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BACKGROUND: Vitiligo treatment is challenging, especially for resistant and stable vitiligo, which requires surgical management. Noncultured epidermal cell suspension has been modified to enhance the treatment outcomes. OBJECTIVE: Comparison of autologous noncultured trypsinized epidermal cell suspension in recipient site prepared by cryoblebbling and noncultured nontrypsinized epidermal cell graft homogenized with plasma gel in recipient site prepared by dermabrasion for stable vitiligo treatment. MATERIALS AND METHODS: Interventional comparative study on 30 patients with stable vitiligo, randomly divided into 2 equal groups. Group A: noncultured trypsinized epidermal cell suspension for recipient prepared by cryoblebbling. Group B: noncultured nontrypsinized epidermal cell graft homogenized with plasma gel for recipient prepared by dermabrasion. Afterward, both groups received 3 months of narrow-band ultraviolet B phototherapy. RESULTS: The plasma gel group showed a significantly earlier onset of repigmentation and faster healing ( p = .002* and <.001*, respectively). Overall, repigmentation was higher in the plasma gel group ( p = .037* at the end of the second month). Color matching and patient satisfaction were higher in the plasma gel group, without statistical significance. The cryobleb group showed more recipient site complications, and the plasma gel procedure was relatively easier and cheaper. CONCLUSION: Plasma gel modification is cost-effective, less time-consuming, does not require trypsinization, and provides rapid, satisfactory, and uniform repigmentation. Cryoblebbing and trypsinization are effective; however, there are more technical difficulties, delayed healing, and delayed onset of repigmentation.

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BACKGROUND: Treatment of horizontal forehead lines with botulium toxin type A is a common procedure that helps achieve a youthful and rejuvenated look. Adequate knowledge of the anatomy and an individualized treatment approach is the key to successful treatment outcome. AIM: To evaluate the cosmetic outcome following treatment of dynamic forehead wrinkles by locking the line of convergence using botulinum toxin type A. PATIENTS AND METHODS: Fifty female patients with dynamic forehead wrinkles were included. The line of convergence was identified, and injection points were determined. Patients received injections of botulinum toxin type A in the upper part of the frontalis along the line of convergence. Patients were evaluated before injection and the response was evaluated after 2 weeks and after 3 months of injection. RESULTS: Post-treatment significant decrease in dynamic wrinkle scale was detected. The distance between the medial and lateral canthi and their corresponding lower brow margins on maximum brow elevation was also significantly decreased after treatment. Meanwhile, the validated brow positioning score revealed no significant change in the resting brow position when pre-and post-treatment scores were compared. CONCLUSIONS: Treating forehead wrinkles by injecting botulinum toxin along the line of convergence is an effective technique that requires less overall amount of toxin, improves the appearance of the wrinkles and minimizes the risk of development of side effects.

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Several theories were proposed to explain the pathophysiology of varicocele-related infertility seen in some patients. Our aim was to study the levels of angiotensin II in semen and angiotensin II type 2 receptor expression on spermatozoa in varicocele patients in relation to their fertility status and to evaluate the influence of varicocelectomy on their levels in infertile varicocele patients. Thirty fertile and 30 infertile varicocele patients and 30 healthy controls were subjected to measurement of reproductive hormones, semen analysis, measurement of seminal angiotensin II and evaluation of angiotensin II type 2 receptor expression on spermatozoa. Infertile varicocele patients underwent varicocelectomy and were re-evaluated for the same parameters after the operation. Sperm concentration, morphology, progressive motility, seminal angiotensin II and angiotensin II type 2 receptor expression were significantly lower in infertile varicocele patients compared with the other groups. Post-operative values showed significant increase in the studied parameters compared with the pre-operative values but not to other two groups. A significant positive correlation between angiotensin II type 2 receptor expression and progressive motility was detected in all studied groups. In conclusion, dysregulation of angiotensin II and angiotensin II type 2 receptor in varicocele patients may be involved in varicocele-related infertility.

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BACKGROUND: Different techniques have been used for filler injection of the tear trough and palpebromalar groove. Most patients report good results; however, some patients here experienced variable degrees of side effects. OBJECTIVE: To assess if previous estimation of the bony orbit depth could affect the choice between bolus and serial puncture technique, and thereby the procedure outcome. MATERIALS AND METHODS: In 32 patients, the periosteum depth was measured by using a 28 G needle at 2 points: Point A at the midpupillary line and Point B at the outer canthus. The bolus technique was performed in the right side, and serial puncture technique was done on the left side. RESULTS: There was a significant difference in the degree of improvement between both sides in 71% of patients: 40% had better improvement on the right side, whereas 31% had better improvement on the left side. Cases with skin-to-periosteum depth less than 0.5 cm showed better results with serial puncture technique, whereas those with more than 0.5 cm depth showed better results with bolus technique. CONCLUSION: Assessment of bony orbit depth could offer new tool for selecting infraorbital groove injection technique.

