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  Citation statistics : Table of Contents
   2019| January-February  | Volume 21 | Issue 1  
    Online since January 3, 2019

 
 
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INVITED REVIEW
Radical prostatectomy in patients aged 75 years or older: review of the literature
Philipp Mandel, Thenappan Chandrasekar, Felix K Chun, Hartwig Huland, Derya Tilki
January-February 2019, 21(1):32-36
DOI:10.4103/aja.aja_43_17  PMID:28948940
Given the demographic trends toward a considerably longer life expectancy, the percentage of elderly patients with prostate cancer will increase further in the upcoming decades. Therefore, the question arises, should patients ≥75 years old be offered radical prostatectomy and under which circumstances? For treatment decision-making, life expectancy is more important than biological age. As a result, a patient's health and mental status has to be determined and radical treatment should only be offered to those who are fit. As perioperative morbidity and mortality in these patients is increased relative to younger patients, patient selection according to comorbidities is a key issue that needs to be addressed. It is known from the literature that elderly men show notably worse tumor characteristics, leading to worse oncologic outcomes after treatment. Moreover, elderly patients also demonstrate worse postoperative recovery of continence and erectile function. As the absolute rates of both oncological and functional outcomes are still very reasonable in patients ≥75 years, a radical prostatectomy can be offered to highly selected and healthy elderly patients. Nevertheless, patients clearly need to be informed about the worse outcomes and higher perioperative risks compared to younger patients.
  2 2,778 286
ORIGINAL ARTICLES
Lycopene exerts anti-inflammatory effect to inhibit prostate cancer progression
Li-Ning Jiang, Ya-Bin Liu, Bing-Hui Li
January-February 2019, 21(1):80-85
DOI:10.4103/aja.aja_70_18  PMID:30198495
Lycopene is a natural compound that alleviates oxidative stress and inflammation, exerting therapeutic effects in a number of cancers. The aim of this study is to investigate the efficacy of lycopene in inhibiting prostate cancer. Cell viability assays indicated the dose- and time-dependent toxicity of lycopene in prostate cancer cells. Annexin V/propidium iodide double-staining assays revealed the strong apoptotic effects of lycopene. The levels of inflammatory factors, including interleukin-1 (IL1), IL6, IL8, and tumor necrosis factor-α (TNF-α), in lycopene-treated cells were also reduced by lycopene treatment. With the increasing dose of lycopene, the survival of mice bearing prostate cancer xenografts was significantly improved (P < 0.01), and the tumor burden was significantly reduced (P < 0.01). Our results indicate that lycopene is a promising chemotherapy drug, which inhibits prostate cancer progression by suppressing the inflammatory response.
  2 1,776 305
CLINICIAN’S WORKSHOP
Implementation of length expanding inflatable penile prosthesis is not sufficient to prevent postsurgical penile shortening
Jared J Wallen, SriGita K Madiraju, Run Wang, Gerard D Henry
January-February 2019, 21(1):98-100
DOI:10.4103/aja.aja_77_18  PMID:30264738
  1 1,649 154
INVITED REVIEW
Circulating tumor cells and their role in prostate cancer
Moritz Maas, Miriam Hegemann, Steffen Rausch, Jens Bedke, Arnulf Stenzl, Tilman Todenhöfer
January-February 2019, 21(1):24-31
DOI:10.4103/aja.aja_29_17  PMID:28836508
Circulating tumor cells (CTC) have become an important biomarker in patients with advanced prostate cancer. CTC count has been demonstrated to be a prognostic factor for overall survival in patients with metastatic castration-resistant prostate cancer (mCRPC). In localized prostate cancer, a clear correlation between CTC counts and clinicopathological risk parameters and outcome has not been observed. Currently, the focus of research is shifting from CTC enumeration towards molecular characterization of CTC leading to the discovery of markers predicting treatment response. The role of androgen receptor splice variants expressed by CTC as markers of resistance to abiraterone and enzalutamide has been assessed by various studies. The identification of CTC markers predicting treatment response represents a key step to guide the selection of treatment (e.g., abiraterone/enzalutamide vs taxanes), particularly in patients with mCRPC. As an alternative to CTC, the analysis of circulating tumor DNA has been shown to enable a noninvasive disease characterization having high potential to promote precision oncology.
