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   2017| January-February  | Volume 19 | Issue 1  
    Online since December 26, 2016

 
 
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REVIEW
Major regulatory mechanisms involved in sperm motility
Rute Pereira, Rosália Sá, Alberto Barros, Mário Sousa
January-February 2017, 19(1):5-14
DOI:10.4103/1008-682X.167716  PMID:26680031
The genetic bases and molecular mechanisms involved in the assembly and function of the flagellum components as well as in the regulation of the flagellar movement are not fully understood, especially in humans. There are several causes for sperm immotility, of which some can be avoided and corrected, whereas other are related to genetic defects and deserve full investigation to give a diagnosis to patients. This review was performed after an extensive literature search on the online databases PubMed, ScienceDirect, and Web of Science. Here, we review the involvement of regulatory pathways responsible for sperm motility, indicating possible causes for sperm immotility. These included the calcium pathway, the cAMP-dependent protein kinase pathway, the importance of kinases and phosphatases, the function of reactive oxygen species, and how the regulation of cell volume and osmolarity are also fundamental components. We then discuss main gene defects associated with specific morphological abnormalities. Finally, we slightly discuss some preventive and treatments approaches to avoid development of conditions that are associated with unspecified sperm immotility. We believe that in the near future, with the development of more powerful techniques, the genetic causes of sperm immotility and the regulatory mechanisms of sperm motility will be better understand, thus enabling to perform a full diagnosis and uncover new therapies.
  5,231 880 2
INVITED ORIGINAL ARTICLE
Men with a complete absence of normal sperm morphology exhibit high rates of success without assisted reproduction
Jason R Kovac, Ryan P Smith, Miguel Cajipe, Dolores J Lamb, Larry I Lipshultz
January-February 2017, 19(1):39-42
DOI:10.4103/1008-682X.189211  PMID:27751992
In couples with infertility, abnormal strict morphology of 0% normal forms (NF) is a criterion to proceed rapidly to in vitro fertilization (IVF). Since no data currently exist, we investigated the outcomes for men with 0% NF to determine reproductive success without the use of assisted reproductive technologies (ART). A cohort of 24 men with 0% NF were identified (2010-2013) with 27 randomly selected men with ≥4% NF as controls. Patient charts were reviewed with men contacted and administered an Institutional Review Board (IRB)-approved telephone questionnaire to ascertain outcomes. After a median follow-up time of 2.5 years, 29.2% of men with 0% NF did not require ART for their first pregnancy (controls = 55.6%, P ≤ 0.05). When all pregnancies were analyzed together, men with 0% NF achieved twenty pregnancies of which 75% did not require IVF (controls = thirty pregnancies; 76.7% did not require IVF). The average age of men and female partners was similar between men with 0% NF and ≥4% NF. All men had normal follicle-stimulating hormone (FSH), testosterone, prolactin, sex hormone-binding globulin (SHBG), and estradiol. Although, global semen parameters were worse in men with 0% NF, when a first pregnancy was a natural conception (NC), 100% of men with 0% NF (n = 7/7) and 37.5% of controls (n = 3/8) went on to have a subsequent pregnancy via NC. Men with 0% NF conceived without IVF in 29.2% of cases compared to 55.6% of controls. Strict morphology should not be used to predict fertilization, pregnancy, or live birth potential. In men with 0% NF, alternative modalities should be considered before immediate IVF.
  4,306 479 1
ORIGINAL ARTICLES
A systematic review and meta-analysis to determine the effect of sperm DNA damage on in vitro fertilization and intracytoplasmic sperm injection outcome
Luke Simon, Armand Zini, Alina Dyachenko, Antonio Ciampi, Douglas T Carrell
January-February 2017, 19(1):80-90
DOI:10.4103/1008-682X.182822  PMID:27345006
Sperm DNA damage is prevalent among infertile men and is known to influence natural reproduction. However, the impact of sperm DNA damage on assisted reproduction outcomes remains controversial. Here, we conducted a meta-analysis of studies on sperm DNA damage (assessed by SCSA, TUNEL, SCD, or Comet assay) and clinical pregnancy after IVF and/or ICSI treatment from MEDLINE, EMBASE, and PUBMED database searches for this analysis. We identified 41 articles (with a total of 56 studies) including 16 IVF studies, 24 ICSI studies, and 16 mixed (IVF + ICSI) studies. These studies measured DNA damage (by one of four assays: 23 SCSA, 18 TUNEL, 8 SCD, and 7 Comet) and included a total of 8068 treatment cycles (3734 IVF, 2282 ICSI, and 2052 mixed IVF + ICSI). The combined OR of 1.68 (95% CI: 1.49-1.89; P < 0.0001) indicates that sperm DNA damage affects clinical pregnancy following IVF and/or ICSI treatment. In addition, the combined OR estimates of IVF (16 estimates, OR = 1.65; 95% CI: 1.34-2.04; P < 0.0001), ICSI (24 estimates, OR = 1.31; 95% CI: 1.08-1.59; P = 0.0068), and mixed IVF + ICSI studies (16 estimates, OR = 2.37; 95% CI: 1.89-2.97; P < 0.0001) were also statistically significant. There is sufficient evidence in the existing literature suggesting that sperm DNA damage has a negative effect on clinical pregnancy following IVF and/or ICSI treatment.