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OBJECTIVE: To assess the effect of treatment of seminal Helicobacter pylori in infertile asthenozoospermic men. METHODS: In all, 223 infertile asthenozoospermic men were consecutively selected. They were subjected to history taking, clinical examination, semen analysis, and estimation of H pylori IgA antibodies in their seminal fluid. Infertile men with high seminal H pylori IgA were subjected to triple drug treatment, omeprazole, 20 mg; tinidazole, 500 mg; and clarithromycin, 250 mg twice a day for 2 weeks. Semen analysis as well as H pylori IgA antibodies was estimated after 3 months. RESULTS: In all, 22 of 223 men (9.87%) demonstrated H pylori IgA antibodies in their seminal plasma. After treatment, mean seminal H pylori IgA levels demonstrated significant decrease (1.55 ± 0.4 vs 0.52 ± 0.26; 95% confidence interval, 0.83-1.21; P = .001) concomitant with improved progressive as well as nonprogressive sperm motility. H pylori IgA antibodies demonstrated significant negative correlation with progressive sperm motility, nonprogressive sperm motility, normal sperm morphology, and significant positive correlation with immotile sperm motility. CONCLUSION: H pylori treatment significantly improves sperm motility in infertile asthenozoospermic men with elevated seminal H pylori IgA.

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BACKGROUND: Deep peeling using phenol and percutaneous collagen induction (PCI) are used in treating acne scars. AIM: To compare deep peeling using phenol and PCI combined with trichloroacetic acid (TCA) 20% in treating atrophic acne scars. METHODS: 24 patients with post-acne atrophic scars were randomly divided into two groups; group 1 was subjected to one session of deep peeling using phenol, and group 2 was subjected to four sessions of PCI combined with TCA 20%. As a secondary outcome measure, side effects were recorded and patients were asked to assess their % of improvement by a questionnaire completed 8 months after the procedure. RESULTS: Scar severity scores improved by a mean of 75.12% (p < 0.001) in group 1 and a mean of 69.43% (p < 0.001) in group 2. Comparing the degree of improvement in different types of scars, within the same group after treatment, revealed a significant highest degree of improvement in the rolling type (p = 0.005) in group 2. CONCLUSION: Deep peeling using phenol and PCI with TCA 20% were effective in treating post-acne atrophic scars.

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BACKGROUND: There have been no well-controlled studies evaluating the efficacy of combining 1540 nm nonablative fractional laser with percutaneous collagen induction (PCI) and trichloroacetic acid (TCA) 20% in the treatment of atrophic acne scars. OBJECTIVE: We hypothesized that combined alternating sessions of both modalities would show better results than each individual modality. METHODS AND MATERIALS: Thirty-nine patients with post acne atrophic scars were included in this study. Patients were randomly equally divided into three groups; group 1 was subjected to six sessions of PCI combined with TCA 20% in the same session, group 2 was subjected to six sessions of 1540 nm fractional laser and group 3 was subjected to combined alternating sessions of the previously mentioned two modalities. RESULTS: Scar severity scores improved by a mean of 59.79% (95% CI 47.38-72.21) (p < 0.001) in group 1, a mean of 61.83% (95% CI 54.09-69.56) (p < 0.001) in group 2 and a mean of 78.27% (95% CI 74.39-82.15) (p < 0.001) in group 3. The difference in the degree of improvement was statistically significant when comparing the three groups using ANOVA test (p = 0.004). CONCLUSION: The current work recommends combining 1540 nm nonablative fractional laser in alternation with PCI and TCA 20% in the treatment of atrophic acne scars.

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BACKGROUND: Rejuvenation of the lower face can be challenging and no single modality can accomplish all its complex events. PATIENTS AND METHODS: This 18-month study included 24 female patients with a primary complaint of lower-face aging signs. They were randomly allocated to either Group A, who received injection lipolysis and hyaluronic acid dermal filler, or Group B who in addition received non-ablative 1540 fractional laser. The improvement evaluation score used was the global aesthetic improvement scale (GAIS). Patient's satisfaction level was also recorded. Both were repeated at Months 6, 13 and 18. RESULTS: At all evaluations, laser group showed higher degree of improvement. Interestingly, at short-term evaluation (6 month), there was no significant difference between both groups (P > 0.05). However, the laser group improvement in comparison to the other group became significant in the long-term evaluations (13 and 18 months) (P < 0.05). CONCLUSION: This study further documents the importance of combination therapy in facial rejuvenation, offering a treatment protocol combining injection lipolysis and hyaluronic acid as an effective, safe, short-term therapeutic option in lower-face rejuvenation. The addition of 1540 non-ablative fractional laser to the protocol offers a higher efficacy with longer-term effects and no adverse events.

