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Cardiac cirrhosis (congestive hepatopathy) refers to a group of hepatic abnormalities that develop as a result of right-sided heart failure. Cirrhosis of the liver can be induced by any right-sided pathology that leads to right-sided heart failure, which leads to increased venous congestion and pressure in the hepatic sinusoids. Because cardiac cirrhosis might be asymptomatic or diagnosed incorrectly due to other types of liver disease, determining its prevalence is difficult. The underlying heart disease, rather than the hepatic congestion and damage, is usually the cause of death in cardiac cirrhosis. The control of the underlying cardiac disease, as well as the optimization of cardiac output, are the mainstays of congestive hepatopathy treatment. Diuresis can help with hepatic congestion, but it must be used with caution to avoid causing hepatic ischemia. Hemodynamic therapy may be able to reverse the early stages of congestive hepatitis. The widespread use of heart transplantation (HT) and considerable breakthroughs in medical and surgical treatments have drastically altered the profile of CH patients. In this overview we will be looking at the disease cause, epidemiology, diagnosis, and treatment.

Male infertility is mostly due to low sperm quality, which accounts for about 50% of the causes of infertility. The reasons for low sperm quality are still unclear. Nowadays, many drinks contain high levels of fat, and its effect on fertility is not yet known.To investigate the effect of cholesterol-containing water on male fertility.Forty BALB/c male mice were divided into 2 groups: the control group and the water-induced obesity (WIO) group. Body and testicular weights were recorded and analyzed statistically. Testicular tissues were examined. Serum contents of total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), free testosterone (FT), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were determined. Motility count and morphology of sperm were analyzed. Real-time polymerase chain reaction (RT-PCR) was performed for SYCP3, VEGFA and WT1 genes.The results showed that the WIO group presented the highly significant values for mice body and testis weight, and TC, TG and LDL level in serum (p0.05), when compared to the control group. The level of FT, LH and FSH in serum was significantly decreased (p0.05) in the WIO group compared with the control group. Seminiferous tubules of testes became thin, and Sertoli cells showed mild atrophy in this group. Also, the count and motility of sperm significantly reduced while the ratio of sperm abnormalities significantly increased in the WIO group compared with the control group (p0.05). The results of RT-PCR showed that SYCP3, VEGFA and WT1 genes were significantly downregulated (p0.05) in the WIO group compared with the control group.This study indicated that drinks containing high levels of fat may have negative effects on male fertility due to the reduction of the sexual hormones level in serum, the expression of SYCP3, VEGFA and WT1 genes, count and motility of sperm, as well as an increase in sperm abnormalities and pathological changes in the testicular tissues.

Cluster headache (CH) has always been associated with several risk factors, including hereditary, environmental, and lifestyle habits. This study focuses on important risk factors, including family history, smoking, alcohol consumption, male predominance, and head trauma associated with CH. The present study aimed at investigating the available literature on cluster headaches and evaluating their associated risk factors. A systematic data search was designed, and scientific data were collected from renowned databases, including PubMed, Cochrane, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Google Scholar. Thirty-two studies were selected to execute a systemic review, and 26 studies, consisting of 6,065 CH patients, qualified for a meta-analysis. Statistical analyses were conducted by using MedCalc, version 16.8.4; (MedCalc Software, Ostend, Belgium; http://www.medcalc.org) and Rapidminer statistical software, version 9.6.0 (www.rapidminer.com). We conclude the evidence of family history, smoking, alcohol consumption, male predominance, and head trauma are associated with cluster headaches. However, sex discrimination in familial cases needs to be revisited because of the female predominance reported by familial history and CH association studies.

Diabetes is a metabolic disorder described as insufficient secretion of insulin in the pancreas or the inability of the existing insulin to function properly. It poses a greater risk on human health as it is considered the base of several diseases. Thus, this study was designed to evaluate two novel strains of Lactobacillus in handling pancreas disorders. 50 BALB/c male mice were divided into five groups; (a) feeding on normal diet only as control group, (b) given 21% fructose in drinking water as diabetes group, (c) feeding on Lactobacillus rhamnosus strain Pro2 (MT505335.1) plus 21% fructose as LR group, (d) feeding on Lactobacillus plantarum strain Pro1 (MT505334.1) plus 21% fructose as LP group and (e) mixture of two strains plus 21% fructose as Mix group. The serum content of glucose, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) was determined. Pancreases histopathology was examined. Expression of GH, IGF1, and GLP-1 genes was measured in the liver and pancreas by RT-qPCR. Serum content of glucose, ALT, and AST significantly increased in diabetes group, and significantly reduced in (LP) and (Mix) groups compared with control. Pathological changes occurred in the exocrine and endocrine components of the diabetes group pancreas. Besides, islet cells are almost entirely disturbed and acinar cells degenerated. However, in (LP) and (Mix) groups, the pathological changes significantly decreased and became related to the control group. Expression of GH, IGF1, and GLP-1 genes was significantly downregulated in the liver and pancreas of mice given fructose compared with control. Expression of these genes was either significantly upregulated in groups (LP and Mix) or identical to the control group. This study shows that the strain Pro1 (MT505334.1) or a combination of two strains is useful in reducing diabetic risk.