  1 3,849 619
Current concepts and trends in the treatment of bone metastases in patients with advanced prostate cancer
Miriam Hegemann, Moritz Maas, Steffen Rausch, Simon Walz, Jens Bedke, Arnulf Stenzl, Tilman Todenhöfer
January-February 2019, 21(1):12-18
DOI:10.4103/aja.aja_59_17  PMID:29286005
Bone metastases have a major impact on quality of life and survival of patients with advanced prostate cancer. In the last decade, the development and approval of substances inhibiting the vicious cycle of bone metastases have enabled the reduction of complications caused by bone metastases in patients with castration-resistant prostate cancer. These drugs have raised awareness of the importance of skeletal-related events which in the meantime represent an important end point also in trials using agents not specifically designed for bone lesions. Second-generation antihormonal drugs such as enzalutamide or abiraterone have been shown to have a positive impact on the incidence of skeletal complications and therefore provide an important tool in the armamentarium used for treating bone metastases. Radiopharmaceuticals such as radium-223 dichloride ([223Ra]) have been demonstrated not only to reduce skeletal-related events and bone-related pain, but also to prolong overall survival, thereby being the first bone-targeting agent showing a survival benefit. As previous studies have not provided an obvious benefit of bone-targeted lesions in castration-sensitive disease, the use of these agents is not recommended. In oligometastatic prostate cancer, the role of local treatment of metastases using stereotactic radiation or radiosurgery is a matter of intense debates and may play an increasing role in the future.
  1 2,169 424
ORIGINAL ARTICLES
Mean platelet volume might be an effective indicator of arterial erectile dysfunction
Xue-Sheng Wang, Li-Qiang Guo, Zhi-Ying Xiao, Yong Guan, Jian-Ye Zhang, Ming Li, Zhen Ma, Zhi-He Xu, Guo-Mei Ye, Ming-Zhen Yuan
January-February 2019, 21(1):62-66
DOI:10.4103/aja.aja_74_18  PMID:30198496
The aim of our study was to investigate the role of platelet parameters including mean platelet volume (MPV) and platelet count (PC) in the pathogenesis of penile arteriogenic erectile dysfunction (ED) and to evaluate the association between the platelet parameters and arteriogenic ED. There were 244 patients with ED (based on the International Index of Erectile Function [IIEF]-5 ≤21) and 60 healthy controls (IIEF-5 >21) enrolled. All participants were asked to undergo a laboratory examination, and penile vascular function was evaluated using penile color Doppler ultrasonography (pDUS). Among these ED patients, 24 patients with no abnormality on nocturnal penile tumescence (NPT) and 84 with normal vasculature or mixed vascular abnormalities were excluded. The other patients were classified into three groups as follows: control (n = 60), arteriogenic ED (n = 99), and venous leakage (n = 37) groups. MPV and PC were significantly higher in the arteriogenic ED group compared with the venous and control groups (P < 0.05). Receiver operating characteristic curve analysis revealed that the area under the curve for MPV to predict arteriogenic ED was 0.707. MPV ≥9.65 fl was recognized as a cut-off value for potential arteriogenic ED (sensitivity: 47.5%; specificity: 91.7%). A significant inverse correlation was detected between MPV and 10-min peak systolic velocity (PSV) (r = −0.34; P < 0.001) in the arteriogenic ED group. These findings suggest that the MPV might be a powerful indicator to predict and diagnose arteriogenic ED, and MPV may be a marker for ED when using pDUS.