  3,990 759 10
Sexual outcomes after partial penectomy for penile cancer: results from a multi-institutional study
Salvatore Sansalone, Mauro Silvani, Rosario Leonardi, Giuseppe Vespasiani, Valerio Iacovelli
January-February 2017, 19(1):57-61
DOI:10.4103/1008-682X.168690  PMID:26643562
Penile cancer is an uncommon malignancy. Surgical treatment is inevitably mutilating. Considering the strong impact on patients' sexual life we want to evaluate sexual function and satisfaction after partial penectomy. The patients in this study (n = 25) represented all those who attended our institutions and were diagnosed and treated for penile cancer from October 2011 to November 2013. All patients underwent partial penectomy and followed-up (mean: 14 months; range: 12-25). Sexual presurgical baseline was estimated using the International Index of Erectile Dysfunction 15 (IIEF-15). Sexual outcomes of each patient were estimated considering four standardized and validated questionnaires. We analyzed the means and ranges of IIEF-15 including erectile function (IIEF-1-5 and -15), orgasmic function (IIEF-9 and -10), sexual desire (IIEF-11 and -12), intercourse satisfaction (IIEF-6-8), and overall satisfaction (IIEF-13 and -14). Then, we also used Quality of Erection Questionnaire (QEQ), Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and Self-Esteem and Relationship (SEAR) to evaluate the sexual function and satisfaction of our patients. The final results showed that penile cancer leads to several sexual and psychosexual dysfunctions. Nevertheless, patients who undergo partial penectomy for penile cancer can maintain the sexual outcomes at levels slightly lower to those that existed in the period before surgery.
  3,988 347 -
Relationship between circumcision and human papillomavirus infection: a systematic review and meta-analysis
Yi-Ping Zhu, Zhong-Wei Jia, Bo Dai, Ding-Wei Ye, Yun-Yi Kong, Kun Chang, Yue Wang
January-February 2017, 19(1):125-131
DOI:10.4103/1008-682X.175092  PMID:26975489
Male circumcision (MC) is reported to reduce human papillomavirus (HPV) prevalence in men. However, the efficacy remains imprecise. The aim of this study was to conduct a systematic review and meta-analysis to assess the relationship between MC and genital HPV infection and genital warts. PUBMED, EMBASE, and Web of Science were searched from inception to March 22, 2015. We identified 30 papers, including a total of 12149 circumcised and 12252 uncircumcised men who were evaluated for the association of circumcision with genital HPV or genital warts. Compared with men who were not circumcised, circumcised men may have had significantly reduced odds of genital HPV prevalence (odds ratio [OR]: 0.68; 95% confidence interval [95% CI]: 0.56-0.82). There was no significant association between MC and genital HPV acquisition of new infections (OR: 0.99; 95% CI: 0.62-1.60), genital HPV clearance (OR: 1.38; 95% CI: 0.96-1.97), and prevalence of genital warts (OR: 1.17; 95% CI: 0.63-2.17). This meta-analysis suggests that circumcision reduces the prevalence of genital HPV infections. However, no clear evidence was found that circumcision was associated with decreased HPV acquisition, increased HPV clearance, or decreased the prevalence of genital warts. More studies are required to evaluate adequately the effect of MC on the acquisition and clearance of HPV infections and prevalence of genital warts.
  3,298 434 4
Global methylation status of sperm DNA in carriers of chromosome structural aberrations
Marta Olszewska, Miroslawa Z Barciszewska, Monika Fraczek, Nataliya Huleyuk, Vyacheslav B Chernykh, Danuta Zastavna, Jan Barciszewski, Maciej Kurpisz
January-February 2017, 19(1):117-124
DOI:10.4103/1008-682X.168684  PMID:26908061
Male infertility might be clearly associated with aberrant DNA methylation patterns in human spermatozoa. An association between oxidative stress and the global methylation status of the sperm genome has also been suggested. The aim of the present study was to determine whether the global sperm DNA methylation status was affected in the spermatozoa of carriers of chromosome structural aberrations. The relationships between the 5-methylcytosine (m 5 C) levels in spermatozoa and chromatin integrity status were evaluated. The study patients comprised male carriers of chromosome structural aberrations with reproductive failure (n = 24), and the controls comprised normozoospermic sperm volunteers (n = 23). The global m 5 C level was measured using thin-layer chromatography (TLC) and immunofluorescence (IF) techniques. The sperm chromatin integrity was assessed using aniline blue (AB) staining and TUNEL assay. The mean m 5 C levels were similar between the investigated chromosome structural aberrations carriers (P) and controls (K). However, sperm chromatin integrity tests revealed significantly higher values in chromosomal rearrangement carriers than in controls (P < 0.05). Although the potential relationship between sperm chromatin integrity status and sperm DNA fragmentation and the m 5 C level juxtaposed in both analyzed groups (P vs K) was represented in a clearly opposite manner, the low chromatin integrity might be associated with the high hypomethylation status of the sperm DNA observed in carriers of chromosome structural aberrations.
