پنج شنبه ٢٥ شهريور ١٤٠٠ - 
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آخرین عناوین :   
منو اصلی
آمار بازدید
 بازدید این صفحه : 166
 بازدید امروز : 121
 کل بازدید : 641564
 بازدیدکنندگان آنلاين : 1
 زمان بازدید : 3.91
 
 

Impact of enhanced optical techniques at time of TURBT with or without single immediate intravesical chemotherapy on recurrence rate of NMIBC, a systematic review and network meta-analysis of randomized trials

Abstract

Introduction: The novel optical techniques such as blue light cystoscopy (BLC) during transurethral resection of bladder tumor (TURBT) has been shown to improve the tumor detection rate and recurrence rate. Whether a single immediate intravesical chemotherapy (SIIC) still has an additive therapeutic effect in the setting of these novel optical techniques (e.g., photodynamic diagnosis (PDD) and narrow band imaging (NBI)) remains unclear. The main aim of this systematic review and network meta-analysis was to assess whether SIIC still adds value to bladder tumor management in combination with optical techniques- enhanced TURBT. Methods: A systematic search was performed using PubMed and Web of Science databases in September 2020 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) extension statement for network meta-analysis. Studies that compared recurrence rates between intervention groups (TURBT by PDD ± SIIC, NBI ± SIIC, or WLC + SIIC) and control group (TURBT by WLC alone) were included. We used the Bayesian approach in the network meta-analysis. Results: Twenty-two studies (n= 4,519) met our eligibility criteria. Out of six different interventions including three different optical techniques, compared to WLC alone, BLC plus SIIC (odds ratio (OR): 0.349, 95% credible interval (CrI):0.196-0.601) and BLC alone (OR: 0.668, 95% CrI:0.459-0.931) were associated with a significantly lower likelihood of 12-month recurrence rate. In the sensitivity analysis, out of eight different interventions compared to WLC alone, PDD by 5-aminolevulinic plus SIIC (OR: 0.327, 95% CrI:0.159-0.646) and by hexaminolevulinic acid plus SIIC (OR: 0.376, 95% CrI:0.172-0.783) were both associated with a significantly lower likelihood of 12-month recurrence rate. NBI with and without SIIC were not associated with a significantly lower likelihood of 12-month recurrence rate (OR: 0.385, 95% CrI:0.105-1.29 and OR: 0.653, 95% CrI:0.343-1.15). Conclusion: BLC during TURBT with concomitant SIIC seems to yieled superior recurrence outcomes in patients with non-muscle invasive bladder cancer. The Use of PDD was able to reduce the 12-month recurrence rate; moreover, a concomitant SIIC increased this risk benefit by 32% additional reduction of odds ratio. Although using PDD could reduce the recurrence rate, SIIC remains necessary. Moreover, the ranking analysis showed that both PDD and NBI, plus SIIC were better than these techniques alone.

Keywords: blue light cystoscopy; hexaminolevulinic acid; narrow band imaging; non-muscle invasive urolthelial carcinoma; photodynamic diagnosis; single immediate intravesical chemotherapy.

DOI: 10.1111/bju.15383 


Pyrvinium pamoate induces in-vitro suppression of IL-6 and IL-8 produced by human endometriotic stromal cells

 

Abstract

Endometriosis, a chronic inflammatory disease, is identified by the presence of endometrial tissue outside the uterus. The prevalence of this disease among reproductive-age women is almost 10-15%. High levels of IL-6 and IL-8 have been found in the peritoneal fluid (PF) of women with endometriosis and are involved in its pathogenesis. Isolated stromal cells from 12 ectopic and eutopic endometrial biopsies of women with ovarian endometrioma and also 12 endometrial biopsies of nonendometriotic controls were treated with 1.1 µM pyrvinium pamoate, a Wnt/β-catenin signaling pathway inhibitor, for 72 hrs. Before treatment, mRNA gene expression and secretion of IL-6 and IL-8 were significantly higher in ectopic (EESCs) than eutopic (EuESCs) and control (CESCs) endometrial stromal cells. After treatment, mRNA gene expression and also secretion of IL-6 and IL-8 were significantly reduced. Our Findings showed that pyrvinium pamoate suppresses the mRNA gene expression and secretion of IL-6 and IL-8 in human endometriotic stromal cells. Additional investigations on this compound are required before clinical application.
 
