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American Journal of Respiratory and... May 2023Sepsis causes significant morbidity and mortality worldwide. Resuscitation is a cornerstone of management. This review covers five areas of evolving practice in the... (Review)
Review
Sepsis causes significant morbidity and mortality worldwide. Resuscitation is a cornerstone of management. This review covers five areas of evolving practice in the management of early sepsis-induced hypoperfusion: fluid resuscitation volume, timing of vasopressor initiation, resuscitation targets, route of vasopressor administration, and use of invasive blood pressure monitoring. For each topic, we review the seminal evidence, discuss the evolution of practice over time, and highlight questions for additional research. Intravenous fluids are a core component of early sepsis resuscitation. However, with growing concerns about the harms of fluid, practice is evolving toward smaller-volume resuscitation, which is often paired with earlier vasopressor initiation. Large trials of fluid-restrictive, vasopressor-early strategies are providing more information about the safety and potential benefit of these approaches. Lowering blood pressure targets is a means to prevent fluid overload and reduce exposure to vasopressors; mean arterial pressure targets of 60-65 mm Hg appear to be safe, at least in older patients. With the trend toward earlier vasopressor initiation, the need for central administration of vasopressors has been questioned, and peripheral vasopressor use is increasing, although it is not universally accepted. Similarly, although guidelines suggest the use of invasive blood pressure monitoring with arterial catheters in patients receiving vasopressors, blood pressure cuffs are less invasive and often sufficient. Overall, the management of early sepsis-induced hypoperfusion is evolving toward fluid-sparing and less-invasive strategies. However, many questions remain, and additional data are needed to further optimize our approach to resuscitation.
Topics: Humans; Aged; Sepsis; Vasoconstrictor Agents; Fluid Therapy; Blood Pressure; Hypotension; Resuscitation; Shock, Septic
PubMed: 36812500
DOI: 10.1164/rccm.202209-1831CI -
Frontiers in Bioscience (Elite Edition) Jan 2013The prevalence of semen hyperviscosity (SHV) is estimated to be between 12-29% and can lead to male factor infertility both in vivo and in vitro. Semen is composed of... (Review)
Review
The prevalence of semen hyperviscosity (SHV) is estimated to be between 12-29% and can lead to male factor infertility both in vivo and in vitro. Semen is composed of fluids secreted by the male accessory glands, which contain proteins essential to the coagulation and liquefaction of semen. Hypofunction of the prostate or seminal vesicles causes abnormal viscosity of seminal fluid. Infection and high levels of seminal leukocytes may also result in the development of SHV. Oxidative stress and biochemical and genetic factors can furthermore contribute to this condition. Hyperviscosity can impair normal sperm movement in the female reproductive tract, and can lead to decreased sperm count. SHV is treated with a hypodermic needle, mucolytic enzymes, antibiotics and anti-inflammatory agents in certain cases. Further research is needed to better understand the contributors to SHV and the treatments that can be used for infertile males with hyperviscous semen.
Topics: Humans; Infertility, Male; Male; Prostatic Diseases; Semen; Seminal Vesicles; Viscosity
PubMed: 23276984
DOI: 10.2741/e610 -
Current Biology : CB Jun 2017Seminal fluid does more than transport sperm. Hopkins et al., describe the diverse features and functions of seminal fluid, and its role in evolution and medicine.
Seminal fluid does more than transport sperm. Hopkins et al., describe the diverse features and functions of seminal fluid, and its role in evolution and medicine.