  2,623 354 2
Plasmakinetic enucleation of prostate versus 160-W laser photoselective vaporization for the treatment of benign prostatic hyperplasia
Si-Jun Wang, Xiao-Nan Mu, Ji Chen, Xun-Bo Jin, Shi-Bao Zhang, Long-Yang Zhang
January-February 2017, 19(1):15-19
DOI:10.4103/1008-682X.164199  PMID:26732101
To evaluate the safety and efficacy of plasmakinetic enucleation of the prostate (PKEP) for the treatment of symptomatic benign prostatic hyperplasia (BPH) compared with 160-W lithium triboride laser photoselective vaporization of the prostate (PVP). From February 2011 to July 2012, a prospective nonrandomized study was performed. One-hundred one patients underwent PKEP, and 110 underwent PVP. No severe intraoperative complications were recorded, and none of the patients in either group required a blood transfusion. Shorter catheterization time (38.14 ± 23.64 h vs 72.54 ± 28.38 h, P< 0.001) and hospitalization (2.32 ± 1.25 days vs 4.07 ± 1.23 days, P< 0.001) were recorded in the PVP group. At 12-month postoperatively, the PKEP group had a maintained and statistically improvement in International Prostate Symptom Score (IPSS) (4.07 ± 2.07 vs 5.00 ± 2.10; P< 0.001), quality of life (QoL) (1.08 ± 0.72 vs 1.35 ± 0.72; P= 0.007), maximal urinary flow rate (Qmax) (24.75 ± 5.87 ml s−1 vs 22.03 ± 5.04 ml s−1 ; P< 0.001), postvoid residual urine volume (PVR) (14.29 ± 6.97 ml vs 17.00 ± 6.11 ml; P= 0.001), and prostate-specific antigen (PSA) value (0.78 ± 0.57 ng ml−1 vs 1.27 ± 1.07 ng ml−1 ; P< 0.001). Both PKEP and PVP relieve low urinary tract symptoms (LUTS) due to BPH with low complication rates. PKEP can completely remove prostatic adenoma while the total amount of tissue removed by PVP is less than that can be removed by PKEP. Based on our study of the follow-up, PKEP provides better postoperative outcomes than PVP.
  2,575 377 1
Combination of low-energy shock-wave therapy and bone marrow mesenchymal stem cell transplantation to improve the erectile function of diabetic rats
Hai-Tao Shan, Hai-Bo Zhang, Wen-Tao Chen, Feng-Zhi Chen, Tao Wang, Jin-Tai Luo, Min Yue, Ji-Hong Lin, An-Yang Wei
January-February 2017, 19(1):26-33
DOI:10.4103/1008-682X.184271  PMID:27427555
Stem cell transplantation and low-energy shock-wave therapy (LESWT) have emerged as potential and effective treatment protocols for diabetic erectile dysfunction. During the tracking of transplanted stem cells in diabetic erectile dysfunction models, the number of visible stem cells was rather low and decreased quickly. LESWT could recruit endogenous stem cells to the cavernous body and improve the microenvironment in diabetic cavernous tissue. Thus, we deduced that LESWT might benefit transplanted stem cell survival and improve the effects of stem cell transplantation. In this research, 42 streptozotocin-induced diabetic rats were randomized into four groups: the diabetic group (n = 6), the LESWT group (n = 6), the bone marrow-derived mesenchymal stem cell (BMSC) transplantation group (n = 15), and the combination of LESWT and BMSC transplantation group (n = 15). One and three days after BMSC transplantation, three rats were randomly chosen to observe the survival numbers of BMSCs in the cavernous body. Four weeks after BMSC transplantation, the following parameters were assessed: the surviving number of transplanted BMSCs in the cavernous tissue, erectile function, real-time polymerase chain reaction, and penile immunohistochemical assessment. Our research found that LESWT favored the survival of transplanted BMSCs in the cavernous body, which might be related to increased stromal cell-derived factor-1 expression and the enhancement of angiogenesis in the diabetic cavernous tissue. The combination of LESWT and BMSC transplantation could improve the erectile function of diabetic erectile function rats more effectively than LESWT or BMSC transplantation performed alone.
  2,548 379 1
Comparison of intraperitoneal and intratesticular ozone therapy for the treatment of testicular ischemia-reperfusion injury in rats
Fatih Mete, Huseyin Tarhan, Orcun Celik, Ilker Akarken, Kamil Vural, Rahmi Gokhan Ekin, Isil Aydemir, Yusuf Ozlem Ilbey
January-February 2017, 19(1):43-46
DOI:10.4103/1008-682X.171570  PMID:26732112
We compare the efficacy of intratesticular ozone therapy with intraperitoneal ozone therapy in an experimental rat model. For this purpose, 24 rats were divided into four groups including sham-operated, torsion/detorsion, torsion/detorsion plus intraperitoneal ozone (O-IP), and torsion/detorsion plus intratesticular ozone (O-IT). The O-IP ozone group received a 4 mg kg−1 intraperitoneal injection of ozone, and the O-IT group received the same injection epididymally. At 4 h after detorsion, the rats were sacrificed and orchiectomy materials were assessed histopathologically. Spermatogenesis in the seminiferous tubules and damage to the Sertoli cells were histopathologically evaluated in the testes using the Johnsen scoring system. i-NOS and e-NOS activities in the testis tissue were also evaluated. Torsion-detorsion caused a decreased Johnsen score and increased apoptosis of spermatogonial and Sertoli cells. Ozone injection prevented increases in Johnsen score and i-NOS level. e-NOS level of the O-IP group was significantly lower than that of the O-IP group, and i-NOS level of the O-IT group was significantly lower than that of the O-IP group. Local ozone therapy is more effective than systemic ozone therapy at improving IRI-related testicular torsion. Our study is the first to show that the efficacy of intratesticular implementation of ozone therapy is higher than that of intraperitoneal ozone therapy.