Keywords: Endometriosis; Wnt signaling pathway; interleukin-6; interleukin-8; pyrvinium pamoate; stromal cells.
 
 

Photobiomodulation preconditioned human semen protects sperm cells against detrimental effects of cryopreservation

 

Abstract

The biological consequences of semen samples preconditioning with photobiomodulation (PBM) were studied on human sperm cells post cryopreservation. Donated semen samples were collected from 22 married men with normal sperm parameters according to World Health Organization (WHO) criteria. Included samples were divided into control and PBM-preconditioning (one session, 810 nm, diode laser, and 0.6 J/cm2) groups before cryopreservation procedure. Progressive sperm motility (PSM), morphology, viability, sperm mitochondrial membrane potential(MMP), intracellular reactive oxygen species (ROS) and lipid peroxidation of sperm cells were assessed post thawing. PBM preconditioning of cryopreserved semen samples most prominently increased the PSM percentage 30 min post thawing (p = 0.000).Application of PBM before cryopreservation significantly increased the number of viable spermatozoa (p = 0.000), increased significantly the number of spermatozoa with high MMP (p = 0.004) and decreased significantly the number of spermatozoa with low MMP post-thawing(P = 0. 007)compared to control group. Cryopreserved human sperm cells with PBM preconditioning showed significant decrease in the levels of intracellular ROS (47.66 ± 2.14 versus 60.42 ± 3.16, p = 0.002) and lipid peroxidation (3.06 ± 0.13 versus 3.68 ± 0.27, p = 0.05)compared to control group.
 
Our findings, as the first evidence, indicated that PBM-preconditioning of human semen before cryopreservation provides a real and substantial advantage. This might lead to a novel strategy in improving PBM application in the procedures of assisted reproductive technologies.
 
Keywords: SpermSemen analysisPhotobiomodulationCryopreservation procedureSperm motilitySperm viabilityMitochondrial membrane potentialIntracellular reactive oxygen speciesLipid peroxidation
 
 

Expression of T helper 1-associated lncRNAs in breast cancer

Abstract

Interferon gamma (IFN-gamma)-associated genes participate in the pathobiology of cancer and response of patients to immunotherapeutic modalities. This cytokine is regarded as a hallmark of T helper 1 type responses. In the current study, we estimated expression of this gene and a number of genes/ long non-coding RNAs (IFNG.AS001 and IFNG.AS003, AC007278.2 and AC007278.3 and IL18R1) which are encoded from proximal genomic regions to IFNG in a larger cohort of Iranian patients with breast cancer. Both IFNG.AS001 and IFNG.AS003 were up-regulated in breast cancer tissues compared with nearby non-cancerous tissues (Ratios of Mean Expressions = 5.62 and 5.88, P values = 1.28E-03 and 1.47E-03, respectively). Finally, IL18R1 was over-expressed in breast cancer tissues compared with nearby non-cancerous tissues (Ratio of Mean Expressions = 9.43, P values = 3.14E-03). Expression of AC007278.3 was associated with breast feeding duration (P value = 2.65E-02). Positive significant correlations were detected between expression levels of all genes in both sets of samples. The most robust correlation in the nearby non-cancerous tissues was detected between IFNG-AS003 and AC007278.2 (r = 088, P value = 5.19E-23). In the tumoral tissues, the strongest correlation was found between IFNG-AS001 and IL18R1 (r = 0.86, P value = 3.79E-15). AC007278.3 had the best diagnostic power among the assessed genes (AUC = 0.82). Both AC007278.2 and AC007278.3 were reported to be specific markers for differentiation of tumor tissues from nearby non-cancerous tissues. Combination of expression levels of genes increased specificity, sensitivity and AUC values to 0.97, 0.89 and 0.95, respectively. The current study accentuates the role of IFNG-associated genes in the pathogenesis of breast cancer.

