The effect of sperm DNA fragmentation on miscarriage rates: a systematic review and meta-analysis

STUDY QUESTION Is there an association between high levels of sperm DNA damage and miscarriage?SUMMARY ANSWERMiscarriage rates are positively correlated with sperm DNA damage levels.WHAT IS KNOWN ALREADYMost ejaculates contain a subpopulation of sperm with DNA damage, also referred to as DNA fragmentation, in the form of double or single-strand breaks which have been induced in the DNA prior to or following ejaculation. This DNA damage may be particularly elevated in some subfertile men, hence several studies have examined the link between sperm DNA damage levels and conception and miscarriage rates.STUDY DESIGN, SIZE, DURATIONA systematic review and meta-analysis of studies which examined the effect of sperm DNA damage on miscarriage rates was performed. Searches were conducted on MEDLINE, EMBASE and the Cochrane Library without any language restrictions from database inception to January 2012.PARTICIPANTS/MATERIALS, SETTING, METHODSWe used the terms 'DNA damage' or 'DNA fragmentation' combined with 'miscarriage', 'abortion' or 'pregnancy' to generate a set of relevant citations. Data extraction was performed by two reviewers. Study quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis of relative risks of miscarriage was performed with a random effects model. Subgroup analyses were performed by the type of DNA damage test, whether the sperm examined were prepared or from raw semen and for pregnancies resulting from IVF or ICSI treatment.MAIN RESULTS AND THE ROLE OF CHANCEWe identified 16 cohort studies (2969 couples), 14 of which were prospective. Eight studies used acridine orange-based assays, six the TUNEL assay and two the COMET assay. Meta-analysis showed a significant increase in miscarriage in patients with high DNA damage compared with those with low DNA damage [risk ratio (RR) = 2.16 (1.54, 3.03), P <0.00001)]. A subgroup analysis showed that the miscarriage association is strongest for the TUNEL assay (RR = 3.94 (2.45, 6.32), P <0.00001).LIMITATIONS, REASONS FOR CAUTIONThere is some variation in study characteristics, including the use of different assays and different thresholds for DNA damage and the definition of pregnancy loss.WIDER IMPLICATIONS OF THE FINDINGSThe use of methods which select sperm without DNA damage for use in assisted conception treatment may reduce the risk of miscarriage. This finding indicates that assays detecting DNA damage could be considered in those suffering from recurrent pregnancy loss. Further research is necessary to study the mechanisms of DNA damage and the potential therapeutic effects of antioxidant therapy.STUDY FUNDING/COMPETING INTEREST(S)None.

Progressive lung cancer determined by expression profiling and transcriptional regulation

Clinically, our ability to predict disease outcome for patients with early stage lung cancer is currently poor. To address this issue, tumour specimens were collected at surgery from non-small cell lung cancer (NSCLC) patients as part of the European Early Lung Cancer (EUELC) consortium. The patients were followed-up for three years post-surgery and patients who suffered progressive disease (PD, tumour recurrence, metastasis or a second primary) or remained disease-free (DF) during follow-up were identified. RNA from both tumour and adjacent-normal lung tissue was extracted from patients and subjected to microarray expression profiling. These samples included 36 adenocarcinomas and 23 squamous cell carcinomas from both PD and DF patients. The microarray data was subject to a series of systematic bioinformatics analyses at gene, network and transcription factor levels. The focus of these analyses was 2-fold: firstly to determine whether there were specific biomarkers capable of differentiating between PD and DF patients, and secondly, to identify molecular networks which may contribute to the progressive tumour phenotype. The experimental design and analyses performed permitted the clear differentiation between PD and DF patients using a set of biomarkers implicated in neuroendocrine signalling and allowed the inference of a set of transcription factors whose activity may differ according to disease outcome. Potential links between the biomarkers, the transcription factors and the genes p21/CDKN1A and Myc, which have previously been implicated in NSCLC development, were revealed by a combination of pathway analysis and microarray meta-analysis. These findings suggest that neuroendocrine-related genes, potentially driven through p21/CDKN1A and Myc, are closely linked to whether or not a NSCLC patient will have poor clinical outcome.