  2,464 368 -
Therapeutic effects of adipose-derived stem cells-based microtissues on erectile dysfunction in streptozotocin-induced diabetic rats
Feng Zhou, Yu Hui, Hua Xin, Yong-De Xu, Hong-En Lei, Bi-Cheng Yang, Rui-Li Guan, Meng Li, Jian-Quan Hou, Zhong-Cheng Xin
January-February 2017, 19(1):91-97
DOI:10.4103/1008-682X.182817  PMID:27345005
This study aimed to explore the therapeutic effects of adipose-derived stem cells (ADSCs)-based microtissues (MTs) on erectile dysfunction (ED) in streptozotocin (STZ)-induced diabetic rats. Fifty-six 8-week-old Sprague-Dawley rats received intraperitoneal injection of STZ (60 mg kg−1 ), and 8 weeks later, the determined diabetic rats randomly received intracavernous (IC) injection of phosphate buffer solution (PBS), ADSCs, or MTs. Another eight normal rats equally got IC injection of PBS. MTs were generated with a hanging drop method, and the injected cells were tracked in ADSC- and MT-injected rats. Four weeks after the treatments, intracavernous pressure (ICP), histopathological changes in corpus cavernosum (CC), and functional proteins were measured. Rat cytokine antibody array was used to detect ADSCs or MTs lysate. The results showed that MTs expressed vascular endothelial growth factor (VEGF), nerve growth factor (NGF), and tumor necrosis factor-stimulated gene-6 (TSG-6). MTs injection had a higher retention than ADSCs injection and MTs treatment improved ICP, neuronal nitric oxide synthase (nNOS) expression, smooth muscle, and endothelial contents in diabetic rats, ameliorated local inflammation in CC better. Thus, our findings demonstrate that IC injection of MTs improves erectile function and histopathological changes in STZ-induced diabetic rats and appears to be more promising than traditional ADSCs. The underlying mechanisms involve increased cell retention accompanied with neuroprotection and anti-inflammatory behaviors of the paracrine factors.
  2,338 342 2
Minimal volume vitrification of epididymal spermatozoa results in successful in vitro fertilization and embryo development in mice
Fabrizzio Horta, Hamida Alzobi, Sutthipat Jitanantawittaya, Sally Catt, Penny Chen, Mulyoto Pangestu, Peter Temple-Smith
January-February 2017, 19(1):107-112
DOI:10.4103/1008-682X.183378  PMID:27427551
This study compared three cryopreservation protocols on sperm functions, IVF outcomes, and embryo development. Epididymal spermatozoa cryopreserved using slow-cooling (18% w/v raffinose, RS-C) were compared with spermatozoa vitrified using 0.25 M sucrose (SV) or 18% w/v raffinose (RV). The motility, vitality, and DNA damage (TUNEL assay) of fresh control (FC) spermatozoa were compared with post-thawed or warmed RS-C, RV, and SV samples. Mouse oocytes (n = 267) were randomly assigned into three groups for insemination: RV (n = 102), RS-C (n = 86), and FC (n = 79). The number and the proportion of two-cell embryos and blastocysts from each treatment were assessed. Sperm motility (P < 0.01) and vitality (P < 0.05) were significantly reduced after vitrification compared with slow-cooled spermatozoa. However, DNA fragmentation was significantly reduced in spermatozoa vitrified using sucrose (15 ± 1.8% [SV] vs 26 ± 2.8% [RV] and 27 ± 1.2% [RS-C]; P < 0.01). Although the number of two-cell embryos produced by RS-C, RV, and FC spermatozoa was not significantly different, the number of blastocysts produced from two-cell embryos using RV spermatozoa was significantly higher than FC spermatozoa (P = 0.0053). This simple, small volume vitrification protocol and standard insemination method allows successful embryo production from small numbers of epididymal spermatozoa and may be applied clinically to circumvent the need for ICSI, which has the disadvantage of bypassing sperm selection.