Keywords: IFNGIFNG.AS001IFNG.AS003AC007278.2AC007278.3IL18R1Breast cancer
 
 

Penile Rehabilitation Strategy after Nerve Sparing Radical Prostatectomy: A Systematic Review and Network Meta-Analysis of Randomized Trials

 

Abstract

Purpose: Despite the advances in nerve sparing and minimally invasive radical prostatectomy, erectile dysfunction remains an important adverse event after radical prostatectomy. Penile rehabilitation strategies have been developed to expedite and improve erectile function recovery. However, the differential efficacy and the best penile rehabilitation strategy are unclear as yet. We conducted a systematic review and network meta-analysis to investigate and compare the efficacy of different penile rehabilitation strategies.
 
Materials and methods: A systematic search was performed in May 2020 using PubMed® and Web of Science™ databases according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) extension statement for network meta-analysis. Studies that compared the erectile function recovery rate and adverse events between penile rehabilitation treatment groups (eg medications, devices and actions) and control group were included. We used the Bayesian approach in the network meta-analysis.
 
Results: A total of 22 studies (2,711 patients) met our eligibility criteria. Out of 16 different penile rehabilitation strategies and schedules vs placebo, only pelvic floor muscle training (OR 5.21, 95% CrI 1.24-29.8) and 100 mg sildenafil regular doses, ie once daily or nightly (OR 4.00, 95% CrI 1.40-13.4) were associated with a significantly higher likelihood of erectile function recovery. The certainty of results for 100 mg sildenafil regular dose was moderate, while pelvic floor muscle training had low certainty. The sensitivity analysis confirmed that the regular high dose of phosphodiesterase-5 inhibitors regardless of type vs placebo (OR 2.09, 95% CrI 1.06-4.17) was associated with a significantly higher likelihood of erectile function recovery with a moderate certainty. The on-demand doses of phosphodiesterase-5 inhibitors were not proven to be more beneficial than placebo. Secondary outcomes such as adverse events were not analyzed due to incomplete data in the literature. However, no serious adverse events were reported in any of the studies.
 
Conclusions: Sildenafil 100 mg regular dose is the best penile rehabilitation strategy to improve erectile function recovery rates after radical prostatectomy. Although pelvic floor muscle training has been shown to be effective in increasing the erectile function recovery rate, well designed randomized controlled trials with larger sample sizes are needed to confirm the presented early results. The on-demand dose of phosphodiesterase-5 inhibitors should not be considered as a penile rehabilitation strategy.
 

 

Keywords: erectile dysfunction; penis; prostatectomy; prostatic neoplasms; urogenital surgical procedures.
 
 

The effects of vitamin E on colistin-induced nephrotoxicity in treatment of drug-resistant gram-negative bacterial infections: A randomized clinical trial

Abstract

Introduction: Nephrotoxicity remains a major long-standing concern for colistin, and it is critical to find agents that can prevent it. The present study aims to investigate the effect of vitamin E on the prevention of colistin-induced nephrotoxicity based on its antioxidant and free radical scavenging properties.
 
Methods: A randomized clinical trial was designed for 52 patients taking colistin. These patients were categorized into two groups of equal size, receiving colistin or colistin plus vitamin E (α-Tocopherol). Vitamin E with doses of 400 units was administrated daily either orally or by a nasogastric tube if needed. The incidence of Acute Kidney Injury (AKI) and its duration was recorded based on RIFLE criteria.
 
Results: The Incidence of AKI based on RIFLE criteria was 42.3% and 46.2% in intervention and control groups, respectively. The analysis showed no significant difference in the prevalence of AKI for the two groups (P = 0.78). There was no significant difference in the duration of AKI neither (P = 0.83).
 
Conclusion: Although vitamin E is a powerful biological antioxidant, the effects of Vitamin E prophylaxis on colistin-induced nephrotoxicity was not taken into consideration in this study.
 
Keywords: Acute kidney injury; Colistin; Nephrotoxicity; Prophylaxis; Vitamin E.
 
 

Impact of systemic Immune–inflammation Index on oncologic outcomes in patients treated with radical prostatectomy for clinically nonmetastatic prostate cancer

Abstract

Purpose
To evaluate the predictive and prognostic value of the Systemic Immune–inflammation Index (SII) in a large cohort of patients treated with radical prostatectomy (RP) for clinically non–metastatic prostate cancer (PCa).
 
