The effect of a six-week Aqua Pilates and Aqua Stretch intervention on pain, function, and quality of life in patients affected by ankylosing spondylitis: A rater-blind randomized controlled trial.

BACKGROUND: There has been a dearth of research into the benefits of water-based workouts for ankylosing spondylitis (AS) patients. OBJECTIVE: This study aimed to compare the effect of Aqua Stretch and Aqua Pilates in improving quality of life (QOL), function, and pain in AS patients. METHODS: This study was conducted on 40 patients, who were randomly assigned to the Aqua Pilates, Aqua Stretch, and control groups. The experimental groups attended interventions for six-week. QOL, pain intensity, function, and fatigue were measured before and after treatments. RESULTS: Except for the chest expanding, all variables in the Aqua Stretch group changed significantly after six weeks (p< 0.05). QOL (p= 0.002), 6MWT (p= 0.016), and Schober flexion (p= 0.011) showed changes, while BASDAI (p= 0.0001), VAS (p= 0.0001), fatigue (p= 0.0001), and Schober extension (p= 0.028) showed significant decreases. Except for chest expansion and Schober extension, which did not alter significantly after six-week of Aqua Pilates (p> 0.05), all other variables did. There was an increasing trend in 6MWT and Schober flexion (p= 0.021) and a decreasing trend in BASDAI (p= 0.002), VAS (p= 0.0001) and fatigue (p= 0.002). Except for QOL (p= 0.016), no statistically significant differences were found between the groups. CONCLUSION: All variables had a significant change after six-week Aqua Stretch, except for the chest expanding. Chest expanding and Schober extension were the variables which had no significant change after six-week Aqua Pilates. With the exception of QOL, no statistically significant differences were found between the groups. Aqua Stretch had the greatest effect on the VAS, as measured by the minimum clinically relevant differences (MCID). Moreover, in Aqua Stretch alone, there was a notable impact on fatigue, QOL, and the BASDAI.

The effect of Aqua Stretching exercises and Pilates on pain, function and spine posture in patients with ankylosing spondylitis: a randomized controlled trial.

BACKGROUND: Aqua Pilates and Aqua Stretch exercises are different and new methods for the rehabilitation of musculoskeletal disorders. This study aimed to compare the effectiveness of Aqua Stretch and Aqua Pilates interventions in the treatment of pain, function, and posture of the spine in ankylosing spondylitis (AS) patients. METHODS: Forty patients participated in this study who were randomly allocated into Aqua Stretch, aqua Pilates, and control. The experimental groups received four 60-min training sessions each week for six weeks. However, the control group had only its routine drug treatment (NSAIDs & Anti TNF). Pain with Visual Analog Scale (VAS), function with Bath Ankylosing Spondylitis Functional Index (BASFI) and 40-m walking test (MWT), quality of life with ankylosing spondylitis quality of life (ASQoL), and posture of the spine with the Spinal Mouse were evaluated. Evaluations were performed before and after the interventions. Repeated measure ANOVA was employed to determine the main and interaction effects. RESULTS: Aqua Stretch and Aqua Pilates had a significant effect on pain (Aqua-Pilates: P = 0.0001; Aqua-Stretch: P = 0.0001), BASFI (Aqua-Pilates: P = 0.01; Aqua-Stretch: P = 0.02), 40-MWT (Aqua-Pilates: P = 0.006; Aqua-Stretch: P = 0.0001) and ASQoL (Aqua-Pilates: P = 0.01; Aqua-Stretch: P = 0.001), spinal range of motion (ROM) (Aqua-Pilates: P = 0.0001; Aqua-Stretch: P = 0.0001) at a similar ratio. However, the control group did not present any improvement in these factors (P > 0.05). Moreover, the minimal clinically important difference (MCID) revealed that the Aqua Stretch group performed better than the Aqua Pilates group in terms of VAS, ASQOL, and 40-MWT factors. CONCLUSIONS: Aqua Stretch and Aqua Pilates had statistically the same effect on improving pain, function, quality of life, and spinal ROM, while MCID results revealed that the Aqua Stretch group performed better than the Aqua Pilates in terms of VAS-ASQOL-40-MWT. Trial registration It is notable that local ethics committee approval was obtained (IR.KUMS.REC.1399.1137), and the study was registered in Iranian Registry of Clinical Trials (IRCT; IRCT20190426043377N3; registered on 22/05/2021, https://fa.irct.ir/user/trial/56058/view ) and patient recruitments were started on 06/07/2021.