  2,288 319 -
Reduced corporal fibrosis to protect erectile function by inhibiting the Rho-kinase/LIM-kinase/cofilin pathway in the aged transgenic rat harboring human tissue kallikrein 1
Kai Cui, Yang Luan, Tao Wang, Li Zhuan, Ke Rao, Shao-Gang Wang, Zhang-Qun Ye, Ji-Hong Liu, Dao-Wen Wang
January-February 2017, 19(1):67-72
DOI:10.4103/1008-682X.189209  PMID:27678468
Our previous studies have demonstrated that erectile function was preserved in aged transgenic rats (TGR) harboring the human tissue kallikrein 1 (hKLK1), while the molecular level of hKLK1 on corporal fibrosis to inhibit age-related erectile dysfunction (ED) is poorly understood. Male wild-type Sprague-Dawley rats (WTR) and TGR harboring the hKLK1 gene were fed to 4- or 18-month-old and divided into three groups: young WTR (yWTR) as the control, aged WTR (aWTR), and aged TGR (aTGR). Erectile function of all rats was assessed by cavernous nerve electrostimulation method. Masson's trichrome staining was used to evaluate corporal fibrosis in the corpus cavernosum. We found that the erectile function of rats in the aWTR group was significantly lower than that of other two groups. Masson's trichrome staining revealed that compared with those of the yWTR and aTGR groups, the ratio of smooth muscle cell (SMC)/collagen (C) was significantly lower in the aWTR group. Immunohistochemistry and Western blotting analysis were performed, and results demonstrated that expression of α-SMA was lower, while expressions of transforming growth factor-β 1 (TGF-β1), RhoA, ROCK1, p-MYPT1, p-LIMK2, and p-cofilin were higher in the aWTR group compared with those in other two groups. However, LIMK2 and cofilin expressions did not differ among three groups. Taken together, these results indicated that the RhoA/ROCK1/LIMK/cofilin pathway may be involved in the corporal fibrosis caused by advanced age, and hKLK1 may reduce this corporal fibrosis by inhibiting the activation of this pathway to ameliorate age-related ED.
  2,376 227 1
In vivo oxidative stress alters thiol redox status of peroxiredoxin 1 and 6 and impairs rat sperm quality
Yannan Liu, Cristian O'Flaherty
January-February 2017, 19(1):73-79
DOI:10.4103/1008-682X.170863  PMID:26823067
Oxidative stress, the imbalance between the production of reactive oxygen species (ROS) and antioxidant activity is a major culprit of male infertility. Peroxiredoxins (PRDXs) are major antioxidant enzymes of mammalian spermatozoa and are thiol oxidized and inactivated by ROS in a dose-dependent manner. Their deficiency and/or inactivation have been associated with men infertility. The aim of this study was to elucidate the impact of oxidative stress, generated by the in vivo tert-butyl hydroperoxide (tert-BHP) treatment on rat epididymal spermatozoa during their maturation process. Adult Sprague-Dawley males were treated with 300 μmoles tert-BHP/kg or saline (control) per day intraperitoneal for 15 days. Lipid peroxidation (2-thibarbituric acid reactive substances assay), total amount and thiol oxidation of PRDXs along with the total amount of superoxide dismutase (SOD), motility and DNA oxidation (8-hydroxy-deoxyguanosine) were determined in epididymal spermatozoa. Total amount of PRDXs and catalase and thiol oxidation of PRDXs were determined in caput and cauda epididymis. While animals were not affected by treatment, their epididymal spermatozoa have decreased motility, increased levels of DNA oxidation and lipid peroxidation along with increased PRDXs (and not SOD) amounts. Moreover, sperm PRDXs were highly thiol oxidized. There was a differential regulation in the expression of PRDX1 and PRDX6 in the epididymis that suggests a segment-specific role for PRDXs. In conclusion, PRDXs are increased in epididymal spermatozoa in an attempt to fight against the oxidative stress generated by tert-BHP in the epididymis. These findings highlight the role of PRDXs in the protection of sperm function and DNA integrity during epididymal maturation.
  2,208 302 1
Apoptotic and nonapoptotic function of caspase 7 in spermatogenesis
Bin Lei, Xuming Zhou, Daojun Lv, Bo Wan, Huayan Wu, Liren Zhong, Fangpeng Shu, Xiangming Mao
January-February 2017, 19(1):47-51
DOI:10.4103/1008-682X.169563  PMID:26643564
Recent studies have reported that caspase 7 has an apoptotic and nonapoptotic function. However, the relationship between caspase 7 and spermatogenesis remains unknown. This study aimed to investigate the possible function of caspase 7 during normal and abnormal spermatogenesis. The cleaved form of caspase 7 was detected in testis tissues at different postpartum times (5-14 weeks) by qRT-PCR, Western blot and immunohistochemistry (IHC). Then, the mice models of spermatogenic dysfunction were obtained by busulfan (30 mg kg−1 to further evaluate the potential function and mechanism of caspase 7. qRT-PCR and Western blot results showed that caspase 7 expression was gradually elevated from 5 to 14 weeks, which was not connected with apoptosis. IHC results revealed that caspase 7 was mainly located in spermatogenic cells and Leydig cells. In addition, spermatogenic dysfunction induced by busulfan gradually enhanced the apoptosis and elevated the expression of caspase 3, caspase 6, and caspase 9, but decreased the expression of caspase 7 in spermatogenic cells. However, when spermatogenic cells were mostly disappeared at the fourth week after busulfan treatment, caspase 7 expression in Leydig cells was significantly increased and positively correlated with the expression of caspase 3, caspase 6, and caspase 9. Therefore, these results indicate that caspase 7 has a nonapoptic function that participates in normal spermatogenesis, but also displays apoptotic function in spermatogenic dysfunction.