An integrated transcriptomics and proteomics analysis of the secretome of the helminth pathogen Fasciola hepatica: Proteins associated with invasion and infection of the mammalian host

To infect their mammalian hosts, Fasciola hepatica larvae must penetrate and traverse the intestinal wall of the duodenum, move through the peritoneum, and penetrate the liver. After migrating through and feeding on the liver, causing extensive tissue damage, the parasites move to their final niche in the bile ducts where they mature and produce eggs. Here we integrated a transcriptomics and proteomics approach to profile Fasciola secretory proteins that are involved in host-pathogen interactions and to correlate changes in their expression with the migration of the parasite. Prediction of F. hepatica secretory proteins from 14,031 expressed sequence tags (ESTs) available from the Wellcome Trust Sanger Centre using the semiautomated EST2Secretome pipeline showed that the major components of adult parasite secretions are proteolytic enzymes including cathepsin L, cathepsin B, and asparaginyl endopeptidase cysteine proteases as well as novel trypsin-like serine proteases and carboxypeptidases. Proteomics analysis of proteins secreted by infective larvae, immature flukes, and adult F. hepatica showed that these proteases are developmentally regulated and correlate with the passage of the parasite through host tissues and its encounters with different host macromolecules. Proteases such as FhCL3 and cathepsin B have specific functions in larvae activation and intestinal wall penetration, whereas FhCL1, FhCL2, and FhCL5 are required for liver penetration and tissue and blood feeding. Besides proteases, the parasites secrete an array of antioxidants that are also highly regulated according to their migration through host tissues. However, whereas the proteases of F. hepatica are secreted into the parasite gut via a classical endoplasmic reticulum/Golgi pathway, we speculate that the antioxidants, which all lack a signal sequence, are released via a non-classical trans-tegumental pathway.

Investigating the use of compliant webs in the damage-tolerant design of stiffener run-outs

In this work, the use of a compliant web design for improved damage tolerance in stiffener run-outs is investigated. Firstly, a numerical study that incorporates the possibility of debonding and delamination (using VCCT) is used to select a favourable compliant run-out configuration. Then, three different configurations are compared to establish the merits of the compliant design: a baseline configuration, a configuration with optimised tapering and the selected compliant configuration. The performance of these configurations, in terms of strength and damage tolerance, was compared numerically using a parametric finite element analysis. The energy release rates for debonding and delamination, for different crack lengths across the specimen width, were used for this comparison. The three configurations were subsequently manufactured and tested. In order to monitor the failure process, acoustic emission (AE) equipment was used and proved valuable in the detection and analysis of failure. The predicted failure loads, based on the energy release rates, showed good agreement with the experiments, particularly when the distribution of energy release rate across the width of the specimen was taken into account. As predicted numerically, the compliant configuration failed by debonding and showed improved damage tolerance compared to the baseline and tapered stiffener run-outs.

Design of composite stiffener run-outs for damage tolerance

A major concern in stiffener run-out regions, where the stiffener is terminated due to a cut-out, intersecting rib, or some other structural feature which interrupts the load path, is the relatively weak skin–stiffener interface in the absence of mechanical fasteners. More damage tolerant stiffener run-outs are clearly required and these are investigated in this paper. Using a parametric finite element analysis, the run-out region was optimised for stable debonding crack growth. The modified run-out, as well as a baseline configuration, were manufactured and tested. Damage initiation and propagation was investigated in detail using state-of-the-art monitoring equipment including Acoustic Emission and Digital Image Correlation. As expected, the baseline configuration failed catastrophically. The modified run-out showed improved crack-growth stability, but subsequent delamination failure in the stiffener promptly led to catastrophic failure.

Predicting low-velocity impact damage on a stiffened composite panel

An intralaminar damage model, based on a continuum damage mechanics approach, is presented to model the damage mechanisms occurring in carbon fibre composite structures incorporating fibre tensile and compressive breakage, matrix tensile and compressive fracture, and shear failure. The damage model, together with interface elements for capturing interlaminar failure, is implemented in a finite element package and used in a detailed finite element model to simulate the response of a stiffened composite panel to low-velocity impact. Contact algorithms and friction between delaminated plies were included, to better simulate the impact event. Analyses were executed on a high performance computer (HPC) cluster to reduce the actual time required for this detailed numerical analysis. Numerical results relating to the various observed interlaminar damage mechanisms, delamination initiation and propagation, as well as the model’s ability to capture post-impact permanent indentation in the panel are discussed. Very good agreement was achieved with experimentally obtained data of energy absorbed and impactor force versus time. The extent of damage predicted around the impact site also corresponded well with the damage detected by non destructive evaluation of the tested panel.