The association between dietary fat and mineral intake with semen parameters: A cross-sectional study in infertile men.

Background: Infertility has been a significant problem for couples in recent decades, and the issue can often lie with the male rather than the female. Objective: This study aimed to investigate the effects of fats and minerals intake on semen parameters in infertile men. Materials and Methods: This cross-sectional study was performed on 260 infertile men referred to Isfahan Infertility Clinic, Isfahan, Iran in the summer of 2018. Semen parameters regarding sperm concentration, total motility, normal morphology, and sperm volume were considered. To assess dietary intakes, a validated food frequency questionnaire was used. Results: In the adjusted model, the prevalence of abnormal concentration was 5.23 times higher in the top quartile of calcium intake, compared with the bottom quartile (p = 0.03). Also, the prevalence of abnormal morphology was 68% lower in the third quartile of calcium intake (p = 0.03). Additionally, the prevalence of abnormal concentration was 84% lower in the top quartile of folate intake in comparison to the bottom quartile (p = 0.01) and the prevalence of abnormal morphology was 70% lower in the top quartile of folate intake (p = 0.03). Additionally, the prevalence of abnormal concentration was 72% lower in the top quartile of selenium intake in comparison to the bottom quartile (p = 0.04). Furthermore, in the crude model, the prevalence of abnormal volume was 64% lower in the second quartile of linoleic acid intake rather than the first quartile (p = 0.01). Conclusion: In conclusion, diets containing higher amounts of folate and selenium, and lower amounts of cholesterol, saturated fatty acid and calcium were associated with more favorable semen quality parameters.

Synbiotic (FamiLact) administration in idiopathic male infertility enhances sperm quality, DNA integrity, and chromatin status: A triple-blinded randomized clinical trial.

BACKGROUND: Idiopathic male infertility is often treated empirically. A recent body of evidence has indicated the association between pro ± prebiotics administration and improvement in semen parameters. OBJECTIVE: To assess the effect of FamiLact (probiotic + prebiotic) administration on male subjects with idiopathic infertility. MATERIALS AND METHODS: Fifty-six men with idiopathic male infertility were randomly/equally divided into two groups. Men in the case and control groups received 500 mg of FamiLact and an identical placebo for 80 days, respectively. A semen sample was obtained from each of the participants before initiation and after the termination of the treatment course. Samples underwent regular semen analysis and were further analyzed to assess the level of DNA damage (sperm chromatin structure assay), oxidative stress (BODIPY C11 staining), and protamine deficiency (chromomycin-A3 staining) in spermatozoa. RESULTS: No significant difference was observed between the baseline values of both groups. After intervention, mean sperm concentration, motility, and normal morphology were significantly higher in the FamiLact group compared to the placebo group (p < 0.05). In the FamiLact receivers, we detected improvement regarding the following parameters: concentration, motility, abnormal morphology, sperm lipid peroxidation, and DNA fragmentation (p ≤ 0.02). Likewise, in the placebo group, we noticed a decrease in the post-medication mean value of DNA fragmentation (p = 0.03) while observing no significant difference regarding other parameters. CONCLUSION: FamiLact administration improves sperm concentration, motility, and abnormal morphology and decrease sperm DNA damage, possibly through alleviating oxidative stress in the seminal fluid.

Alpha-lipoic acid improves sperm motility in infertile men after varicocelectomy: a triple-blind randomized controlled trial.