  2,177 290 -
Association of time to prostate-specific antigen nadir and logarithm of prostate-specific antigen velocity after progression in metastatic prostate cancer with prior primary androgen deprivation therapy
Jeremy YC Teoh, James HL Tsu, Steffi KK Yuen, Peter KF Chiu, Samson YS Chan, Ka-Wing Wong, Kwan-Lun Ho, Simon SM Hou, Chi-Fai Ng, Ming-Kwong Yiu
January-February 2017, 19(1):98-102
DOI:10.4103/1008-682X.164921  PMID:26585698
We investigated the association of time to prostate-specific antigen nadir (TTPN) and logarithm of prostate-specific antigen velocity after progression Log(PSAVAP) in metastatic prostate cancer with prior primary androgen deprivation therapy (ADT). All metastatic prostate cancer patients treated with primary ADT from 2000 to 2009 were reviewed. Patients who developed disease progression were included in the subsequent analyses. Patients were categorized into three groups according to their TTPN: TTPN of <3 months, 3-17 months, and >17 months. We compared the Log(PSAVAP) between the different TTPN groups using Mann-Whitney U-test and Kruskal-Wallis test. Further multiple linear regression analyses on Log(PSAVAP) were performed to adjust for other potential confounding factors. Among 419 patients who were treated with primary ADT, 306 patients developed disease progression with a median follow-up of 28 months. Longer TTPN was associated with lower Log(PSAVAP) (P = 0.008) within all subgroup analyses (TTPN of <3 vs 3-17 months, P= 0.020; TTPN of 3-17 vs >17 months, P= 0.009; and TTPN of <3 vs >17 months, P= 0.001). Upon multiple linear regression analyses, baseline PSA (regression coefficient 0.001, P= 0.045), PSA nadir (regression coefficient 0.002, P= 0.040), and TTPN (regression coefficient −0.030, P= 0.001) were the three factors that were significantly associated with Log(PSAVAP). In conclusion, a longer TTPN was associated with lower Log(PSAVAP) in metastatic prostate cancer patients following primary ADT. TTPN cut-offs at 3 months and 17 months appeared to have prognostic significance in predicting Log(PSAVAP). TTPN may serve as a good prognostic indicator in deciding the treatment strategy in patients with disease progression.
  2,199 247 -
Refining the American Urological Association and American Society for Radiation Oncology guideline for adjuvant radiotherapy after radical prostatectomy using the pathologic Gleason score
Wan Song, Young Suk Kwon, Seong Soo Jeon, Isaac Yi Kim
January-February 2017, 19(1):20-25
DOI:10.4103/1008-682X.159715  PMID:26620454
Recently, it has been suggested that the guideline for adjuvant radiotherapy (ART) following radical prostatectomy (RP) sponsored by the American Urological Association and American Society for Radiation Oncology (AUA/ASTRO) may result in a significant overtreatment. Thus, the objective of the present study was to refine the AUA/ASTRO guideline for ART in patients at risk for biochemical recurrence (BCR) after RP. To this end, we reviewed our prospectively maintained database and selected 193 patients who met the AUA/ASTRO ART criteria. With a median follow-up of 24.0 months, BCR rate was 17.6% (34/193). When stratified by the Gleason score, BCR rate in men with Gleason score 6 was 6.8%. There was no significant association between BCR-free survival and surgical margin (P = 0.690) and pathologic stage (P = 0.353) in patients with the Gleason score 6. However, in patients with positive surgical margins (PSMs)/pathologic stage ≥T3, there was a significant difference in BCR-free survival according to Gleason score (≤ 7 vs 8-10, P = 0.047). Multivariate Cox regression analysis demonstrated that pathologic stage ≥T3 (HR = 2.106; P= 0.018), PSMs (HR = 2.411; P= 0.003), and pathologic Gleason score 8-10 (HR = 4.715; P< 0.001) were independent predictors of BCR after RP. Therefore, in addition to pathologic stage ≥T3 and PSMs, Gleason score 8-10 predicts BCR after RP. In patients with Gleason score 6, observation rather than ART may be more appropriate regardless of stage and surgical margin status.
