COVID-19 and male reproductive system: pathogenic features and possible mechanisms.

Multiorgan dysfunction is the main characteristic of severe COVID-19 patients and the involvement of male reproductive system may occur among these patients. Although there is a limited evidence to confirm the orchitis and virus presence in the semen of patients, there are concerns about the transmission of virus through the semen. In addition, reduced fertility or infertility can be seen as consequences of severe COVID-19 in recovered subjects. In this study, we aimed to review articles related to COVID-19 and male reproductive system to find the possible underlying mechanisms of SARS-CoV-2 in affecting male fertility. The following keywords of SARS-CoV-2, COVID-19, testis, orchitis, semen, angiotensin-converting enzyme 2 (ACE2), hypothalamic-pituitary-testicular (HPT) axis, Hypothalamus, etc., were defined to find the related publications from standard search engines, e.g., PUBMED, SCOPUS, Google Scholar. According to studies, COVID-19 occurs in severe patients as respiratory disease, along with multi-organ failure. The most important mechanisms are classified as direct and indirect pathogenesis of SARS-CoV-2. The presence of ACE2 on the cell surface of various cells in testis increases the risk of direct infection by this virus. SARS-CoV-2 also affects the testis through the cytokine storm. In addition, the important role of HPT axis dysregulation through impaired Leydig cells and hypothalamus should be considered. Using antiviral and immunomodulatory therapy can be harmful for testis function. Further investigations are required to investigate potential mechanisms of male infertility in survivals of COVID-19. Since involvement of testis is essential for fertility, increasing the knowledge of health system may improve the outcomes.

Dietary supplements in the management of varicocele-induced infertility: A review of potential mechanisms.

Varicocele is a main cause of lower production of spermatozoon and infertility with multiple pathophysiological mechanisms. In the past decades, the use of dietary supplements has significantly increased due to both the modern lifestyle and the food shortages of the industrialised countries. The purpose of this review paper is to collect scientific evidences from basic and clinical studies which support the use of dietary supplements to define the clinical framework for patients with varicocele. In the present review, we used keywords such as dietary supplements, varicocele, male infertility, oxidative stress, DNA fragmentation, sperm parameters to find the proper articles. The standard search biomedical engines were used for seeking the papers. The use of dietary supplements such as minerals, vitamins and antioxidants has an essential role in the prevention and treatment of varicocele by increasing the levels of antioxidant enzymes (e.g. peroxidase, superoxide dismutase and catalase) and decreasing the levels of inflammatory markers (e.g. tumour necrosis factor-α, interleukin-6 and interleukin-1) in testis. According to the results, the dietary supplements may alleviate the spermatogenesis in varicocele patients through different mechanisms such as suppression of stress oxidative and inflammation in testicular tissue.

An Overnight Stay Versus three Days Admission after Uncomplicated Percutaneous Nephrolithotomy: A Randomized Clinical Trial.

PURPOSE: To evaluate the safety and efficacy of discharging patients on the first postoperative day after an uncomplicated percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: after an uncomplicated successful PCNL without significant residual stone (>5mm) or any complication up to the first postoperative day, we randomly assigned patients into two groups-Group 1: overnight surgery, and Group 2: routine discharge after three days. Patients with significant residual stone on control fluoroscopy were excluded. Ninety eight and 102 patients were assigned to groups 1 and 2, respectively. Serum Hemoglobin and Cr were evaluated before the operation as well as the first postoperative day. Stone free status was evaluated using ultrasound and KUB radiography at the first postoperative day. RESULTS: The stone and patient characteristics were not different in two groups. The preoperative and change in the hemoglobin and creatinine levels were not significantly different between the two groups. Nine patients (9.2%) in Group 1 and five (4.9%) in Group 2 were readmitted because of complications (mainly hematuria) (p=.23). Of the readmitted patients, five in Group 1 (55%), and three in Group 2 (60%) received blood transfusion (p=.87). in these patients, group 1 received 1.6±0.51 units of blood compared with 1.93±0.25 in group 2 (p=.07). All the readmitted patients did well with conservative therapy with no need for angioembolization. CONCLUSION: In uncomplicated PCNL with no significant residual stone, discharging the patient on the first postoperative day is safe. The outcome is comparable to a routine three-day hospital stay.

Urease immobilization on magnetic micro/nano-cellulose dialdehydes: Urease inhibitory of Biginelli product in Hantzsch reaction by urea.