Background: The lungs of particularly newborn are fragile and can be easily damaged. With injury, scarring may follow which is translated into difficult breathing and increased oxygen needs, a condition called bronchopulmonary dysplasia (BPD) or Chronic Lung Disease (CLD). Since inflammation plays an important role in the pathogenesis of CLD, corticosteroids, especially dexamethasone, have been extensively used to avert or treat CLD. Thus, several studies suggest that systemic corticosteroids decrease the duration of ventilator dependence. Aim of the Study: investigate the beneficial and harmful effects of the use of steroid in the prevention and treatment of BPD. Methods: A systematic review and meta-analysis of observational studies and randomized controlled trials was conducted. A review of the scientific literature. Pubmed, Embase and Central were searched to identify randomized controlled trials that investigated postnatal corticosteroids treatment for BPD were the primary endpoints. Identification of papers and data extraction were performed by two independent researchers. We searched for relevant trials in the Cochrane Library, MEDLINE (from 1955), Embase (from 1970), the Transfusion Evidence Library (from 1980), and ongoing trial databases; all searches current to September 2017.Results: The search yielded seven RCTs which enrolled a total of 1862 participants eligible for inclusion in the present review. There were significant beneficial outcomes such as lower rates of failure to extubate and decreased risks of chronic lung disease at both 28 days (RR 0.84, 95% CI 0.83 to 0.87) and 36 weeks' postmenstrual age (RR 0.77, 95% CI 0.72 to 0.84), death or chronic lung disease at 28 days (RR 0.9, 95% CI 0.85 to 0.96) and 36 weeks' postmenstrual age (RR 0.91, 95% CI 0.87 to 0.96). Nevertheless, there were no significant differences in the rates of neonatal mortality (RR= 1.06, 95% CI 0.93, 1.26), periventricular leukomalacia (RR 1.16, 95% CI 0.9 to 1.46), necrotizing enterocolitis or pulmonary haemorrhage (RR 1.21, 95% CI 0.83 to 1.62). In contrast, gastrointestinal bleeding (RR 2.13, 95% CI 1.41 to 2.84) and intestinal perforation (RR 1.77, 95% CI 1.46 to 2.1) were imperative adverse effects. Moreover, many adverse neurological effects were found at follow-up examinations, including developmental delay (RR 1.72, 95% CI 1.4 to 2.05) and cerebral palsy (RR 1.56, 95% CI 1.03 to 2.1). Additionally, the rates of the combined outcomes of death or cerebral palsy (1.92, 95% CI 1.18 to 2.67), or of death or major neurosensory disability (RR 1.25, 95% CI 0.98 to 1.53), were not significantly increased. In subgroup analyses by type of corticosteroid, most of the advantageous and disadvantageous effects were related chiefly to dexamethasone whilst hydrocortisone had slight effect on any of the outcomes except for an increase in intestinal perforation and a borderline reduction in patent ductus arteriosus. The overall risk for bias was low as all were RCTs using robust methods. Conclusion: despite the fact that early corticosteroid treatment can have beneficial outcome for BPD management through facilitation of extubation and decreasing the risk of chronic lung disease and patent ductus arteriosus, it ,on the other hand, results in short-term adverse effects including gastrointestinal bleeding, intestinal perforation, hyperglycaemia, hypertension, hypertrophic cardiomyopathy and growth failure. Clinicians should carefully assess the risks of a short course of glucocorticoid therapy to mitigate BPD for premature neonates such that an individualized decision should be made in conjunction with the infant's parents.