  2,114 279 -
CLINICIANS WORKSHOP
A novel approach for removal of an inflatable penile prosthesis reservoir using laparoscopic instruments
Angie L Staller, Courtney M Chang, Gavin N Wagenheim, Run Wang
January-February 2017, 19(1):132-134
DOI:10.4103/1008-682X.188661  PMID:27751990
  2,169 220 1
ORIGINAL ARTICLES
Transperineal prostate biopsies for diagnosis of prostate cancer are well tolerated: a prospective study using patient-reported outcome measures
Karan Wadhwa, Lina Carmona-Echeveria, Timur Kuru, Gabriele Gaziev, Eva Serrao, Deepak Parashar, Julia Frey, Ivailo Dimov, Jonas Seidenader, Pete Acher, Gordon Muir, Andrew Doble, Vincent Gnanapragasam, Boris Hadaschik, Christof Kastner
January-February 2017, 19(1):62-66
DOI:10.4103/1008-682X.173453  PMID:26924279
We aimed to determine short-term patient-reported outcomes in men having general anesthetic transperineal (TP) prostate biopsies. A prospective cohort study was performed in men having a diagnostic TP biopsy. This was done using a validated and adapted questionnaire immediately post-biopsy and at follow-up of between 7 and 14 days across three tertiary referral hospitals with a response rate of 51.6%. Immediately after biopsy 43/201 (21.4%) of men felt light-headed, syncopal, or suffered syncope. Fifty-three percent of men felt discomfort after biopsy (with 95% scoring <5 in a 0-10 scale). Twelve out of 196 men (6.1%) felt pain immediately after the procedure. Despite a high incidence of symptoms (e.g., up to 75% had some hematuria, 47% suffered some pain), it was not a moderate or serious problem for most, apart from hemoejaculate which 31 men suffered. Eleven men needed catheterization (5.5%). There were no inpatient admissions due to complications (hematuria, sepsis). On repeat questioning at a later time point, only 25/199 (12.6%) of men said repeat biopsy would be a significant problem despite a significant and marked reduction in erectile function after the procedure. From this study, we conclude that TP biopsy is well tolerated with similar side effect profiles and attitudes of men to repeat biopsy to men having TRUS biopsies. These data allow informed counseling of men prior to TP biopsy and a benchmark for tolerability with local anesthetic TP biopsies being developed for clinical use.
  2,116 242 1
Prospective randomized comparison of transumbilical two-port laparoscopic and conventional laparoscopic varicocele ligation
Guo-Xi Zhang, Jun Yang, Da-Zhi Long, Min Liu, Xiao-Feng Zou, Yuan-Hu Yuan, Ri-Hai Xiao, Yi-Jun Xue, Xin Zhong, Quan-Liang Liu, Fo-Lin Liu, Bo Jiang, Rui-Quan Xu, Kun-Lin Xie
January-February 2017, 19(1):34-38
DOI:10.4103/1008-682X.169994  PMID:26732104
We have established a novel method named transumbilical two-port laparoscopic varicocele ligation (TTLVL) for varicocele, which is still needed to evaluate. In this study, 90 patients with left idiopathic symptomatic varicoceles of grades II-III according to the Dubin grading system were randomly assigned to TTLVL (n = 45) and conventional laparoscopic varicocele ligation (CLVL) (n = 45). The demographic, intraoperative, postoperative, and follow-up data were recorded and compared between the two groups. All the procedures in the two groups were completed successfully with no intraoperative complications and no conversions to open surgery. No significant difference was found in the operative time, resuming ambulation, bowel recovery, postoperative hospital stay, and postoperative resolution of scrotal pain between the two groups (P > 0.05). However, the postoperative mean visual analog pain scale scores for TTLVL group were all less at 24 h, 48 h, 72 h, and 7 days postoperatively compared to CLVL (P = 0.001, 0.010, 0.006, and 0.027, respectively). The mean patient scar assessment questionnaire score in postoperative month 3 was 29.7 for TTLVL group compared with 32.1 for CLVL group (P < 0.001). There was no testicular atrophy observed in both groups during the follow-up period. The study shows that TTLVL is a safe, feasible, and effective minimally invasive surgical alternative to CLVL for the treatment of varicocele. Compared with CLVL, TTLVL may decrease postoperative pain and improve the cosmetic outcomes.
  2,004 242 -
INVITED RESEARCH HIGHLIGHT
Another piece of the meiosis puzzle
Paul S Cooke, Manjunatha K Nanjappa
January-February 2017, 19(1):3-4
DOI:10.4103/1008-682X.189210  PMID:27633909
  1,766 310 -
ORIGINAL ARTICLES
The performance characteristics of prostate-specific antigen and prostate-specific antigen density in Chinese men
Jeremy YC Teoh, Steffi KK Yuen, James HL Tsu, Charles KW Wong, Brian SH Ho, Ada TL Ng, Wai-Kit Ma, Kwan-Lun Ho, Ming-Kwong Yiu
January-February 2017, 19(1):113-116
DOI:10.4103/1008-682X.167103  PMID:26620456
We investigated the performance characteristics of prostate-specific antigen (PSA) and PSA density (PSAD) in Chinese men. All Chinese men who underwent transrectal ultrasound-guided prostate biopsy (TRUS-PB) from year 2000 to 2013 were included. The receiver operating characteristic (ROC) curves for both PSA and PSAD were analyzed. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at different cut-off levels were calculated. A total of 2606 Chinese men were included. For the ROC, the area under curve was 0.770 for PSA (P < 0.001) and 0.823 for PSAD (P < 0.001). PSA of 4.5 ng ml−1 had sensitivity of 94.4%, specificity of 14.1%, PPV of 29.5%, and NPV of 86.9%; PSAD of 0.12 ng ml−1 cc−1 had sensitivity of 94.5%, specificity of 26.6%, PPV of 32.8%, and NPV of 92.7%. On multivariate logistic regression analyses, PSA cut-off at 4.5 ng ml−1 (OR 1.61, 95% CI 1.05-2.45, P= 0.029) and PSAD cut-off at 0.12 ng ml−1 cc−1 (OR 6.22, 95% CI 4.20-9.22, P< 0.001) were significant predictors for prostate cancer detection on TRUS-PB. In conclusion, the performances of PSA and PSAD at different cut-off levels in Chinese men were very different from those in Caucasians. PSA of 4.5 ng ml−1 and PSAD of 0.12 ng ml−1 cc−1 had near 95% sensitivity and were significant predictors of prostate cancer detection in Chinese men.
