Analysis 2.4. Comparison 2 Head-to-head antioxidant(s), Outcome 4 Total sperm motility at 6 months; type of antioxidant........ Analysis 2.5. Comparison 2 Head-to-head antioxidant(s), Outcome 5 Total sperm motility at 6 months

The importance of CD4+ cells in resistance to Pneumocystis carinii (PC) in PC-susceptible severe combined immunodeficient (SCID) mice that were made resistant to PC by immunocompetent spleen cell transfer, and in conventional PC-resistant mice, was investigated. SCID mice with naturally acquired PC pneumonia (PCP) were given infusions of spleen cells from immunocompetent donors. This reconstitution caused the recipients to resolve their PCP. Treatment of reconstituted SCID mice with anti-CD4 monoclonal antibodies (mAbs) to deplete them of CD4+ cells eliminated their ability to resolve PCP, whereas treating them with anti-CD8 mAb to deplete CD8+ cells had no effect. The findings indicate, therefore, that resistance to PCP in immunologically reconstituted SCID mice is dependent on CD4+ cells. To determine whether CD4+ cells enable conventional mice to resist PCP, B6D2 mice were treated with anti-CD4 mAb to deplete them of CD4+ cells in an attempt to induce PCP. After 10-11 wk of treatment, these mice developed progressive PCP. Taken together, these results indicate that loss of CD4+ cells predisposes mice to PC infection.

There is low quality evidence from only four small randomised controlled trials suggesting that antioxidant supplementation in subfertile males may improve live birth rates for couples attending fertility clinics. Low quality evidence suggests that clinical pregnancy rates may increase. There is no evidence of increased risk of miscarriage but this is uncertain as the evidence is of very low quality. Data were lacking on other adverse effects. Further large well-designed randomised placebo-controlled trials are needed to clarify these results.

The evidence suggests that antioxidant supplementation in subfertile males may improve the outcomes of live birth and pregnancy rate for subfertile couples undergoing ART cycles. Further head to head comparisons are necessary to identify the superiority of one antioxidant over another.

Twenty-two Klebsiella pneumoniae and two K. oxytoca extended-spectrum ␤-lactamase (ESBL)-producing isolates were collected in 1996 from patients in two pediatric wards of the University Hospital in Wrocław, Poland. Molecular typing has revealed that the K. pneumoniae isolates represented four different epidemic strains. Three kinds of enzymes with ESBL activity (pI values of 5.7, 6.0, and 8.2) were identified. The pI 6.0 ␤-lactamases belonged to the TEM family, and sequencing of the bla TEM genes amplified from representative isolates revealed that these enzymes were TEM-47, previously identified in K. pneumoniae isolates from pediatric hospitals in Łódź and Warsaw. One of the TEM-47-producing strains from Wrocław was very closely related to the isolates from the other cities, and this indicated countrywide spread of the epidemic strain. The pI 5.7 ␤-lactamase was produced by a single K. pneumoniae isolate for which, apart from oxyimino-␤-lactams, the MICs of ␤-lactam-inhibitor combinations were also remarkably high. Sequencing revealed that this was a novel TEM ␤-lactamase variant, TEM-68, specified by the following combination of mutations: Gly238Ser, Glu240Lys, Thr265Met, and Arg275Leu. The new enzyme has most probably evolved from TEM-47 by acquiring the single substitution of Arg275, which before was identified only twice in enzymes with inhibitor resistance (IR) activity. TEM-68 was shown to be a novel complex mutant TEM ␤-lactamase (CMT-2) which combines strong ESBL activity with relatively weak IR activity and, when expressed in K. pneumoniae, is able to confer high-level resistance to a wide variety of ␤-lactams, including inhibitor combinations. This data confirms the role of the Arg275Leu mutation in determining IR activity and documents the first isolation of K. pneumoniae producing the complex mutant enzyme.