Insulin receptors are widely distributed in the central nervous system and their activation by insulin elicits renal sympatho-excitatory effects. Resistin, an adipokine, promotes resistance to the metabolic effects of insulin. Resistin also induces increases in renal sympathetic nerve activity (RSNA) by acting in the brain, but whether it can influence insulin’s actions on RSNA is unknown. In the present study we investigated, in male Sprague-Dawley rats (7–8 weeks of age), the effects of central administration of insulin combined with resistin on RSNA following a normal diet (ND) and a high fat diet (HFD) (22% fat), since HFD can reportedly attenuate insulin’s actions. RSNA, mean arterial pressure (MAP) and heart rate (HR) responses were monitored and recorded before and for 180 min after intracerebroventricular injection of saline (control) (n = 5 HFD and ND), resistin (7 μg; n = 4 ND, n = 5 HFD), insulin (500 mU; n = 6 ND, n = 5 HFD), and the combination of both resistin and insulin (n = 7 ND, n = 5 HFD). The key finding of the present study was that when resistin and insulin were combined there was no increase in RSNA induced in rats fed a normal diet or the high fat diet. This contrasted with the sympatho-excitatory RSNA effects of the hormones when each was administered alone in rats fed the ND and the HFD.

Leptin and resistin act centrally to increase renal sympathetic nerve activity (RSNA). We investigated whether resistin and leptin combined could induce a greater response than each alone. MAP, HR and RSNA were recorded before and for 3 hours after intracerebroventricular saline (control) (n = 5), leptin (7 μg; n = 5), resistin (7 μg; n = 4) and leptin administered 15 min after resistin (n = 6). Leptin alone and resistin alone significantly increased RSNA (74±17%, 50±14% respectively) (P < 0.0001 compared to saline). When leptin and resistin were combined there was a significantly greater increase in RSNA (163±23%) compared to either drug alone (P < 0.0001). Maximum responses in MAP and HR were not significantly different between groups. We also used Fos protein to quantify the number of activated neurons in the brain. Compared to controls, there were significant increases in numbers of Fos-positive neurons (i) in the arcuate and hypothalamic paraventricular nuclei when leptin or resistin were administered alone, or combined, and (ii) in the lamina terminalis when leptin or resistin were combined. Only in the arcuate nucleus was the increase significantly greater compared to either drug alone. The findings show that leptin and resistin, combined, induces (i) a greater RSNA increase, and (ii) a greater number of activated neurons in the arcuate nucleus, than with either drug alone. Since leptin makes an important contribution to the elevated RSNA observed in obese/overweight conditions, the increased levels of leptin and resistin may mean the contribution of leptin to the elevated RSNA in those conditions is enhanced.

Resistin and leptin are adipokines which act in the brain to regulate metabolic and cardiovascular functions which in some instances are similar, suggesting activation of some common brain pathways. High-fat feeding can reduce the number of activated neurons observed following the central administration of leptin in animals, but the effects on resistin are unknown. The present work compared the distribution of neurons in the brain that are activated by centrally administered resistin, or leptin alone, and, in combination, in rats fed a high fat (HFD) compared to a normal chow diet (ND). Immunohistochemistry for the protein, Fos, was used as a marker of activated neurons. The key findings are (i) following resistin or leptin, either alone or combined, in rats fed the HFD, there were no significant increases in the number of activated neurons in the paraventricular and arcuate nuclei, and in the lateral hypothalamic area (LHA). This contrasted with observations in rats fed a normal chow diet; (ii) in the OVLT and MnPO of HFD rats there were significantly less activated neurons compared to ND following the combined administration of resistin and leptin; (iii) In the PAG, RVMM, and NTS of HFD rats there were significantly less activated neurons compared to ND following resistin. The results suggest that the sensitivity to resistin in the brain was reduced in rats fed a HFD. This has similarities with leptin but there were instances where there was reduced sensitivity to resistin with no significant effects following leptin. This suggests diet influences neuronal effects of resistin.

Similar to leptin, resistin acts centrally to increase renal sympathetic nerve activity (RSNA). In high-fat fed animals, the sympatho-excitatory effects of leptin are retained, in contrast to the reduced actions of leptin on dietary intake. In the present study, we investigated whether the sympatho-excitatory actions of resistin were influenced by a high-fat diet. Further, because resistin and leptin combined can induce a greater sympatho-excitatory response than each alone in rats fed a normal chow diet, we investigated whether a high-fat diet (22%) could influence this centrally-mediated interaction. Mean arterial pressure (MAP), heart rate (HR) and RSNA were recorded before and for 3 hours after i.c.v. saline (control; n=5), leptin (7 μg; n=4), resistin (7 μg; n=5) and leptin and resistin combined (n=6). Leptin alone and resistin alone significantly increased RSNA (71±16%, 62±4%, respectively). When leptin and resistin were combined, there was a significantly greater increase in RSNA (195±41%) compared to either hormone alone. MAP and HR responses were not significantly different between hormones. When the responses in high-fat fed rats were compared to normal chow fed rats, there were no significant differences in the maximum RSNA responses. The findings indicate that sympatho-excitatory effects of resistin on RSNA are not altered by high-fat feeding, including the greater increase in RSNA observed when resistin and leptin are combined. Our results suggest that diets rich in fat do not induce resistance to the increase in RSNA induced by resistin alone or in combination with leptin.