Methods
We retrospectively analyzed our multicenter database comprising 6,039 consecutive patients. The optimal preoperative SII cut–off value was assessed with the Youden index calculated on a time–dependent receiver operating characteristic (ROC) curve. Logistic regression and Cox regression analyses were used to investigate the association of SII with pathologic features and biochemical recurrence (BCR), respectively. The discriminatory ability of the models was evaluated by calculating the concordance-indices (C-Index). The clinical benefit of the implementation of SII in clinical decision making was assessed using decision curve analysis (DCA).
 
Results
Patients with high preoperative SII (≥ 620) were more likely to have adverse clinicopathologic features. On multivariable logistic regression analysis, high preoperative SII was independently associated with extracapsular extension (odds ratio [OR] 1.16, P?=?0.041), non–organ confined disease (OR 1.18, P?=?0.022), and upgrading at RP (OR 1.23, P < 0.001). We built two Cox regression models including preoperative and postoperative variables. In the preoperative multivariable model, high preoperative SII was associated with BCR (hazard ratio [HR] 1.34, 95% CI 1.15-1.55, P < 0.001). In the postoperative multivariable model, SII was not associated with BCR (P?=?0.078). The addition of SII to established models did not improve their discriminatory ability nor did it increase the clinical net benefit on DCA.
 
Conclusion
In men treated with RP for clinically nonmetastatic PCa, high preoperative SII was statistically associated with an increased risk of adverse pathologic features at RP as well as BCR. However, it did not improve the predictive accuracy and clinical value beyond that obtained by current predictive and prognostic models. SII together with a panel of complementary biomarkers is praised to help guide decision–making in clinically nonmetastatic PCa.
 
Keywords: SIIRadical prostatectomyProstate cancerBCRBiomarkers
 
 

Sexual Function Before and After Mid-Urethral Sling Procedure for Stress Urinary Incontinence

Abstract

Purpose
We aimed to assess the effect of TOT procedure on sexual function and quality of life in sexually active patients.
 
Materials and Methods
Forty-one patients with SUI aged 18–70 years participated in this study during 2015–2019. Sexual function was evaluated by Female Sexual Function Index (FSFI), Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory Questionnaire (UDI-6) prior to TOT surgery and six months after surgery.
 
Results
The mean IIQ-7 and UDI-6 scores were significant lower after surgery (P < 0.001). The mean FSFI score was 22.69 ± 5.48 prior to surgery and 29.79 ± 4.12 in the sixth month after surgery (P < 0.001). We found significant changes in all FSFI domains except for pain. Two patients complained of new dyspareunia after surgery. There was also a direct significant correlation between education and sexual function improvement in terms of desire (P = 0.031).
 
Conclusion

 

TOT can significantly enhance sexual function with low rate of complications in patients with SUI.
 
Keywords: Mid-urethral sling, Sexual function, Stress urinary incontinence, Trans-obturator tape, Urinary incontinence
 

Long Intergenic Non-Protein Coding RNA 460: Review of its Role in Carcinogenesis

Abstract

Abstract
Long intergenic non-coding RNAs (lincRNAs) establish a group of long non-coding RNAs (lncRNAs) that have no overlap with protein-coding genes. These transcripts have been found to affect chromatin configurations, arrange high-order nuclear structures, function as scaffolds for proteins and RNAs and serve as molecular decoys. LINC00460 is a member of this group of lincRNAs that participate in the pathoetiology of cancers. This lincRNA has been found to serve as a sponge for a number of tumor suppressor miRNAs, including miR-539, miR-1224-5p, miR-612, miR-342-3p, miR-485-5p and miR-149-5p, and increase expression of oncogenic targets of these miRNAs. Moreover, through targeting miRNAs that regulate sensitivity to chemotherapeutic agents, it can affect response of cancer cells to these agents. In the current manuscript, we tended to describe the role of LINC00460 in this process through summarizing the results of in vitro, in vivo and human studies.
 
Keywords: Long Intergenic Non-Protein Coding RNA 460long non-coding RNAcancer
 
 

Comparing the effect of sitagliptin and metformin on the oocyte and embryo quality in classic PCOS patients undergoing ICSI

Abstract

Keywords: GnRH antagonist; ICSI; Metformin; PCOS; Sitagliptin.