Element-Free Galerkin modelling of composite damage

Delamination and matrix cracking are routine damage mechanisms, observed by post-mortem analysis of laminated structures containing geometrical features such as notches or bolts. Current finite element tools cannot explicitly model an intralaminar matrix microcrack, except if the location of the damage is specified a priori. In this work, a meshless technique, the Element-Free Galerkin (EFG) method, is utilized for the first time to simulate delamination (interlaminar) and intralaminar matrix microcracking in composite laminates.

A pseudo-transient solution strategy for the analysis of delamination by means of interface elements

Recent efforts in the finite element modelling of delamination have concentrated on the development of cohesive interface elements. These are characterised by a bilinear constitutive law, where there is an initial high positive stiffness until a threshold stress level is reached, followed by a negative tangent stiffness representing softening (or damage evolution). Complete decohesion occurs when the amount of work done per unit area of crack surface is equal to a critical strain energy release rate. It is difficult to achieve a stable, oscillation-free solution beyond the onset of damage, using standard implicit quasi-static methods, unless a very refined mesh is used. In the present paper, a new solution strategy is proposed based on a pseudo-transient formulation and demonstrated through the modelling of a double cantilever beam undergoing Mode I delamination. A detailed analysis into the sensitivity of the user-defined parameters is also presented. Comparisons with other published solutions using a quasi-static formulation show that the pseudo-transient formulation gives improved accuracy and oscillation-free results with coarser meshes

The behaviour of damage tolerant hat-stiffened composite panels loaded in uniaxial compression

Damage tolerant hat-stiffened thin-skinned composite panels with and without a centrally located circular cutout, under uniaxial compression loading, were investigated experimentally and analytically. These panels incorporated a highly postbuckling design characterised by two integral stiffeners separated by a large skin bay with a high width to skin-thickness ratio. In both configurations, the skin initially buckled into three half-wavelengths and underwent two mode-shape changes; the first a gradual mode change characterised by a central deformation with double curvature and the second a dynamic snap to five half-wavelengths. The use of standard path-following non-linear finite element analysis did not consistently capture the dynamic mode change and an approximate solution for the prediction of mode-changes using a Marguerre-type Rayleigh-Ritz energy method is presented. Shortcomings with both methods of analysis are discussed and improvements suggested. The panels failed catastrophically and their strength was limited by the local buckling strength of the hat stiffeners. (C) 2001 Elsevier Science Ltd. All rights reserved.

Progress in Fracture and Damage Mechanics

This special-topic volume reports on new progress made in the analysis and understanding of fracture and damage mechanics. The Finite Element Method is a well-established analytical tool for theoretical fracture analysis. The development of interface elements which combine aspects of both fracture and damage mechanics has permitted the prediction of both crack initiation and propagation. A number of the papers presented here deal with their use and further development.Substantial progress has also been made in the use of the Boundary Element Method for treating crack problems. The inherent mathematical complexity of this method has resulted in somewhat slower progress than that enjoyed by the Finite Element Method and is still the focus of much research. The volume also presents a number of contributions arising from this field. A topic which is closely related to the study of fracture is structural repair. Although repairs are usually effected after fracture occurs, the structural analyst must still ensure that the repair itself is not prone to cracking or other forms of damage. Two approaches to the study of damage in a repaired structure are described in this special volume. These three aspects, taken together, ensure that even the expert will learn something new from this book.

