly documented. The aim of this study is to reach international expert consensus on the postinjury and surgical rehabilitation, physical preparation and RTS strategies in a range of climbers. This will provide a framework for the safe RTS of climbers. The study will be reported in accordance with guidance on conducting and reporting Delphi Studies guidelines. Panel members will be recruited with expertise in either the delivery of healthcare and/or physical preparation of climbers. The electronic Delphi is anticipated to consist of three irritative rounds. Round 1 will consist of open and closed questions to generate a broad range of statements on the rehabilitation, RTS and outcome measures used after climbing injury. In round 2, all participants will be provided with a summary of the current literature of the rehabilitation and RTS strategies for upper limb sports injuries. Rounds 2 and 3 will consist of a summary of the results from the previous round including any dissonance. Participants will be asked to anonymously rate responses on a 5-point Likert scale. The study steering group and patient public involvement representatives will be involved from conceptualisation until final dissemination.

The present paper aims to provide an overview of the use of biologically active components derived from mineral, synthetic, phyto-, and organic sources in the development of local hemostatic agents. The study highlights the historical and contemporary use of these agents in medical practice, and examines the scientific evidence supporting their efficacy. Hemostasis, the process of stopping bleeding, is a critical component of surgical and medical procedures. Local hemostatic agents are widely used to achieve hemostasis in a targeted and controlled manner, thereby minimizing the risk of complications associated with bleeding. The use of biologically active components derived from various sources, including minerals, synthetic materials, plants, and organic compounds, has a long history in the development of hemostatic agents. These components can act through various mechanisms, such as inducing platelet aggregation, activating the coagulation cascade, or promoting the formation of blood clots. Recent advances in biotechnology and nanotechnology have led to the development of novel hemostatic agents with improved properties, such as enhanced biocompatibility, targeted delivery, and controlled release. These agents have the potential to revolutionize hemostasis in surgical and medical procedures, and improve patient outcomes. Overall, the study highlights the importance of biologically active components derived from mineral, synthetic, phyto-, and organic sources in the development of local hemostatic agents. The review of historical and contemporary use of these agents underscores their continued relevance in medical practice, while recent advances in technology offer exciting new possibilities for future development. After a thorough review of domestic and foreign literature, the development team used adsorbing materials from biologically active components of mineral, synthetic, phyto-, and organic origin to create a hemostatic powder known as "PLANTOR." The active components of PLANTOR include aerosol, carrageenan of a special brand, and a specific mixture of medicinal vegetable oils, which have a special sorption effect. Due to the well-selected composition of the product, PLANTOR forms a blood clot in the wound through a biophysical process of liquid absorption. Notably, PLANTOR does not contain procoagulant minerals or nanoparticles that could remain in the human body, and therefore does not belong to means with a chemical or biochemical mechanism of action. Based on the above, it is possible to recommend the hemostatic agent-powder "PLANTOR" of the trade mark "PLANTOR tm" and "Dr. Sokolovskiy R" of the manufacturer "Medpro Nutraceuticals" (Latvia) by order of LLC "Plantor" (Ukraine, Dnipro), the author and owner of the developed technology of the hemostatic agent - powder "PLANTOR" (TU U 20.4-44827581-001:2022) as an auxiliary means of revitalization, local coagulation, treated wound surfaces during emergency medical care for external bleeding.

To investigate the 90° change of direction (COD) task in an extensive cohort of competitive healthy football players within the CUTtheACLstudy and to provide normative values and differences between males and females for full-body kinematics based on two-dimensional (2D) video analysis and scoring system. One-thousand-and-two competitive football (soccer) players (age 16.3 ± 2.8 years, 264 females) were prospectively enroled. Each player performed three preplanned 90° COD tasks per limb. The 2D evaluation was performed through objective measures (collected through three high-speed cameras) of frontal and sagittal plane joint kinematics at the cut initial foot contact (IC) and maximum knee flexion angle. A previously published scoring system was adopted to measure the movement quality of the COD task. The scoring system included five criteria (limb stability [LS], pelvis stability [PS], trunk stability [TS], shock absorption [SA], movement strategy [MS]) ranked from 0/2 (nonadequate) to 2/2 (adequate) with a maximum score of 10/10. Normative data were provided for all the variables; statistical differences between male and female players were investigated (p < 0.05). A total of 6008 valid attempts were included. Frontal plane knee projection angle (FPKPA) at initial contact was 24.4 ± 9.8° (95thpercentile: FPKPA > 40°). The total score was ≤4/10 in 71.2% of the trials, the lowest subscores were LS and PS. Female players showed different movement patterns with lower hip and trunk flexion both at IC and maximum knee flexion angle (p < 0.01, ES = 0.41-0.64). Female players also showed worse scores than males in SA, MSand total score (p < 0.01). Female players seem more prone to stiffer lower limb strategy and greater pelvis-trunk frontal plane instability than males. Clinicians could adopt normative data and sex-specific differences in players' movement techniques to improve ACL injury risk mitigation protocols. Level IV.

PurposeNon-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations.Materials and MethodsA 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 countries were analyzed descriptively, with a Delphi process used for expert recommendations.ResultsOf 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoospermia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differentiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate.ConclusionsThis expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations.

