Prognostic value of magnetic resonance spectroscopy in patients with diffuse axonal injury: a systematic literature review

Introduction: Magnetic resonance spectroscopy [MRS] is an imaging technique that provides spectroscopic information about changes in biological markers. Studies suggest that MRS can be helpful in determining the prognosis of patients with diffuse axonal injury [DAI]

Methods: The PubMed and Scopus databases were systematically searched in June 2015 using following search strategy: ["Magnetic resonance spectroscopy" OR MRS OR "MR spectroscopy"] AND [["Diffuse axonal injury" OR DAI] AND Prognosis] to find relevant articles in which the prognostic value of MRS had been investigated in patients with traumatic DAI. All relevant information was extracted from the identified articles and used to synthesize the data for the purpose of this study

Result: In total, 19 articles were found in PubMed and 151 in Scopus. Of these, eight documents were selected for further data extraction following the application of the inclusion/exclusion criteria. The total number of patients who participated in the research studies described in the selected documents was 197. All of the selected documents showed that MRS can be used to quantitatively assess metabolite changes in patients with DAI

Discussion: The results of the studies indicate that MRS imaging as a sensitive method can quantitatively determine even small variations in metabolites. Any changes in the metabolite level of the brain after traumatic injury may be a useful predictor of a patient's outcome; therefore, if the sensitivity of MRS is proven, this method can have prognostic value when employed with patients with DAI

Conclusion: Based on the results of this systematic review, MRS is a sensitive tool that is helpful in determining the prognosis of patients with DAI

[Molecular investigation of Y chromosome microdeletions in AZF regions of the non-obstructive azoospermic and oligospermic patients referred to Montaseriyeh infertility center in Mashhad]

Background and Aim: The Y-chromosome azoospermic factor [AZF] regions consist of genes whose specific roles and functions in spermatogenesis and fertility have not been completely clarified. Hence, recognition of the association between AZF microdeletions and male infertility has suggestions for the diagnosis, treatment, and genetic counseling. The main objective of the present study was investigation of Y chromosome microdeletions in the non-obstructive azoospermic and oligospermic patients in Mashhad and identification of appropriate STS markers associated with azoospermia and oligospermia

Materials and Methods: This descriptive-analytical study was performed on 45 infertile men with azoospermia and oligospermia with normal karyotypes referred to infertility center of Montaseriyeh hospital in Mashhad. Molecular screening technique was performed by using Multiplex PCR and sequence-tagged sites [STS] primers according to the EAA/EMQN guideline for detection of microdeletions in Y-chromosomal AZF regions and the Y specific sequences

Results: Three out of 45 infertile men had deletions in the AZFc and AZFa regions. Among every 3 infertile men, two patients [7.7%] and one patient [5%] had microdeletion in the AZFc region and in the AZFa, respectively. The results indicated that AZF microdeletions had a significant effect on azoospermia and oligospermia in infertile men

Conclusion: Y-chromosome microdeletion analysis can be recommended as an important molecular test for infertile males to obtain reliable genetic information before the administration of assisted-reproductive techniques. It will help to decrease the cost and technical difficulty of the procedure

Fasting and urinary stones

Fasting is considered as one of the most important practices of Islam, and according to Prophet Mohammad, fasting is obligatory upon Muslims. The aim of this study is to evaluate the effects of fasting on urinary stones. Very few studies have been carried out on urinary stones and the effect of Ramadan fasting. The sources of the present study are Medline and articles presented by local and Muslim researchers. Meanwhile, since we are acquainted with three well-known researchers in the field of urology, we contacted them via email and asked for their professional opinions. The results of studies about the relationship of urinary stones and their incidence in Ramadan are not alike, and are even sometimes contradictory. Some believe that increased incidence of urinary stones in Ramadan is related not to fasting, but to the rise of weather temperature in hot months, and an increase in humidity. Numerous biological and behavioral changes occur in people who fast in Ramadan and some researchers believe that urinary stone increases during this month

Assessment of angiogenic factor, vascular endothelial growth factor, serum and urine level changes in superficial bladder tumor immunotherapy by intravesical Bacillus Calmette-Guerin

