Sperm retrieval and intracytoplasmic sperm injection outcomes in men with cystic fibrosis disease versus congenital bilateral absence of the vas deferens / 亚洲男科学杂志(英文版)

Recent data suggest that cystic fibrosis transmembrane conductance regulator (CFTR) gene alterations negatively impact male fertility beyond obstruction. We sought to compare gene alterations, sperm retrieval rates, and intracytoplasmic sperm injection (ICSI) outcomes among men with cystic fibrosis (CF) disease and congenital bilateral absence of the vas deferens (CBAVD) only. We retrospectively evaluated all men who underwent surgical sperm retrieval at two academic, high-volume andrology centers from 2010 to 2018. Only men with documented CFTR alterations and obstructive azoospermia from either CBAVD or CF were included. Differences between groups for CFTR abnormality, sperm retrieval, and ICSI outcomes were statistically analyzed. Overall, 39 patients were included with 10 in the CF and 29 in the CBAVD groups. Surgical sperm retrieval rates were significantly lower in the CF group for sperm concentration (14.8 × 10

Round spermatid injection into human oocytes: a systematic review and meta-analysis / 亚洲男科学杂志(英文版)

Many azoospermic men do not possess mature spermatozoa at the time of surgical sperm extraction. This study is a systematic review and meta-analysis evaluating outcomes following round spermatid injection (ROSI), a technique which utilizes immature precursors of spermatozoa for fertilization. An electronic search was performed to identify relevant articles published through October 2018. Human cohort studies in English involving male patients who had round spermatids identified and used for fertilization with human oocytes were included. Fertilization rate, pregnancy rate, and resultant delivery rate were assessed following ROSI. Meta-analysis outcomes were analyzed using a random-effects model. Data were extracted from 22 studies involving 1099 couples and 4218 embryo transfers. The fertilization rate after ROSI was 38.7% (95% confidence interval [CI]: 31.5%-46.3%), while the pregnancy rate was 3.7% (95% CI: 3.2%-4.4%). The resultant delivery rate was low, with 4.3% of embryo transfers resulting in a delivery (95% CI: 2.3%-7.7%). The pregnancy rate per couple was 13.4% (95% CI: 6.8%-19.1%) and the resultant delivery rate per couple was 8.1% (95% CI: 6.1%-14.4%). ROSI has resulted in clinical pregnancies and live births, but success rates are considerably lower than those achieved with mature spermatozoa. While this technique may be a feasible alternative for men with azoospermia who decline other options, couples should be aware that the odds of a successful delivery are greatly diminished and the prognosis is relatively poor.

Resident involvement in the prostatic urethral lift: implementing innovative technology in an academic setting / 亚洲男科学杂志(英文版)

Adoption of the prostatic urethral lift (PUL) as a treatment for benign prostatic hyperplasia highlights the importance of training residents with novel technology without compromising patient care. This study examines the effect of resident involvement during PUL on patient and procedural outcomes. Retrospective chart review was conducted on all consecutive PUL cases performed by a single academic urologist between October 2017 and November 2019. Trainees in post-graduate year (PGY) 1-3 are considered junior residents, while those in PGY 4-6 are senior residents. The International Prostate Symptom Score (IPSS) and quality of life (QOL) scores were used to measure outcomes. Simple and mixed-effects linear regression models were used to compare differences. There were 110 patients with a median age of 66.4 years. Residents were involved in 73 cases (66.4%), and senior residents were involved in 31 of those cases. Resident involvement was not associated with adverse perioperative outcomes with respect to the number of implants fired, the percentage of implants successfully placed, or the postoperative catheterization rate. After adjustment for confounding factors, junior residents were associated with significantly longer case length compared to the attending alone (+12.6 min, P = 0.003) but senior residents were not (+2.4 min, P = 0.59). IPSS and QOL scores were not significantly affected by resident involvement (P = 0.12 and P = 0.21, respectively). The presence of surgeons-in-training, particularly those in the early stages, prolongs PUL case length but does not appear to have an adverse impact on patient outcomes.

Aggregatibacter actinomycetemcomitansarcB influences hydrophobic properties, biofilm formation and adhesion to hydroxyapatite / arcB em Aggregatibacter actinomycetmcomitans influencia propriedades hidrofóbicas, formação de biofilme e aderência a hidroxiapatita

The regulation of gene expression in the oral pathogen Aggregatibacter actinomycetemcomitans is still not fully elucidated. ArcAB is a two-component system which allows facultative anaerobic bacteria to sense various respiratory growth conditions and adapt their gene expression accordingly. This study investigated in A. actinomycetemcomitans the role of arcB on the regulation of biofilm formation, adhesion to saliva coated hydroxyapatite (SHA) and the hydrophobic properties of the cell. These phenotypic traits were determined for an A. actinomycetemcomitansarcB deficient type and a wild type strain. Differences in hydrophobic properties were shown at early and late exponential growth phases under microaerobic incubation and at late exponential phase under anaerobiosis. The arcB mutant formed less biofilm than the wild type strain when grown under anaerobic incubation, but displayed higher biofilm formation activity under microaerobic conditions. The adherence to SHA was significantly lower in the mutant when compared with the wild type strain. These results suggest that the transmembrane sensor kinase arcB, in A. actinomycetemcomitans, senses redox growth conditions and regulates the expression of surface components of the bacterial cell related to biofilm formation and adhesion to saliva coated surfaces.