  1 1,164 220
Hypogonadism is independently associated with varicocele repair in a contemporary cohort of men in the USA
Cailey Guercio, Dattatraya Patil, Akanksha Mehta
January-February 2019, 21(1):45-49
DOI:10.4103/aja.aja_61_18  PMID:30381578
We aimed to identify demographic and clinical predictors of varicocele repair in a contemporary cohort of men in the USA. We queried the 2009–2015 MarketScan Database using relevant ICD9, ICD10, and CPT codes to identify all 18–45 year olds with varicoceles. Differences in age, area of residence, clinical characteristics, and medical management between men who did and did not undergo varicocelectomy (open, laparoscopic, or microsurgical) during the study period were compared using unpaired t-tests and Chi-squared tests for continuous and categorical variables, respectively. Multivariable logistic regression analysis was used to evaluate age, semen analyses, and serum hormone assessment as predictors of varicocele repair. SAS version 9.4 was used for all statistical analyses. Significance was set at P < 0.05. Approximately 40% of men with varicoceles underwent repair, primarily through an open approach. Men who underwent repair were more likely to have a diagnosis of male infertility (15.5% vs 7.9%, P < 0.001) and male hypogonadism (3.4% vs 0.9%) and were more likely to complete semen analyses (36.1% vs 12.2%, P < 0.001) and serum testosterone evaluation (42.5% vs 18.8%, P < 0.001). In multivariable regression models, the strongest predictors of varicocele repair were semen analysis (OR = 2.78, 95% CI: 2.56–3.02), age 18–25 years (OR = 2.66, 95% CI: 2.36–2.98), and serum testosterone evaluation (OR = 1.67, 95% CI: 1.51–1.86). Although male infertility remains the most important indication for varicocele repair, male hypogonadism is emerging as an independent predictor of varicocelectomy, which may represent a change in the clinical management of varicoceles in the USA.
  1 1,111 170
Pretreatment serum albumin/globulin ratio as a prognostic biomarker in metastatic prostate cancer patients treated with maximal androgen blockade
Ning Wang, Jian-Ye Liu, Xiong Li, Min-Hua Deng, Zhi Long, Jin Tang, Kun Yao, Yi-Chuan Zhang, Le-Ye He
January-February 2019, 21(1):56-61
DOI:10.4103/aja.aja_50_18  PMID:30027930
The pretreatment serum albumin/globulin ratio (AGR) has been used as a prognostic biomarker for various cancer types. However, the prognostic value of the AGR for prostate cancer, especially for metastatic prostate cancer (mPCa) after maximal androgen blockade (MAB), remains unclear. The aim of this study was to evaluate the prognostic value of the pretreatment serum AGR for mPCa treated with MAB. This retrospective study included 214 mPCa patients receiving MAB from October 2007 to March 2017. The correlation of the AGR with survival was estimated using Kaplan–Meier analysis and Cox proportional hazards models. The cutoff value of the AGR was 1.45 according to the receiver operating characteristic curve. Kaplan–Meier analysis demonstrated that patients with a low AGR (<1.45) had poor outcomes in terms of progression-free survival (PFS) and cancer-specific survival (CSS). Multivariate Cox analyses showed that the AGR was an independent predictor of PFS (hazard ratio [HR] = 0.642; 95% confidence interval [CI]: 0.430–0.957; P = 0.030) and CSS (HR = 0.412; 95% CI: 0.259–0.654; P < 0.001). Furthermore, in a subset of 79 patients with normal serum albumin levels (≥40.0 g l−1), the serum AGR remained an independent predictor of CSS (P = 0.009). The pretreatment AGR was an independent prognostic biomarker for PFS and CSS in patients with mPCa receiving MAB. In addition, the AGR remained effective for the prediction of CSS in patients with normal albumin levels (≥40 g l−1). However, further prospective studies are needed to confirm our conclusions.