RESEARCH QUESTION: Does supplementation with alpha-lipoic acid (ALA) enhance sperm parameters and/or the status of sperm lipid peroxidation and DNA fragmentation in men who have undergone microsurgical repair of a varicocele? DESIGN: Individuals with a varicocele who had undergone varicocelectomy were divided into two groups receiving either 600 mg of ALA or an identical placebo for 80 days. Semen samples obtained from the participants before surgery and after completion of the course of medication were analysed and compared. Participants, clinicians and data analysts were blinded to the randomization sequence. RESULTS: In the ALA group, total motility (P = 0.01) and progressive motility (P = 0.002) of the spermatozoa were significantly higher compared with the placebo group after surgery. Sperm lipid peroxidation and DNA damage (assessed by sperm chromatin structure assay) showed significant decreases in both the ALA and placebo groups (P ≤ 0.02) after treatment. CONCLUSIONS: An 80-day course of ALA medication after surgical repair improves total motility and progressive motility of the spermatozoa in individuals with a varicocele.

Associations of Major Dietary Patterns and Dietary Diversity Score with Semen Parameters: A Cross-Sectional Study in Iranian Infertile Men.

BACKGROUND: This cross-sectional study pointed to assess the relationship between major dietary patterns and dietary diversity score with semen parameters, in infertile Iranian males. MATERIALS AND METHODS: In this cross-sectional study, 260 infertile men (18-55 years old) who met the inclusion criteria, entered the study. Four Semen parameters, namely sperm concentration (SC), total sperm movement (TSM), normal sperm morphology (NSM) and sperm volume were considered according to spermogram. A 168-item food frequency questionnaire (FFQ) was used to collect dietary intakes and calculate dietary diversity score. Factor analysis was used to extract dietary patterns. RESULTS: The following four factors were extracted: "traditional pattern", "prudent pattern", "vegetable-based pattern" and "mixed pattern". After adjusting potential confounders, those in the highest quartile of the traditional pattern had 83% less odds for abnormal concentration, compared with the first quartile (OR=0.17, 95% CI: 0.04-00.73); however, subjects in the highest quartile of this pattern had 2.69 fold higher odds for abnormal sperm volume as compared with those of the first quartile (95%Cl: 1.06-6.82). Men in the second quartile of prudent pattern had 4.36 higher odds of an abnormal sperm volume in comparison to the reference category (95%CI: 1.75-10.86), after considering potential confounders. With regard to mixed pattern, men in the second, third and fourth quartile of this pattern had respectively 85 (5%Cl: 0.03-0.76,), 86 (95%Cl: 0.02-0.75) and 83 % (95%Cl: 0.034-0.9) less odds of abnormal concentration, compared with the first quartile. Additionally, no significant association was found between dietary diversity score and sperm quality parameters. CONCLUSION: Higher intake of the traditional diet was linked to lower abnormal semen concentration and poorer sperm volume. Also, the mixed diet was associated with reduced prevalence of abnormal semen concentration.

Reduced sperm telomere length in individuals with varicocele is associated with reduced genomic integrity.

Varicocele, defined as enlarged varicose veins in the scrotum, is the most common identifiable cause of male infertility. There are significant correlations between oxidative stress and varicocele-related infertility due to testicular hyperthermia, which can result in low sperm function. In addition, recent excessive oxidative stress can affect sperm telomere length and integrity of sperm DNA. Therefore, we assessed sperm telomere length as a potential marker of paternal genome integrity and leukocyte telomere length as an internal control (real-time PCR), along with sperm chromatin status (TUNEL and chromomycin A3 assay), and lipid peroxidation (Bodipy probe) in 18 infertile men with grade II or III varicocele, and 20 fertile men. Means of sperm parameters, sperm and leukocyte telomere length were significantly lower, while means of sperm DNA fragmentation, protamine deficiency, and lipid peroxidation were significantly higher in infertile men with varicocele compared to fertile men. Therefore, shortened telomere length in sperm and leukocytes is likely associated with increased oxidative stress related to the state of varicocele, which also accounts for increase in sperm DNA fragmentation. Thus, assessment of leukocyte telomere length could be taken as an indicator of antioxidant capacity in an individual, which also affects sperm function.

Hypoxia pathway has more impact than inflammation pathway on etiology of infertile men with varicocele.