 

Background: To investigate the predictive and prognostic value of the preoperative modified Glasgow Prognostic Score (mGPS) in patients with urothelial carcinoma of the bladder (UCB) treated with radical cystectomy (RC).

Methods: We conducted a retrospective analysis of an established multicenter database consisting of 4,335 patients who were treated with RC +/- adjuvant chemotherapy for UCB between 1979 and 2012. The mGPS of each patient was calculated on the basis of preoperative serum C-reactive protein and albumin. Uni- and multivariable logistic and Cox regression analyses were performed. The discriminatory ability of the models was assessed by calculating the area under receiver operating characteristics curves (AUC) and concordance-indices (C-Index). The additional clinical net-benefit was assessed using the decision curve analysis (DCA).

Results: A mGPS of 0, 1, and 2 was observed in 3,158 (72.8%), 1,020 (23.5%), and 157 (3.6%) patients, respectively. On multivariable logistic regression analyses, mGPS of 1 or 2 were associated with an increased risk of pT3/4 disease at RC (OR 1.25, p=0.004 and OR 2.58, p<0.001, respectively) and/or lymph node metastasis (OR 1.7, p<0.001 and OR 3.9, p<0.001, respectively). Addition of the mGPS to a predictive model based on preoperatively available variables improved its accuracy for prediction of lymph node metastasis (change of AUC +3.7%, p<0.001). On multivariable Cox regression analyses, mGPS of 1 or 2 remained associated with worse recurrence-free survival (HR 1.14, p=0.03 and HR 1.89 p<0.001, respectively), cancer-specific survival (HR 1.16, p=0.032 and HR 2.1, p<0.001, respectively) and overall survival (HR 1.5, p=0.007 and HR 1.92 p<0.001, respectively) compared to mGPS of 0. The additional discriminatory ability of the mGPS for prognosis of survival outcomes in separate models that included either established pre- or postoperative variables did not improve the C-Index by a prognostically relevant degree (change of C-Index <2% for all models). On DCA, the inclusion of the mGPS did not meaningfully improve the net-benefit for clinical decision-making regarding survival outcomes.

Conclusions: We confirmed that an elevated mGPS is an independent risk factor for non-organ confined disease and poor survival outcomes in patients with UCB undergoing RC. However, the mGPS showed little value in improving the discriminatory ability of predictive and prognostic models that relied on either pre- or postoperative clinicopathological variables. The discriminatory ability of this biomarker in the age of immunotherapy warrants further evaluation.

DOI: 10.23736/S2724-6051.21.04216-6


Effect of Ceratonia siliqua L. extract on DNA Fragmentation of Sperm in Adult Male Mice Treated with Cyclophosphamide

Abstract

Keywords: Ceratonia siliqua L.; Cyclophosphamide; DNA fragmentation; Sperm.

A survey on infertility in men and its relation to risk factors in selected provinces of Iran

Abstract

Objective: Infertility in men cause significant morbidity and mortality, unfortunately there is not enough information about it due to the lack of a registry in the country. The purpose of this study was to determine the frequency of infertility in men and its association with risk factors.
Methods: This cross-sectional study used data from a nation-wide project on reproductive morbidities among males in Iran in 2007. 2,293 men aged 25-60 years were selected from four provinces across the country including, Golestan Province in the North, Hormozgan Province in the South, Kermanshah Province in the West, and Isfahan Province by cluster sampling scheme. Then, we determined the frequency of infertility in married men, and related risk factors such as smoking, infection, trauma, etc.
Results: Of the 2,293 men interviewed, 2,076 were married, 78 were infertile; current primary and secondary infertility was estimated at 3.75%. The incidence of infertility in urban areas was significantly higher than in rural areas (p value<0.003), and finally the clinically male infertility was estimated at 2%.
Conclusions: We need to explain that this project was a cross-sectional study. Therefore, it is recommended that more studies be conducted for accurate estimates of infertility in Iranian men.