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OBJECTIVE: The aim of this study was to establish an objective definition of "poor responders" for patients undergoing treatment with assisted reproduction. METHODS: A total of 782 infertile couples treated with assisted reproduction were studied by retrospective analysis of the data. Simple linear regression was performed between the number of oocytes retrieved and the clinical pregnancy rate. The sensitivity and specificity were then calculated and the receiver-operator characteristic (ROC) curves were drawn in order to determine a critical number of oocytes retrieved below which the clinical pregnancy rate was significantly diminished. RESULTS: An excellent correlation was found between the number of oocytes retrieved and the clinical pregnancy rate (r = 0.90). The clinical pregnancy rate started to become significantly lower when fewer than 5, 6, and 8 oocytes were retrieved from patients treated with ICSI, IVF, or TeSE/ICSI, respectively. CONCLUSIONS: The definition of poor responders in assisted reproduction depends on the treatment modality. Poor responders are patients undergoing treatment with ICSI, IVF, or TeSE/ICSI from whom fewer than 5, 6, or 8 oocytes are retrieved, respectively.

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BACKGROUND: Various methods for the selection of viable sperm from among immotile testicular spermatozoa for use in ICSI have been described in non-randomized studies. We have conducted a randomized controlled study to compare the use of the modified hypo-osmotic swelling (HOS) test (50% culture medium + 50% Milli-Q grade water) with that of sperm selection on the basis of their morphology alone. METHODS: A total of 79 couples with immotile testicular spermatozoa treated with ICSI were randomly assigned into two groups. In the first group, spermatozoa used for injection were selected using the modified HOS test, while in the second group spermatozoa were selected on the basis of their morphology. RESULTS: The fertilization rate was significantly higher in the HOS test group (43.6%) compared with the no-HOS test group (28.2%) [odds ratio (OR) 2.494; 95% confidence interval (CI) 1.606-3.872]. The pregnancy and ongoing pregnancy rates were also higher in the HOS test group (27.3% versus 20.5%) compared with the no-HOS test group (5.7% versus 2.9%) (OR 6.188, 95% CI 1.282-29.860; and OR 8.743, 95% CI 1.050-72.783, respectively). CONCLUSIONS: The use of the modified HOS test for the selection of viable sperm from among immotile testicular spermatozoa for ICSI results in higher fertilization, pregnancy and ongoing pregnancy rates compared with morphological selection.

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PURPOSE: In this study, we investigated the relationship between functionality of the acrosome and sperm morphology. METHODS: Acrosome reaction (AR) was separately determined in live and dead sperm and in those with normal, small, and large sized acrosomes by means of the triple stain. Morphology was analyzed according to strict criteria after Papanicolaou stain. RESULTS: AR and morphology correlated regarding detection of large and small sized acrosomes, but not for normal sized acrosomes. Spontaneous AR was significantly influenced by acrosomal size. Sperm with large (11.4%) and normal (9.2%) acrosomes exhibited a significantly higher percentage of life spontaneously acrosome-reacted sperm than those with small acrosomes (4.5%). Sperm with small acrosomes were associated with a higher percentage of cell death. CONCLUSION: The results indicate that sperm with small acrosomes are more susceptible to cell death and nonphysiological acrosomal loss. Acrosome size reflects the physiological capability of sperm function and therefore male fertility potential.

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Inhibin B is bidirectionally secreted by Sertoli cells, basal secretion into the circulation exerts negative feedback on follicle-stimulating hormone secretion, and serum inhibin B is considered a marker of spermatogenesis. The precise role of apical secretion is unknown. The objective of our work was to study the relationship between seminal inhibin B and spermatogenesis. Dimeric inhibin B was measured by immunoassay in seminal plasma of volunteers with normozoospermia (n = 10, group 1), in men after vasectomy (n = 10, group 2), and in men with azoospermia (n = 50, group 3). Testicular biopsy and testicular sperm extraction were performed in men with azoospermia. Seminal inhibin B levels were higher in men in group 1 than in men in groups 2 and 3 (P <.0001). In seminal plasma, inhibin B presents a positive correlation with alpha glucosidase activity (r =.37, P =.002). Seminal inhibin B is inversely related with serum FSH (r = -.58, P <.001), and presents a weak positive correlation with serum testosterone concentration (r =.29, P =.03). No difference was found between inhibin B levels in seminal plasma of patients with nonobstructive or obstructive azoospermia, and between positive or negative outcome of TESE. We conclude that inhibin B secretion by Sertoli cells is differentially regulated. The contribution of accessory sex glands limits the use of seminal plasma inhibin B as a marker of spermatogenesis.

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