  1,680 213 -
Seasonal fluctuation in the secretion of the antioxidant melatonin is not associated with alterations in sperm DNA damage
Gunilla Malm, Trine B Haugen, Lars Rylander, Aleksander Giwercman
January-February 2017, 19(1):52-56
DOI:10.4103/1008-682X.186870  PMID:27748316
A high sperm DNA fragmentation index (DFI) is associated with reduced fertility. DFI is influenced by the balance between reactive oxygen species and antioxidants. A circannual variation in melatonin, an antioxidant and free radical scavenger, could thus impact semen quality and fertility. The association between the major melatonin metabolite, urine 6-sulfatoxymelatonin (aMT6s), and DFI was analyzed in 110 Oslo men (south of the Arctic Circle) and 86 Tromsoe men (north of the Arctic Circle). Two semen analyses, summer and winter, and four urine samples (early/late summer; early/late winter), were analyzed. The associations between aMT6s in urine and DFI were characterized in a cross-sectional and longitudinal manner using correlation analysis and linear regression. Regardless of season and location, no significant correlations between aMT6s and DFI were observed. The correlation coefficients for associations between changes over time (early winter-early summer) in aMT6s and DFI were for the total cohort: rho = −0.08 (P = 0.322), for the Oslo cohort: rho = −0.07 (P = 0.485), and for the Tromsoe cohort: rho = −0.14 (P = 0.273), respectively. Similar results were seen when comparing late winter and late summer. There was no any statistically significant correlation between changes over time in aMT6s and DFI for men with DFI below and above the median value (10%), respectively. The seasonal variation in melatonin excretion seems not to have any impact on DFI.
  1,589 264 -
Men becoming fathers by intracytoplasmic sperm injection were more often born small for gestational age
Susanne Liffner, Mats Hammar, Marie Bladh, Elizabeth Nedstrand, Heriberto Rodriguez Martinez, Gunilla Sydsjö
January-February 2017, 19(1):103-106
DOI:10.4103/1008-682X.178848  PMID:27184547
Being born with nonoptimal birth characteristics decreases the chance of becoming a father. Urogenital malformations as well as metabolic syndrome are more common in men born small for gestational age (SGA) and could be contributing factors to the reduced fertility rate seen in these men. It could imply that men becoming fathers by assisted reproductive technology (ART) more often are born with low birth weight (LBW), preterm, and/or SGA than men conceiving without treatment and also that men where intracytoplasmic sperm injection (ICSI) had to be performed more often are born with nonoptimal birth characteristics than men where conventional in vitro fertilization (IVF) successfully could be used. In this retrospective, case-control study using Swedish national registers, we compared the birth characteristics of 1206 men who have become fathers by ART with a control group consisting of age-matched men who became fathers without treatment. The differences in birth characteristics between men becoming fathers by IVF and ICSI were also assessed. For men becoming fathers by ART, OR of being born with LBW was 1.66 (95% CI = 1.17-2.36) compared with fathers who conceived without treatment. OR of being born prematurely was 1.32 (95% CI = 1.00-1.77). Men becoming fathers via ICSI had a doubled increased likelihood of being born SGA compared with men who became fathers via IVF (OR = 2.12; 95% CI = 1.17-3.83). In conclusion, we have found that men becoming fathers by ICSI treatments had more often been born SGA than men becoming fathers by conventional IVF.
  1,549 190 -
LETTER TO THE EDITOR
Characterization by microarray and meiotic segregation study of a der(10)t(10;18) in a patient with infertility and normal phenotype
Stephan Kemeny, Florence Brugnon, Eléonore Eymard-Pierre, Carole Goumy, Laurent Janny, Andreï Tchirkov, Christine Francannet, Philippe Vago, Céline Pebrel-Richard
January-February 2017, 19(1):135-137
DOI:10.4103/1008-682X.172818  PMID:26975482
  1,465 183 -
INVITED COMMENTARY
Kallikrein-kinin system: is it the fountain of youth?
Giulio Garaffa, Fabio Castiglione
January-February 2017, 19(1):138-139
DOI:10.4103/1008-682X.192636  PMID:27924789
  1,363 186 -
CORRIGENDUM
Corrigendum to "Combination of low-energy shock-wave therapy and bone marrow mesenchymal stem cell transplantation to improve the erectile function of diabetic rats" by Hai-Tao Shan et al.
Hai-Tao Shan, Hai-Bo Zhang, Wen-Tao Chen, Feng-Zhi Chen, Tao Wang, Jin-Tai Luo, Min Yue, Ji-Hong Lin, An-Yang Wei
January-February 2017, 19(1):140-140
DOI:10.4103/1008-682X.189623  PMID:27768008
  1,168 145 -
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