This study aimed to compare main molecular markers of hypoxia (HIF1-α and P53) and inflammation (TLR-2, TLR-4 and TNF-α) pathways between infertile men with varicocele and fertile individuals. Sperm parameters such as sperm concentration, motility and morphology were assessed according to World Health Organization (Laboratory manual for the examination and processing of human semen. Geneva, Switzerland, 2010) guideline in 20 infertile men with grade II or III varicocele, and 20 fertile men candidate of family balancing. In addition, sperm DNA fragmentation and molecular markers involved in hypoxia and inflammation pathways were evaluated by terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) assay and real-time PCR respectively. Mean of sperm parameters (concentration, motility and morphology) and DNA integrity were significantly lower in infertile men with varicocele compared to fertile individuals. Unlike markers involved in inflammation pathway, mean expression of markers of hypoxia pathway (HIF1-α and P53) was significantly higher in infertile men with varicocele compared to fertile individuals (p < 0.05), and also a significant correlation was observed between expression of HIF1-α and P53 (r = 0.461; p = 0.003). Overall, the result of this study suggests higher likelihood of involvement of hypoxia pathway, in comparison with inflammation pathway, in pathogenesis varicocele associated with male infertility.

A Preliminary Study: N-acetyl-L-cysteine Improves Semen Quality following Varicocelectomy.

BACKGROUND: Surgery is considered the primary treatment for male infertility from clinical varicocele. One of the main events associated with varicocele is excessive production of reactive oxygen species (ROS). N-acetyl-L-cysteine (NAC), an antioxidant that scavenges free radicals, is considered a supplement to alleviate glutathione (GSH) depletion during oxidative stress. Despite beneficial effects of NAC in other pathological events, there is no report on the effect of NAC in individuals with varicocele. Therefore, the aim of this study is to evaluate the outcome of NAC on semen quality, protamine content, DNA damage, oxidative stress and fertility following varicocelectomy. MATERIALS AND METHODS: This prospective clinical trial included 35 infertile men with varicocele randomly divided into control (n=20) and NAC (n=15) groups. We assessed semen parameters, protamine content [chromomycin A3 (CMA3)], DNA integrity [terminal deoxynucleotidyltransferase-mediated dUTP nick-end labeling (TUNEL)] and oxidative stress [2', 7'-dichlorodihydrofluorescein-diacetate (DCFH-DA)] before and three months after varicocelectomy. RESULTS: Percentage of abnormal semen parameters, protamine deficiency, DNA fragmentation and oxidative stress were significantly decreased in both groups compared to before surgery. We calculated the percentage of improvement in these parameters compared to before surgery for each group, then compared the results between the groups. Only percentage of protamine deficiency and DNA fragmentation significantly differed between the NAC and control groups. CONCLUSION: The results of this study, for the first time, revealed that NAC improved chromatin integrity and pregnancy rate when administered as adjunct therapy post-varico- celectomy (Registeration Number: IRCT201508177223N5).

Efficacy of Varicocele Repair in Different Age Groups.

OBJECTIVE: To compare semen parameters and spouse pregnancy rates after varicocele repair in 2 age groups. MATERIALS AND METHODS: Mean changes in spermatozoa concentration, motility, and morphology after varicocele repair in 83 patients were compared between patients aged 30 years or younger (group 1) and those older than 30 years (group 2). Spouse pregnancy rates were compared between the 2 age groups. RESULTS: The mean sperm concentration increased significantly in both groups (P <.05). The percentage of motile sperm increased from 48.2% to 56.6% in group 1 and from 47.2% to 53.2% in group 2 one year after varicocele repair. The increase in motility was statistically significant for both groups (P <.05), but there was no statistically significant difference in the increase in sperm motility between the 2 groups (P = .01). The percentage of sperm with abnormal morphology decreased significantly in both groups 12 months postoperatively (from 62.7% to 59.6% in group 1 and from 61.3% to 58% in group 2; P = .03). However, there was no statistically significant difference in the improvement in sperm morphology between the 2 groups (P >.05). The pregnancy rates in the patients' spouses were 51.1% and 44.7% in groups 1 and 2, respectively. This difference was not statistically significant (P = .9). CONCLUSION: There was no statistically significant difference in semen parameter improvement and spouse pregnancy rates after varicocelectomy in the 2 age groups.