There is considerable interest in the central actions of insulin and leptin. Both induce sympatho-excitation. This study (i) investigated whether centrally administered leptin and insulin together elicits greater increases in renal sympathetic nerve activity (RSNA), mean arterial pressure (MAP) and heart rate (HR) than when given alone, and (ii) quantified the number of activated neurons in brain regions influencing SNA, to identify potential central sites of interaction. In anesthetised (urethane 1.4–1.6 g/kg iv) male Sprague-Dawley rats, RSNA, MAP, and HR were recorded following intracerebroventricular (ICV) saline (control; n = 5), leptin (7 μg; n = 5), insulin (500 mU; n = 4) and the combination of leptin and insulin; (n = 4). Following leptin or insulin alone, RSNA was significantly increased (74 and 62% respectively). MAP responses were not significantly different between the groups. Insulin alone significantly increased HR. Leptin alone also increased HR but it was significantly less than following insulin alone (P < 0.005). When leptin and insulin were combined, the RSNA increase (124%) was significantly greater than the response to either alone. There were no differences between the groups in MAP responses, however, the increase in HR induced by insulin was attenuated by leptin. Of the brain regions examined, only in the arcuate nucleus did leptin and insulin together increase the number of Fos-positive cell nuclei significantly more than leptin or insulin alone. In the lamina terminalis and rostroventrolateral medulla, leptin and insulin together increased Fos, but the effect was not greater than leptin alone. The results suggest that when central leptin and insulin levels are elevated, the sympatho-excitatory response in RSNA will be greater. The arcuate nucleus may be a common site of cardiovascular integration.

Introduction: The chemotherapeutic agents are effective in destroying cancerous cells for patient with hematological malignancies, but can damage the germinal cells. Hence, the infertility is the therapy-induced complication, which can be transient or permanent, depending on type of treatment protocol used and other factors. The aim of the study was to assess the fertility status among patients treated for Hodgkin lymphoma (HL) and Non-Hodgkin lymphoma (NHL). Methods: A chart review was done for patients followed up in hematology clinic. All male patients treated for hematological malignancies during the period from 2004-2014 were assessed. The infertility status was assessed using WHO infertility criteria. The fertility status was defined based on semen analysis or having a child post chemotherapy. The data was captured for type of protocol, number of cycles, fertility status, having a child pre and post chemotherapy, and sperm bank utilization. Results were summarized as frequency and percentages. Data was analyzed using SAS. Results: 400 medical charts were reviewed. 208/400 were included based on age inclusion criteria (18-60 years). 59/208 included based on available fertility data, of which 31 were diagnosed with HL, 21 NHL, 4 acute lymphocytic leukemia, and 3 acute myeloid leukemia. Only HL and NHL were considered for further analysis. 9/31 (29%) with HL and 1/21 (4.7%) with NHL had infertility prior to starting chemotherapy based on semen analysis with no follow-up fertility assessment done post-treatment. The final sample consisted of 42 patients who had data available on their fertility status post-treatment (22 HL and 20 NHL) (Figure 1). The mean age was 38 ± 8 years. 25(68%) had advanced disease. Among HL, 8/22 (36.36%) were fertile (7 conceived a child and 1 with normal semen analysis) (Figure 2). This includes 6 out of 9 (66.7%) patients who received ABVD protocol alone, 0 out of 6 who received ABVD + BEACOPP protocol, and 2 (28.6%) out of 7 who received salvage chemotherapy. Among the NHL, 11/20 (55%) were fertile (8 conceived a child and 3 with normal semen analysis) (Figure 2). This includes 7 out of 11 (63.6%) who received CHOP +/-Rituximab protocol, 3 out of 5 (60%) who received CHOP + other chemotherapy (MTX/CVP), 1 out of 3 (33.3%) who received only other chemotherapies (Hyper CVAD/MTX) (Figure 2). 9 out of 22( 41%) HL and 6 out of 20 NHL patients had sperm banking done, and only two utilized their sperms with one successful conception in a patient with NHL (Figure 3). Conclusion: Although the sample size is very small, we found a trend that may suggest HL to affect fertility and that ABVD protocol may not be as safe as it thought to be on fertility. The advanced stage of the disease being the majority may have influenced this finding. We found the documentation of fertility status among patients receiving chemotherapy to be scarce. Hence, it is important to educate physicians and dedicate a protocol for assessment of fertility pre- and post-treatment with encouragement to utilize sperm banking. Disclosures No relevant conflicts of interest to declare.