Topics: Animals; Biological Evolution; Humans; Male; Semen; Sexual Behavior, Animal; Species Specificity; Spermatozoa
PubMed: 28586660
DOI: 10.1016/j.cub.2017.03.063 -
Fertility and Sterility Sep 2016Seminal fluid is often viewed as simply a vehicle to carry sperm to fertilize the oocyte, but a more complex function in influencing female reproductive physiology is... (Review)
Review
Seminal fluid is often viewed as simply a vehicle to carry sperm to fertilize the oocyte, but a more complex function in influencing female reproductive physiology is now evident. Remarkably, seminal fluid contains soluble and exosome-born signaling agents that interact with the female reproductive tract to prime the immune response, with consequences for fertility and pregnancy outcome. Experiments in rodent models demonstrate a key role for seminal fluid in enabling robust embryo implantation and optimal placental development. In particular, seminal fluid promotes leukocyte recruitment and generation of regulatory T cells, which facilitate embryo implantation by suppressing inflammation, assisting uterine vascular adaptation, and sustaining tolerance of fetal antigens. There is emerging evidence of comparable effects in women, where seminal fluid provokes an adaptive immune response in the cervical tissues after contact at intercourse, and spermatozoa accessing the higher tract potentially affect the endometrium directly. These biological responses may have clinical significance, explaining why [1] intercourse in IVF ET cycles improves the likelihood of pregnancy, [2] inflammatory disorders of gestation are more common in women who conceive after limited exposure to seminal fluid of the prospective father, and [3] preeclampsia incidence is elevated after use of donor oocytes or donor sperm where prior contact with conceptus alloantigens has not occurred. It will be important to define the mechanisms through which seminal fluid interacts with female reproductive tissues, to provide knowledge that may assist in preconception planning and infertility treatment.
Topics: Animals; Embryo Implantation; Female; Fertility; Histocompatibility, Maternal-Fetal; Humans; Immune Tolerance; Infertility; Isoantigens; Male; Pregnancy; Pregnancy Complications; Reproductive Techniques, Assisted; Semen; Signal Transduction; T-Lymphocytes, Regulatory; Uterus
PubMed: 27485480
DOI: 10.1016/j.fertnstert.2016.07.1101 -
Philosophical Transactions of the Royal... Dec 2020Sperm production and allocation strategies have been a central concern of sperm competition research for the past 50 years. But during the 'sexual cascade' there may be... (Review)
Review
Sperm production and allocation strategies have been a central concern of sperm competition research for the past 50 years. But during the 'sexual cascade' there may be strong selection for alternative routes to maximizing male fitness. Especially with the evolution of internal fertilization, a common and by now well-studied example is the accessory ejaculate investment represented by seminal fluid, the complex mixture of proteins, peptides and other components transferred to females together with sperm. How seminal fluid investment should covary with sperm investment probably depends on the mechanism of seminal fluid action. If seminal fluid components boost male paternity success by directly enhancing sperm function or use, we might often expect a positive correlation between the two forms of male investment, whereas trade-offs seem more likely if seminal fluid acts independently of sperm. This is largely borne out by a broad taxonomic survey to establish the prevailing patterns of seminal fluid production and allocation during animal evolution, in light of which I discuss the gaps that remain in our understanding of this key ejaculate component and its relationship to sperm investment, before outlining promising approaches for examining seminal fluid-mediated sperm competitiveness in the post-genomic era. This article is part of the theme issue 'Fifty years of sperm competition'.
Topics: Animals; Male; Semen; Sexual Behavior, Animal; Spermatozoa
PubMed: 33070740
DOI: 10.1098/rstb.2020.0068 -
Physiological Reviews Jul 2020Seminal fluid is often assumed to have just one function in mammalian reproduction, delivering sperm to fertilize oocytes. But seminal fluid also transmits signaling... (Review)
Review
Seminal fluid is often assumed to have just one function in mammalian reproduction, delivering sperm to fertilize oocytes. But seminal fluid also transmits signaling agents that interact with female reproductive tissues to facilitate conception and .pregnancy. Upon seminal fluid contact, female tissues initiate a controlled inflammatory response that affects several aspects of reproductive function to ultimately maximize the chances of a male producing healthy offspring. This effect is best characterized in mice, where the female response involves several steps. Initially, seminal fluid factors cause leukocytes to infiltrate the female reproductive tract, and to selectively target and eliminate excess sperm. Other signals stimulate ovulation, induce an altered transcriptional program in female tract tissues that modulates embryo developmental programming, and initiate immune adaptations to promote receptivity to implantation and placental development. A key result is expansion of the pool of regulatory T cells that assist implantation by suppressing inflammation, mediating tolerance to male transplantation antigens, and promoting uterine vascular adaptation and placental development. Principal signaling agents in seminal fluid include prostaglandins and transforming growth factor-β. The balance of male signals affects the nature of the female response, providing a mechanism of ‟cryptic female choiceˮ that influences female reproductive investment. Male-female seminal fluid signaling is evident in all mammalian species investigated including human, and effects of seminal fluid in invertebrates indicate evolutionarily conserved mechanisms. Understanding the female response to seminal fluid will shed new light on infertility and pregnancy disorders and is critical to defining how events at conception influence offspring health.