Protection of corneal endothelium from irrigation damage:A comparison of sodium hyaluronate and hydroxypropylmethyl-cellulose

Purpose: To compare the endothelial protection of sodium hyaluronate and hydroxypropylmethylcellulose against endothelial damage induced by irrigation. Methods: An in vitro assay with freshly excised porcine eyes was developed using the Janus green photometry technique. Irrigation and aspiration technique was standardised. Forty pairs of porcine eyes were used. One randomly chosen eye was filled with sodium hyaluronate (SH) and the other with hydroxypropylmethylcellulose (HPMC). Irrigation and aspiration was carried out with balanced salt solution for 5 min. Twenty additional pairs of porcine eyes served as controls. Student's t-test was used for statistical analysis. Results: Both viscoelastic agents protected the endothelium as compared with controls. The endothelial protection, determined with the Janus green photometric technique, was significantly greater with HPMC than with SH. Conclusions: Viscoelastic agents are effective in protecting the endothelium from irrigation damage in porcine eyes in vitro. HPMC provided greater protection than SH in this particular model.

Detection of changes of the optic disc in glaucomatous eyes:Clinical examination and image analysis with the Topcon Imagenet system

Purpose: This study was designed to evaluate the clinical agreement in the detection of optic disc changes and the ability of computerized image analysis to detect glaucomatous deterioration of the optic disc. Methods: Pairs of stereophotographs of 35 glaucomatous optic discs taken 5 years apart and of 5 glaucomatous discs photographed twice on the same day. Two glaucoma specialists examined the pairs of stereophotographs (35 cases and 5 controls) in a masked manner and judged whether the optic disc showed changes in the optic disc compatible with progression of glaucomatous damage. The stereophotographs of the five optic discs photographed twice on the same day (which by definition did not change) and of five cases judged to have deteriorated by both glaucoma specialists were analyzed by computerized image analysis with the Topcon ImageNet system. Intra- and inter-observer agreement in the detection of optic disc changes (evaluated using kappa statistic), and changes in the rim area to disc area ratio (evaluated using descriptive statistics and paired t-test). Results: Intra-observer agreement had a kappa value of 0.75 for observer 1 and 0.60 for the observer 2. Inter-observer agreement between the glaucoma specialists had a kappa value of 0.60. The image analyzer did not discriminate between controls and cases with clinically apparent glaucomatous change of the optic disc. Conclusion: Clinical agreement in detecting changes in the optic disc was moderate to substantial. Computerized image analysis with the Topcon ImageNet system appeared not to be useful in detecting glaucomatous changes of the optic disc.

Reversal of optic disc cupping after glaucoma surgery analyzed with a scanning laser tomograph

Objective: To detect and quantitate changes in optic nerve morphology after glaucoma surgery using the Heidelberg Retina Tomograph (HRT, Heidelberg Instruments, Heidelberg, Germany). Design: Nonconsecutive observational case series. Participants and Intervention: The authors prospectively enrolled 21 adult patients undergoing incisional glaucoma surgery for progressive glaucoma damage. Quantitative analysis of the optic nerve head by scanning laser tomography and automated perimetry were performed before and after glaucoma surgery. Main Outcome Measures: Changes in optic nerve parameters were subjected to linear regression analysis with respect to percent of postoperative reduction of intraocular pressure (IOP), as well as with respect to age, refraction, preoperative cup:disc ratio, and change in visual field parameters. Results: Seventeen patients had pre- and postoperative images suitable for analysis. Mean IOP at the time of image acquisition before surgery was 30.5 ± 12 mmHg, and after surgery 11.8 ± 5.2 mmHg (mean follow-up, 26 ± 7 weeks). Eleven of 13 (85%) patients having IOP reduction of greater than 40% showed improvement in optic disc parameters. All four patients with less than 25% reduction in IOP showed worsening of most parameters. Changes in optic disc parameters were highly correlated with percent IOP reduction and with age. The parameters in which change most strongly correlated with percent change of IOP were cup area, rim area, cup:disc ratio, and mean cup depth (each, P <0.005). The age of the patient correlated highly with change in maximum cup depth (P <0.005). Refraction and clinically determined cup:disc ratio correlated poorly with changes in measured optic disc parameters. Clinical improvement in visual fields was correlated with the degree of improvement of cup:disc ratio (P = 0.025). Conclusion: Most patients showing a 40% lowering of IOP after glaucoma surgery show improved optic nerve morphology as measured by the HRT. The amount of improvement correlated highly with the percent reduction of IOP.