Micro/nano celluloses (MC)/NC) were magnetized by nanoγ-Fe2O3 into the nanoγ-Fe2O3@MC (NMMC) and nanoγ-Fe2O3@NC (NMMC) which oxidized to NMMCD and NMNCD dialdehydes for Schiff-base immobilization of urease as NMMCD/urease and NMMCD/urease. The relative enzyme-activity of the immobilized ureases were comparable with the free-urease, although 75%-80% of the enzyme activity preserved for NMMCD/urease and NMNCD/urease after six cycles. The compared catalytic activities of the NMMCD/urease and NMMCD/urease in Biginelli/Hantzsch reactions in water at 60 °C surprised us by 100% selectivity for the Biginelli product 3,4-dihydropyrimidin-2(1H)-one (DHPM1). With the superiority of NMNCD/urease, this high selectivity using immobilized ureases is owing to the admirable urease inhibitory of the formed Biginelli product DHPM1 by urea condensation instead of urea hydrolysis. The robust enzyme inhibitory of the DHPM1 for free urease was also confirmed by phenol red test to show the deactivation of enzyme for enzymatic hydrolysis of urea and ammonia production in water.

Preparation of nano-alkalinecellulose carboxylates (NACCs) as the methylene blue sorbent and as the catalyst for the large-scale nifedipine synthesis.

In this work, various new nano-alkalinecellulose carboxylates (NACCs) were prepared by oxidative hydrolysis of microalkalinecellulose (MACp) given from prewashed cotton. After the optimization of the reaction time, temperature, oxidant system, and oxidant loading, the new flake-shape anionic NACC24 with base capacity 10.8 mmol HO-/g was obtained from MACp at 50 °C. The characterized NACC24 and MACp were comparatively used as bio-sorbent for removal of methylene blue (MB) from wastewater and as the catalyst in the large-scale synthesis of nifedipine. With the Langmuir model and monolayer pseudo-second-order kinetic mechanism, the negatively charged polymer NACC24 represented high sorption capacity for the MB removal at 780 ±â€¯10 mg/g. A high regeneration stability and 90.5% original efficiency was verified for the NACC24 after five consequence adsorption-desorption cycles, where acidic methanol and aqueous NaOH were used for the efficient desorption of electrostatically interacted MB to NACC24 and respective reactivation of the NACC24 for further runs. Besides, NACC24 showed a high catalytic activity in the base-catalyzed rapid synthesis of anti-hypertension nifedipine even after the five times reusing of catalyst.

The role of Vitamin E - Selenium - Folic Acid Supplementation in Improving Sperm Parameters After Varicocelectomy: A Randomized Clinical Trial.

PURPOSE: In this study, we aimed to evaluate the effects of antioxidants including Vitamin E-Selenium-Folic acid (Vit E -Se- FA) on semen parameters following varicocelectomy (VCT). MATERIALS AND METHODS: Sixty patients from 64 infertile male patients diagnosed with varicocele (VC) who un-derwent sub-inguinal VCT were included in the study. Following sub-inguinal VCT, the patients were randomized into two groups: 30 receiving Vit E-Se-FA supplementation for six months, and 30 as the control group with supplemental treatment. The post-operative semen parameters of Vit E-Se-FA receiving group were compared with control group at the end of experiment. The sperm count, percentage of motile and abnormal sperms were considered. RESULTS: There were statistically significant differences in terms of count (P = .031) and motility (P = .01) of sperm after six months of receiving Vit E-Se-FA supplementation comparing with control group. CONCLUSION: Vit E-Se-FA supplementation can improve sperm parameters (count and motility of sperm) after VCT.

Urease covalently immobilized on cotton-derived nanocellulose-dialdehyde for urea detection and urea-based multicomponent synthesis of tetrahydro-pyrazolopyridines in water.

The urease Schiff-base covalently bonded to the designed high-content nanocellulosedialdehyde (HANCD) prepared from cotton-derived nanocellulose (NC) via tandem acid-hydrolysis and periodate-oxidation reactions was termed HANCD@urease. No change in the aldehyde content of HANCD after Schiff-base bonding to urease and similarity in the relative enzyme activities for HANCD@urease and free enzyme supported that the preparation conditions for HANCD-loaded urease are mild enough to prevent denaturation of the enzyme. As the immobilized urease showed higher stability and reusability versus free enzyme, the HANCD@urease was efficiently used to determine the urea concentration in aqueous solutions and blood serum samples. Alternatively, the catalytic efficiency of the HANCD@urease was demonstrated for the production of ammonia from urea in the multicomponent synthesis of 3,5-dimethyl-4-aryl-1,4,7,8-tetrahydrodipyrazolo[3,4-b:4',3'-e]pyridines (THPPs) in water. This new environment-friendly urea sensor showed 90% preservation of the enzyme activity after the six cycles of reuse in enzymatic reactions, while its catalytic activity in the reaction of benzaldehyde, hydrazine hydrate, and alkyl acetoacetate with urea instead of hygroscopic ammonium salts did not change significantly after the sixth run. Detection and production of ammonia by a bio-compatible sensor and catalyst under mild conditions are features of this new green protocol.