Bladder tumor is one of the most common genitourinary tumors. Management of non-muscle invasive [NMI] bladder tumors is primarily by transurethral resection [TURBT] followed by intravesical immunotherapy or chemotherapy. Bacillus Calmette-Guerin [BCG] is the most effective adjuvant therapy in NMI bladder tumor. Since angiogenesis is an essential factor in solid tumor progression and vascular endothelial growth factor [VEGF] is an important factor in angiogenesis, the aim of this study is the assessment of angiogenic factor, VEGF, serum and urine level changes in superficial bladder tumor immunotherapy by intravesical BCG. A total of 23 patients with bladder transitional cell carcinoma [TCC] in stage Ta/T1 or carcinoma insitu [CIS], low or high grade, which passed a 2-4 week period from TURBT participated in this study. Blood and urine samples were obtained at first and sixth sessions before instillation of BCG. Enzyme-linked immunosorbent assay [ELISA] method was used to obtain VEGF level in samples. Urine and serum VEGF levels did not change significantly before and after BCG therapy. Changes in VEGF level were significantly different neither in low grade against high grade tumors nor in stage T1 against stage Ta tumors. A significant difference in VEGF level was seen between low grade and high grade tumors in serum after BCG therapy [P=0.007]; but not in urine samples. Although intravesical BCG possesses anti-angiogenic activity, it seems that it exerts its effect through pathways other than VEGF, especially in low grade tumors

Comparison of open and laparoscopic varicocelectomies in terms of operative time, sperm parameters, and complications

Varicocele is one of the most common causes of infertility. In this study, we evaluated and compared the operative time, sperm analysis results, and complications of three different methods of open and laparoscopic varicocelectomies. From among all bilateral varicocelectomies in our center, we randomly selected 30 of each following cases: laparoscopic varicocelectomy, open subinguinal varicocelectomy under general anesthesia, and open subinguinal varicocelectomy under local anesthesia. We compared the operative time, sperm analysis results, and complications between these three groups. The mean operative times were 30.0 +/- 5.5 minutes for laparoscopies, 27.0 +/- 3.5 minutes for open varicocelectomies under general anesthesia, and 38.0 +/- 1.8 minutes for open varicocelectomies under local anesthesia [P = .02]. Intra-operative complications occurred only in the laparoscopic group, and postoperative complications were seen in 23.3%, 20.0%, and 4.2% of the patients with laparoscopy, open surgery under general anesthesia, and open surgery under local anesthesia, respectively. Semen analysis did not show any significant changes after varicocelectomy except for a slight improvement of sperm morphology in patients who underwent open varicocelectomy under local anesthesia. Subinguinal varicocelectomy under local anesthesia is better than laparoscopic method in terms of recurrence, hydrocele formation, and operative time. Subinguinal method under general anesthesia has intermediate efficacy regarding less complications than laparoscopic method and shorter operative time than the two other methods

Kidney transplantation in older adults: does age affect graft survival?

There is a paucity of data on long-term patient and graft survival in the older kidney recipients. Our aim was to evaluate the long-term outcomes of kidney transplantation in patients aged 50 years and older and compare them with outcomes in younger recipients. Forty-seven recipients aged 50 years and older and 47 recipients aged younger than 50 years were randomly assigned to two groups [groups 1 and 2, respectively]. Patients who had received a cadaveric kidney allograft were excluded from the study. Data including demographic and clinical characteristics, early complications, early mortality, and actuarial patient and graft survival rates were collected, and the two groups were compared, accordingly. The rates of early complications and mortality were not different between the two groups. Patient survival rates at 1, 3, 5, and 7 years were 72%, 58%, 41%, and 41% for patients in group 1 and 95%, 86%, 86%, and 86% for patients in group 2, respectively [P=0.007]. Graft survival rates were 72%, 58%, 41%, and 41% for patients in group 1 and 95%, 85%, 85%, and 85% for patients in group 2, respectively [P=0.006]. Graft loss due to patient death was 33.33% in group 1 compared with 4.25% in group 2 [P<0.001]. Kidney transplantation should be considered in patients older than 50 years, since the graft survival rate is acceptable in this population, and early mortality and complications in this group are not different than those of younger recipients. Although older patients have a shorter life expectancy, they benefit from renal transplantation in ways similar to younger kidney transplant recipients

Huge primary intrascrotal Schwannoma: a case report and review of the Literature

Testicular schwannoma is a very rare benign scrotal tumor. It is a painless mass, but sometimes referred because of pain or sensory losses. Tumor markers are normal and radical orchidectomy is its best treatment. Here we present an unusual case of intrascrotal schwannoma in a 57 year old man, with a review of the literature

Review of 427 cases of varicocele at Ferdowsi University, Mashad, Iran

427 patients with varicocele aged 14 > 35 years were operated on over a 10 year period [1977 - 1986], 190 [44.5%] were referred for infertility and 365 had left-sided varicoceles [85.5%]. No relationship was found between infertility and the grade of varicocele. Clinical features of prostatitis were often present. Semen analyses were performed in 37% of patients and showed abnormalities in motility, morphology and density; hormone analyses [26 patients] showed elevated FSH, normal LH and decreased testosterone levels. Complications of high ligation were recurrence of varicocele in 10% and oedema of the scrotum in 12%. In the 32 patients presenting with infertility who were followed up there was an improvement in sperm density in 81% and a pregnancy rate of 37.8%