 

Keywords: infertility; morbidity; risk factors; survey.
DOI: 10.5935/1518-0557.20210025
 

Androgen receptor axis-targeted agents for non-metastatic castration-resistant prostate cancer impact on overall survival and safety profile: an updated systematic review and meta-analysis

Abstract

Introduction: The management of non-metastatic castration-resistant prostate cancer (nmCRPC) has undergone a paradigm shift with the development of androgen receptor axis-targeted (ARAT) agents. The updated results with final overall survival (OS) data of the phase III PROSPER, SPARTAN, and ARAMIS trials have recently been reported. Therefore, we performed an updated meta-analysis and network meta-analysis to indirectly compare the efficacy and safety of currently available treatments.
Evidence acquisition: Multiple databases were searched for articles published before January 2021. Studies that compared OS and adverse events (AEs) in patients with nmCRPC were considered eligible.
Evidence synthesis: Three studies (n=4,117) met our eligibility criteria. Formal network meta-analyses were conducted. ARAT agent is associated with significantly longer OS compared to placebo (pooled hazard ratio (HR): 0.74, 95% confidence interval (CI): 0.65-0.83, P<0.001), with similar results shown for patients with both N1 and N0 disease (pooled HR 0.61 and pooled HR 0.76, respectively). In the network meta-analysis, apalutamide, darolutamide, and enzalutamide were more effective than placebo, with similar efficacies in terms of OS. For AEs (including any AEs, grade 3 or grade 4 AEs, grade 5 AEs, serious AEs, and AEs leading to treatment discontinuation), darolutamide was shown to be likely well tolerated. Quality-of-life was preserved in treatment arms irrespective of the drug.

 

Conclusions: All three ARAT agents are efficacious options for the treatment of nmCRPC, whereas darolutamide appears to have the most favorable tolerability profile. These findings may facilitate individualized treatment strategies and inform future direct comparative trials.
 
DOI: 10.23736/S2724-6051.21.04431-1
 

Comparison of the Effect of Ceratonia siliqua L. (Carob) Syrup and Vitamin E on Sperm Parameters, Oxidative Stress Index, and Sex Hormones in Infertile Men: a Randomized Controlled Trial

Herbal products with an antioxidant capacity can boost male reproductive functions. The empiric use of Ceratonia siliqua (carob) for its antioxidant properties is common among infertile men in Iran and Turkey. The objective of this study is to investigate the effects of C. siliqua (carob) on semen parameters, oxidative stress markers, and pregnancy rate in a parallel randomized, controlled study. A total of 60 infertile men with oligozoospermia, asthenospermia, and teratospermia were recruited from April 2018 to March 2019. Participants were divided randomly into the following two groups: carob syrup twice a day or vitamin E 100 mg twice a day for 3 months. Semen analysis was performed and hormonal levels and stress oxidative markers were measured in each treatment arm after 3 months. The quality of semen parameters improved in the carob group compared with Vit E semen count (p = 0.04 Cohen's d = .51), morphology (p = 0.001 Cohen's d = .93) and motility parameters (p = 0.002 Cohen's d = .90) were significantly higher in the carob group. No significant difference can be detected in post-treatment hormonal parameters and oxidative markers between groups, except for total antioxidant capacity(TAC) which was higher after post-treatment in carob group. A significantly higher pregnancy rate was found among the carob group. The administration of carob may be an effective agent for the improvement of semen parameters, probably related both to its involvement in the changing of testosterone level and to its antioxidant properties. Nevertheless, additional studies to evaluate the optimal dose and duration of treatment are needed. The trial has been registered in the Iranian Registry of Clinical Trials (Registration number: IRCT20171209037794N1.

 

Keywords: Ceratonia siliqua (carob); Male infertility; Oxidative stress; Pregnancy; Vitamin E.
 
DOI: 10.1007/s43032-020-00314-3
 

 

 

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آدرس (Affiliation) مرکز در مقالات فارسی :
 
مرکز تحقیقات سلامت مردان و بهداشت باروری ،
دانشگاه علوم پزشکی شهید بهشتی، تهران ، ایران
 
آدرس (Affiliation) مرکز در مقالات لاتین :
 
Men's Health and Reproductive Health
Research Center, Shahid Beheshti
University of Medical Sciences,
Tehran, Iran
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دانشگاه علوم پزشکی شهید بهشتی
 
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