Prostate-specific antigen rising in Iranian men in correlation with body mass index, fasting blood sugar and blood lipid profile.

BACKGROUND: Prostate-specific antigen (PSA) is a serine protease that is secreted by prostate cells and it is useful as a tumor marker for prostate cancer. OBJECTIVES: In this study, the relationship between some of metabolic factors and serum PSA level was investigated. MATERIALS AND METHODS: In this cross-sectional study, patients with urinary symptoms or for screening of the prostate cancer (after 50 years of age or 40 years with a family history of prostate cancer), were evaluated. Collected data included metabolic syndrome factors such as cholesterol (Chol), triglycerides (TG), fasting blood sugar (FBS), and body mass index (BMI), serum PSA level, prostate volume and age. RESULTS: 481 patients were enrolled to this study with the average age of 60.69 ± 9.72 years and the average PSA level of 1.70 ng/ml. Data analysis showed that there was a significant relationship between serum PSA level with age (P < 0.001, r = 0.30) and prostate volume (P < 0.001, r = 0.29). There were not significant relationship between serum PSA level with TG (P = 0.57, r = 0.026), Chol (P = 0.57, r = -0.025), FBS (P = 0.054, r = 0.088), and BMI (P = 0.89, r = 0.006). CONCLUSIONS: This study showed that, with increasing age and prostate volume, serum PSA level increased, and an increase in the levels of cholesterol, TG, FBS and BMI did not have significant effect on serum PSA level.

Percutaneous Nephrolithotomy Using Split Amplatz Sheath: A Randomized Clinical Trial.

PURPOSE: To compare the outcome of percutaneous nephrolithotomy (PCNL) using split or intact Amplatz sheath. MATERIALS AND METHODS: Seventy two patients who underwent PCNL were randomly divided into two groups; PCNL using intact (group 1) and split (group 2) Amplatz sheath. Preoperative data, operative time, largest extracted stone size, fluoroscopy and lithotripsy time, and serum biochemistry tests before and after PCNL were evaluated. RESULTS: Preoperative features and stone size were not significantly different between the groups. There were no significant differences in complications and postoperative changes in hemoglobin and serum electrolytes. Stone free rate in group 2 (88.1%) was insignificantly higher than group 1 (83.3%) (p = .05), but in staghorn stones and stones larger than 1000 mm2, stone free rate in group 2 was significantly higher than group 1 (82% vs. 72%). The mean extracted stone size in group 2 (150 ± 49) was significantly larger than group 1 (40 ± 16 mm2) (p < .005). The mean operative, lithotripsy and fluoroscopy times were significantly longer in group 1. CONCLUSION: Using split Amplatz sheath in PCNL facilitates extraction of larger stone fragments which could contribute to shorter fluoroscopy, lithotripsy and operative times. .

An Extremely Rare Complication of Ureteral Pigtail Stent Placement: A Case Report.

Double-J (DJ) stents are the main tools used in urological practice for prevention and treatment of obstruction. Stenting is also mandatory after complicated ureteroscopy or TUL (Transureteral Lithotripsy). Known complications are upper migration of DJ stents into the kidney and lower migration to the bladder. In a man with an impacted right lower ureteral stone, a DJ stent was placed because the ureteroscope was not passed from an intramural ureter. We reported a very rare complication of DJ ureteral stent placement with intravascular migration to the pulmonary arteries, which was removed percutaneously through the right femoral vein under fluoroscopic guidance.

Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with renal pelvic stones: a randomized clinical trial.

PURPOSE: A randomized clinical trial was designed to compare the efficacy, success rate and surgical complications of percutaneous nephrolithotomy (PCNL) and laparoscopic pyelolithotomy (LP). MATERIALS AND METHODS: Sixty patients with renal pelvic stones larger than 2 cm were randomly divided into two groups of LP and PCNL. All patients were followed up to three months after surgery using renal diethylenetriamine­pentaaceticacid (DTPA) scan and determining the glomerular filtration rate (GFR). RESULTS: Mean operation time (149 ± 31 vs. 107 ± 26 min) and mean hospital stay (3.4 vs. 2.16 days) were significantly higher in LP, but mean hemoglobin drop (0.85 vs. 1.88 g/dL) and the rate of blood transfusion were significantly lower. Stone free rate was 90% and 86.6% for LP and PCNL, respectively (P =.59), while the changes in GFR were not statistically significant 3 days after surgery between two groups. Those in LP group showed better improvement in GFR at three months postoperatively. Improvement of the affected split kidney function was significantly higher in LP group (P =.04). No major complications were observed in both groups according to Clavien grading system. CONCLUSION: PCNL remains the gold standard treatment for most large kidney stones, nevertheless, laparoscopic pyelolithotomy can be considered for selected cases especially in whom maximal preservation of renal function is  necessary. 