A regulação da expressão gênica do patógeno oral Aggregatibacter actinomycetemcomitans não está completamente descrita. O sistema de dois componentes ArcAB permite que bactérias anaeróbias facultativas percebam diferenças nas condições respiratórias durante sua multiplicação e adaptem a expressão de genes à estas condições. Este estudo investigou em A. actinomycetemcomitans o papel de arcB na regulação da formação de biofilme, aderência à hidroxiapatita recoberta por saliva (SHA) e nas propriedades hidrofóbicas celulares. Estas características fenotípicas foram determinadas para uma linhagem de A. actinomycetemcomitans deficiente em arcB e para uma linhagem selvagem. Foram observadas diferenças nas propriedades hidrofóbicas entre as linhagens quando estas foram cultivadas em ambiente microaerófilo até início e final de fase exponencial e quando foram cultivadas em ambiente anaeróbio até final de fase exponencial. A linhagem arcB mutante formou menos biofilme do que a linhagem selvagem quando estas foram cultivadas sob incubação anaeróbica, porém, apresentou maior formação de biofilme quando a incubação foi realizada em condições de microaerofilia. A aderência à SHA apresentada pela linhagem mutante foi significantemente menor do que a observada pela linhagem selvagem. Estes estudos sugerem que a quinase sensora arcB, em A. actinomycetemcomitans, percebe as condições redox de multiplicação e regula a expressão de componentes de superfície bacterianos relacionados à formação de biofilme e adesão a superfícies recobertas com saliva.

A pilot clinical study of continuous intravenous ascorbate in terminal cancer patients

Case studies suggest that vitamin C, given intravenously at doses of 10-100 grams/day can improve patient well being and in some cases, reduce tumor size. While ascorbate is generally considered safe, clinical data on high intravenous doses is limited. Twenty-four late stage terminal cancer patients were given continuous infusions of 150 to 710 mg/kg/day for up to eight weeks. Blood chemistry and blood count profiles were obtained at roughly one-week intervals while patient health, adverse events and tumor progression were monitored. The majority of patients were vitamin C deficient prior to treatment. Intravenous infusions increased plasma ascorbate concentrations to a mean of 1.1 mM. The most common adverse events reported were nausea, edema, and dry mouth or skin; and these were generally minor. Two Grade 3 adverse events 'possibly related' to the agent were reported: one patient with a history of renal calculi developed a kidney stone after thirteen days of treatment and another patient experienced hypokalemia after six weeks of treatment. White blood cell counts were stable while hemoglobin and hematocrit levels dropped slightly during treatment, consistent with trends observed prior to therapy. Blood creatinine, BUN, glucose, and uric acid concentrations decreased or remained stable during therapy, suggesting that ascorbate infusions did not adversely affect renal function. One patient had stable disease and continued the treatment for forty-eight weeks. These data suggest that intravenous vitamin C therapy for cancer is relatively safe, provided the patient does not have a history of kidney stone formation.

Intravenous ascorbic acid: protocol for its application and use

High dose intravenous(i.v.) ascorbic acid (AA) has been used as therapy for infectious disease from bacterial and viral origin and adjuvant therapy for cancer. In this publication we describe a clinical protocol that has been developed over the past twenty years utilizing high dose i.v. AA as therapy for cancer. This includes principles of treatment, rationale, baseline workup, infusion protocol, precautions and side effects.

Clinical diagnosis of malaria : can we improve?

Most cases of malaria in Zimbabwe are diagnosed on the basis of clinical suspicion; without laboratory tests. Of patience treated; between 10 and 30 have malaria parasites on blood slide examination. Can diagnosis be improved by a systematic history? We examined this question in 287 patients treated for malaria in an area of year-round transmission in Zimbabwe. The most common complaints were 'headache' (85.7); 'bodily weakness' (79.0) and 'fever/feeling hot' (73.2). Eighty patients (28) had malaria parasites on blood smear. Using the blood slide as the standard; we calculated the sensitivity; specificity and positive predictive value of a variety of clinical symptoms and signs. None had a positive predictive value substantially higher than the unknown diagnostic criteria used by health workers (28). Multi-variate analysis showed that 15 different demographic and clinical variables did not significantly predict a positive blood slide result. We conclude that; in this setting; clinical history alone will not improve the diagnosis of malaria

Relationship between bladder cancer incidence; schistosoma haematobium infection; and geographical region in Zimbabwe

Bladder cancer is common in Zimbabwe; possibly due to the high prevalence of Schistosoma haematobium infection in some areas. We undertook a correlational study based on retrospective medical record review to see whether the number of bladder cancers could be related to geographical region and prevalence of S. haematobium infection. We also determined patient demographic characteristics and tumour histology. Of 483 patients indentified (1984-1987); 69 with available histology had squamous cell carcinomas. The remainder had transitional cell carcinomas. Patients with squamous cell carcinoma were younger than patients with transitional cell carcinomas (50 vs 20 under 50 years old; P less than 0.05) and had a sex ration of one. [abstract terminated]

Community based schistosomiasis control in Zimbabwe

The project was established to investigate the feasibility of a national schistosomiasis control programme in Zimbabwe based upon an intergrated approach. The project involved community self help sanitation and water programmes; health education; chemotherapy of school children with praziquantel; and focal mollusciciding. The project was carried out in two rural areas of Zimbabwe with a combined population of over 40;000 people. Madziwa (32;00 people) had all of the above interventions; and Bushu (8.000 people) had only the chemotherapy intervention. Infection with schistosomiasis was determined by the use of reagent strip examination for haematuria. This low cost method of diagnosis was found to be very appropriate and feasible for the examination of large numbers of children and the method was recommended for use in a national control programme. Pretreatment infection levels with schistosomiasis generally exceeded 60in both areas although there was considerable heterogenity in distribution