Topics: Animals; Female; Genitalia, Female; Inflammation; Male; Reproduction; Semen; Signal Transduction
PubMed: 31999507
DOI: 10.1152/physrev.00013.2018 -
Antioxidants (Basel, Switzerland) Feb 2021Seminal fluid viscosity is a key parameter to achieve fertilization. Viscosity is more frequently increased in patients with infertility. However, the mechanism by which... (Review)
Review
INTRODUCTION
Seminal fluid viscosity is a key parameter to achieve fertilization. Viscosity is more frequently increased in patients with infertility. However, the mechanism by which hyperviscosity causes infertility is still poorly understood. As an increased blood viscosity is associated with diseases caused by oxidative stress, it can be supposed that there is a relationship between seminal fluid viscosity and oxidative stress in male infertility. Therefore, this systematic review aims to investigate the relationship between hyperviscous seminal fluid and oxidative stress.
MATERIALS AND METHODS
We performed a systematic search on the following databases Pubmed, MEDLINE, Cochrane, and Scopus from the earliest available date to 10 January 2021, using Medical Subjects Headings (MeSH) indexes and keywords searches. The study included all the articles that evaluated the relationship between increased seminal fluid viscosity and oxidative stress. Article reviews even though dealing with seminal fluid hyperviscosity were excluded.
RESULTS
5 articles were included in this systematic review. The results demonstrated an important impairment of antioxidant systems and increased oxidative stress in patients with high seminal fluid viscosity.
CONCLUSIONS
These findings suggest that a careful assessment of oxidative stress in patients with hyperviscosity may be very useful in clinical practice. Infertile patients with seminal fluid hyperviscosity could benefit from the treatment with antioxidants to protect sperm cells from oxidative damage and to improve their functional properties.
PubMed: 33673452
DOI: 10.3390/antiox10030356 -
Journal of Clinical Medicine Apr 2022Seminal vesicles play an important role in the male reproductive system, producing seminal fluid and thus adequate environment for sperm. However, mechanisms underlying...
Seminal vesicles play an important role in the male reproductive system, producing seminal fluid and thus adequate environment for sperm. However, mechanisms underlying secretory functions of the seminal vesicles' epithelium have not been defined yet. The aim of the present study was to characterize expression and immunolocalization of selected membrane transporters and carriers in the seminal vesicles. The study included biopsy specimens collected from non-affected parts of seminal vesicles from 53 patients of Caucasian origin subjected for prostatectomy. RT-PCR was used to define expression of 15 genes coding for ABC-family and 37 genes encoding 37 SLC-family transporters/carriers. Immunohistochemistry was used to define localization of 6 transporters. In the seminal vesicles, the following membrane transporters and carriers were defined: ABCA1, ABCB1, ABCB5, ABCB6, ABCC1, ABCC2, ABCC3, ABCC4, ABCC5, ABCC6, ABCG2, SLC01C1, SLC02B1, SLC04A1, SLC04C1, SLC10A1, SLC15A1, SLC15A2, SLC16A1, SLC16A3, SLC19A1, SLC22A1, SLC22A3, SLC22A11, SLC22A18, SLC22A4, SLC22A5, SLC28A1, SLC2A9, SLC33A1, SLC47A1, SLC47A2, SLC51A, SLC51B, SLC7A5, SLC7A6. Age-dependent expression was evidenced for ABCB1, ABCG2, SLC04C1, SLC15A1, SLC16A1, SLC22A11, SLC22A18, SLC47A1 and SLC47A2. ABCG2, P-gp, MRP1, MRP3, MCT1 and LAT1 were localized in the apical membrane and P-gp in the basolateral membrane of the seminal vesicle epithelium. The expression of the membrane transporters and carriers in the seminal vesicle epithelium confirms its secretory and barrier functions.