Mini-laparoscopic live donor nephrectomy: initial series.

PURPOSE: To present the safety and surgical outcomes of the initial series of mini-laparoscopic live donor nephrectomy and graft outcomes in related recipients. MATERIALS AND METHODS: From January 2012 through July 2012, fifty patients underwent minilaparoscopic live donor nephrectomy. Two 3.5 mm trocars were inserted above and lateral to the umbilicus for grasping and scissoring. One 5 mm trocar with a camera was inserted in the umbilicus and an 11 mm trocar was inserted through fascia from a 6-8 cm Pfannenstiel incision for bipolar coagulation, kidney extraction, and vascular clip applier. RESULTS: Mean age of donors was 28 ± 4.2 (range, 21-39) years. Mean operative time from trocar insertion was 145.8 (range, 85-210) minutes. No major perioperative or postoperative complications occurred. The average decrease in hemoglobin level was 1.14 (range, 0.32-1.8) mg/dL and no one required blood transfusion. Mean warm ischemia time was 4.41 (range, 2.35- 9) minutes. Mean hospital stay was 2.2 (range, 2-5) days. Mean follow-up time of the recipients was 215 (range, 130-270) days. The mean serum creatinine level of the recipients at discharge time and the last follow-up visit was 1.38 mg/dL and 1.22 mg/dL, respectively. CONCLUSIONS: While the primary purpose of this technique is to make donor nephrectomy less invasive and more cosmetic, it is also comfortable for the laparoscopist surgeons because it is nearly similar to standard laparoscopy. A randomized controlled trial with a large sample size, long-term follow-up, and comparison with standard laparoscopy are necessary to present more definitive data about this technique.

p53 protein in serum and urine samples of patients with bladder transitional cell carcinoma and its overexpression in tumoral tissue.

INTRODUCTION: The aim of this study was to evaluate the levels of p53 protein in serum and urine samples of patients with bladder transitional cell carcinoma (TCC) and their relation with the overexpression of p53 in the tumoral tissue. MATERIALS AND METHODS: A total of 39 patients with bladder TCC were evaluated for p53 protein in their serum and urine samples and the overexpression of this marker in their tumoral tissue. RESULTS: Of 39 patients with bladder TCC, 29 (74.4%) had tissue specimens positive for p53 protein overexpression, 20 (51.3%) had p53 protein in their serum samples, and 27 (69.2%) had this protein in their urine samples. A positive immunohistochemical finding was more common in higher grades of the bladder tumor (P = .03), but not in higher stages (P = .07). Eighteen of 20 patients (90%) with a positive serum for p53 showed protein overexpression in the tumoral tissue of the bladder (P = .03). Of 27 patients with a positive urine sample, 25 (92.6%) had p53 overexpression in their bladder tissue, and of the remainder 12 patients with a negative p53 protein in their urine samples, 8 (66.7%) had no evidence of p53 protein overexpression in their tumoral tissue (P < .001). The grade and stage of tumor had no correlation with serum or urinary p53. CONCLUSION: According to our findings, a positive serum or urine sample for p53 protein is highly associated with the overexpression of p53 protein in the tumoral tissue of patients with bladder TCC.

En bloc kidney transplantation from pediatric cadaveric donors to adult recipients.

INTRODUCTION: The shortage of cadaveric donors for kidney transplantation has led to the expansion of the criteria used for donor selection, such as the use of pediatric cadaveric donors. In this study we reviewed our results of en bloc kidney transplantation of pediatric cadaveric donors to adults. MATERIALS AND METHODS: From May 2001 to May 2005, 245 cadaveric kidney transplants have been performed in our hospitals. Seven of these were en bloc kidney transplantations in adult recipients from marginal pediatric donors (age < 5 years, donor weight < 15 kg, high creatinine clearance, or kidney length < 8 cm). We reviewed their records. Follow-up (range, 3 to 24 months) included ultrasonography, dimercaptosuccinic acid renal scintigraphy, and magnetic resonance imaging. RESULTS: Serum levels of creatinine ranged between 0.8 m/dL to 1.9 mg/dL during the follow-up period. One patient died of myocardial infarction 3 months postoperatively. One-year graft and patient survivals were both 85.7%. Complications included acute tubular necrosis in 1 patient (managed by conservative therapy and dialysis for 2 weeks), renal vein thrombosis in 1 (treated by anticoagulation), and subcutaneous hematoma in 1. There were no urologic complications. Median size of the grafts was 7.2 cm preoperatively that reached 9.6 cm, 3 months postoperatively (P = .018). Twelve months following operation, the median size of the grafts reached 11 cm (P = .045). CONCLUSION: En bloc pediatric kidney transplantation is a safe and suitable alternative for adult recipients. One-year graft and patient survivals are acceptable and complication rate is low.