Varicoceles can be a source of elevated seminal oxidative stress (OS) and sperm DNA fragmentation (SDF). However, it remains unclear whether varicocele repair (VR) could reduce these parameters. This systematic review and meta-analysis (SRMA) aims to investigate the impact of VR on SDF and seminal malondialdehyde (MDA). A literature search was performed in Scopus, PubMed, Ovid, Embase, and Cochrane databases. This SRMA included randomized controlled trials and observational studies reporting the pre- and postoperative levels of SDF and seminal OS in infertile men with clinical varicocele that underwent VR. Subgroup analyses included techniques of VR and SDF testing. The effect size was expressed as standardized mean difference (SMD). Out of 1,632 abstracts assessed for eligibility, 29 studies with 1,491 infertile men were included. The analysis showed a significant reduction in SDF after VR, compared to preoperative values (SMD -1.125, 95% confidence interval [CI] -1.410, -0.840; p<0.0001) with high inter-study heterogeneity (I²=90.965%). Reduction in SDF was evident with microsurgical technique and non-microsurgical inguinal approaches (SMD -1.014, 95% CI -1.263, -0.765; p<0.0001, and SMD -1.495, 95% CI -2.116, -0.873; p<0.0001), respectively. Reduction in SDF was significant irrespective of testing was done by sperm chromatin dispersion (SMD -2.197, 95% CI -3.187, -1.207; p<0.0001), sperm chromatin structure assay (SMD -0.857, 95% CI -1.156, -0.559; p<0.0001) or TUNEL (SMD -1.599, 95% CI -2.478, -0.719; p<0.0001). A significant decrease in seminal MDA levels was observed following VR (SMD -2.450, 95% CI -3.903 to -0.997, p=0.001) with high inter-study heterogeneity (I²=93.7%). Using pre- and post-intervention data, this SRMA indicates a significant reduction in SDF and seminal MDA levels in infertile men with clinical varicocele treated with VR. These findings may have important implications for the future management of this selected group of infertile patients.

Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4-6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians.

. Introduction. Vulnerability to developing mood disorders, such as anxiety disorders and depression, depends on a combination of genetic and environmental factors, among which stress plays a significant role. It is interesting that coping with stress is influenced by the level of the biological response to stress and related neuroendocrine systems, active coping with stress is increased with the help of antidepressants. This indicates that drugs that affect the biological side of stress resistance can increase the effectiveness of existing treatment methods and preventive care. The gut microbiome is a biological factor that may also influence resistance to stress. The broad impact of the gut microbiota on human health, including mental health, has begun to be recognized and understood over the past decade. The aim of the study was to determine the effect of chronic mild stress (CMS) on the development of emotional and behavioral disorders under the conditions of experimental pharmacotherapy in rats. Materials and methods. The study was carried out on 24 male Wistar rats weighing 230–250 g. The basis of the modeling of chronic muscle stress was based on the classic method of Willner, adapted to the conditions and purpose of our experiment. The animals of the experimental groups were subjected to daily exposure to weak stressors alternating with a 168-hour (7-day) cycle of changes in these stimuli for 4 weeks. Animals were randomly divided into five groups (n=8 in each). I – negative control, II – positive control (CMS). Group III rats for 28 days of the experiment received intragastric combination therapy – a symbiotic combining the prebiotic Lactulose (Lac) and a probiotic containing 4 billion active cells (CFU)): Lactobacillus acidophilus, Lactobacillus rhamnosus, Streptococcus thermophilus, Lactobacillus delbrueckii subsp. Bulgaricus (Yo). Group IV animals also received intragastric vitamin D3 (vit. D3 ). Group V received triple combination pharmacotherapy, which included yogurt / lactulose + vitamin D3 in the above doses. The results of the study showed significant changes in the positive control group. The rate of crossing in rats was 12.3% lower than the group of negative control. These rats showed a statistically significant decrease in the number of peeping into holes by 44.4%. It was also characterized by a decrease in the number of vertical rises by 35.3% compared with the negative control group. The latency of the exit from the center of the open field in positive control group rats was 22.2% lower than in negative control animals. The reaction to novelty in CMS rats tended to decrease. In animals treated with vit. D3 , compared with the group of animals with CMS, on the 28th day of the study there was a statistically significant increase of 245.5% and 260.0%, respectively, rearing and research activity. It should be noted that under these experimental conditions, administration of the study drug led to a decrease of 100.0% acts of defecation, which indicates a decrease in animal anxiety. The number of grooming acts tended to increase, which indicated a positive effect of the drug on the emotional state of animals. The latency of the exit from the center of the open field in rats treated with vit. D3 was 114.3% higher than in animals with CMS. The reaction to novelty in rats of this group increased. In animals treated with a combination of vit. D3 with Yo + Lac, compared with the group of animals with CMS there was a statistically significant increase by 209.1% of rearing and crossing by 97.2%. It should be noted that under these experimental conditions, the administration of the study combination led to a decrease of 75.0% acts of defecation, which indicates a decrease in animal anxiety. The number of grooming acts tended to increase, which indicated a positive effect of the combination on the emotional state of the animals. Results. Therefore, based on the studies, it can be concluded that chronic mild stress changes the behavior of rats in the open field test, which is characterized by significant inhibition of motor and research activity of experimental animals. Administration of probiotic and prebiotic, both alone and in combination with vitamin D3 , changed the rates of behavioral responses in the open field test in rats on the background of emotional disorders. Conclusion. Chronic stress changes the behavior of rats in the open field test, which is characterized by significant inhibition of motor and research activity of experimental animals and symbiotic drugs with vitamin D3 can be a significant lever in the correction of this condition.