PubMed: 35456310
DOI: 10.3390/jcm11082213 -
BMC Ecology and Evolution Feb 2022The rapid evolution of seminal fluid proteins (SFPs) has been suggested to be driven by adaptations to postcopulatory sexual selection (e.g. sperm competition). However,...
BACKGROUND
The rapid evolution of seminal fluid proteins (SFPs) has been suggested to be driven by adaptations to postcopulatory sexual selection (e.g. sperm competition). However, we have recently shown that most SFPs evolve rapidly under relaxed selective pressures. Given the role of SFPs in competition for fertilization phenotypes, like the ability to transfer and store sperm and the modulation of female receptivity and ovulation, the prevalence of selectively relaxed SFPs appears as a conundrum. One possible explanation is that selection on SFPs might be relaxed in terms of protein amino acid content, but adjustments of expression are essential for post-mating function. Interestingly, there is a general lack of systematic implementation of gene expression perturbation assays to monitor their effect on phenotypes related to sperm competition.
RESULTS
We successfully manipulated the expression of 16 SFP encoding genes using tissue-specific knockdowns (KDs) and determined the effect of these genes' perturbation on three important post-mating phenotypes: female refractoriness to remating, defensive (P1), and offensive (P2) sperm competitive abilities in Drosophila melanogaster. Our analyses show that KDs of tested SFP genes do not affect female refractoriness to remating and P2, however, most gene KDs significantly decreased P1. Moreover, KDs of SFP genes that are selectively constrained in terms of protein-coding sequence evolution have lower P1 than KDs of genes evolving under relaxed selection.
CONCLUSIONS
Our results suggest a more predominant role, than previously acknowledged, of variation in gene expression than coding sequence changes on sperm competitive ability in D. melanogaster.
Topics: Animals; Drosophila Proteins; Drosophila melanogaster; Female; Gene Expression; Genetic Fitness; Male; Spermatozoa
PubMed: 35196983
DOI: 10.1186/s12862-022-01975-1 -
Journal of Proteomics Apr 2020We report in this manuscript what is known about the protein makeup of a selection of biological fluids in the domestic dog. The samples we review - amniotic and... (Review)
Review
We report in this manuscript what is known about the protein makeup of a selection of biological fluids in the domestic dog. The samples we review - amniotic and allantoic fluid, seminal fluid, saliva, bile, synovial fluid, tears - are still very poorly characterized in this species. For some of them we can present results from our own, mainly unpublished experiments. SIGNIFICANCE: The dog is one of the most widespread companion animals, and also of medical relevance as model species for some human diseases. Still, investigation of body fluids other than serum and urine is not so commonly undertaken, although - like in humans - also these sample types may have potential for diagnostic purposes. We compile published data about proteomes of fetal fluids, seminal plasma, saliva, bile, synovial fluid and tears, enriched by some yet unpublished data of our own (proteins of amniotic and allantoic fluid, tears). Closing gaps in our knowledge on dog proteins will further our understanding of (patho)physiological processes.
Topics: Amniotic Fluid; Animals; Body Fluids; Dogs; Proteomics; Saliva; Tears
PubMed: 32126321
DOI: 10.1016/j.jprot.2020.103724