  1 1,436 201
Sodium nitrite-derived nitric oxide protects rat testes against ischemia/reperfusion injury
Jae Won Lee, Dong-Hun Lee, Jae Keun Park, Jin Soo Han
January-February 2019, 21(1):92-97
DOI:10.4103/aja.aja_76_18  PMID:30319134
Testicular torsion, a common urologic emergency, is primarily caused by ischemia/reperfusion (I/R) injury of the testis. Nitric oxide (NO)-derived from nitrite (NO2) has been reported to have prominent therapeutic effects on I/R injury in the heart, liver, and brain; however, its effects on testicular I/R injury have not been evaluated. This study, therefore, investigated whether NO from NO2 is beneficial in a rat model of testicular I/R injury which eventually results in impaired spermatogenesis. Male Sprague-Dawley rats were assigned to the following seven groups: group A, sham-operated control group; Group B, I/R with no treatment; Groups C, D, and E, I/R followed by treatment with three different doses of NO2; Group F, I/R followed by administration of NO2 and NO scavenger (2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide potassium salt [C-PTIO]); and Group G, I/R followed by administration of nitrate (NO3). NO2, NO3, and C-PTIO were intravenously administered. Histological examination of the testes and the western blot analysis of caspase-3 were performed. Levels of antioxidant enzymes and lipid peroxidation were measured. Germ cell apoptosis, oxidative stress, antioxidant enzymatic function, and lipid peroxidation in Group B were significantly higher than those in Group A. Group B exhibited an abnormal testicular morphology and impaired spermatogenesis. In contrast, testicular damages were attenuated in the NO2 treatment groups, which were caused by reduction in superoxide and peroxynitrite levels and an inhibition of caspase-3-dependent apoptosis. The results of this study suggest NO2 to be a promising therapeutic agent with anti-oxidant and anti-apoptotic properties in testicular I/R injury.
  1 1,013 157
INVITED EDITORIAL
The 14th international prostate forum
Mevlana Derya Balbay, Abdullah Erdem Canda
January-February 2019, 21(1):1-2
DOI:10.4103/aja.aja_108_18  PMID:30531060
  - 1,264 124
INVITED RESEARCH HIGHLIGHT
PSA screening - for whom and when?
Peter Albers
January-February 2019, 21(1):3-5
DOI:10.4103/aja.aja_37_17  PMID:28879867
  - 3,232 491
Current and emerging trends in prostate cancer immunotherapy
Adam Schatz, Badar M Mian
January-February 2019, 21(1):6-11
DOI:10.4103/aja.aja_52_17  PMID:29176187
  - 2,957 463
INVITED REVIEW
Focal therapy for localized prostate cancer: is there a “middle ground” between active surveillance and definitive treatment?
Cihan H Demirel, Muammer Altok, John W Davis
January-February 2019, 21(1):37-44
DOI:10.4103/aja.aja_64_18  PMID:30178774
In recent years, it has come a long way in the diagnosis, treatment, and follow-up of prostate cancer. Beside this, it was argued that definitive treatments could cause overtreatment, particularly in the very low, low, and favorable risk group. When alternative treatment and follow-up methods are being considered for this group of patients, active surveillance is seen as a good alternative for patients with very low and low-risk groups in this era. However, it has become necessary to find other alternatives for patients in the favorable risk group or patients who cannot adopt active follow-up. In the light of technological developments, the concept of focal therapy was introduced with the intensification of research to treat only the lesioned area instead of treating the entire organ for prostate lesions though there are not many publications about many of them yet. According to the initial results, it was understood that the results could be good if the appropriate focal therapy technique was applied to the appropriate patient. Thus, focal therapies have begun to find their “middle ground” place between definitive therapies and active follow-up.
  - 1,846 240
Contemporary grading of prostate cancer: 2017 update for pathologists and clinicians
Silvia Gasparrini, Alessia Cimadamore, Marina Scarpelli, Francesco Massari, Andrea Doria, Roberta Mazzucchelli, Liang Cheng, Antonio Lopez-Beltran, Rodolfo Montironi
January-February 2019, 21(1):19-23
DOI:10.4103/aja.aja_24_17  PMID:28782737
The Gleason grading system for prostate cancer (PCa) was developed in the 1960s by DF Gleason. Due to changes in PCa detection and treatment, the application of the Gleason grading system has changed considerably in pathology routine practice. Two consensus conferences were held in 2005 and in 2014 to update PCa Gleason grading. This review provides a summary of the changes in the grading of PCa from the original Gleason grading system to the prognostic grade grouping, as well as a discussion of the clinical significance of the percentage of Gleason patterns 4 and 5.
  - 4,159 462
LETTERS TO THE EDITOR
A constitutional jumping translocation involving the Y and acrocentric chromosomes
Makiko Tsutsumi, Naoko Fujita, Fumihiko Suzuki, Takashi Mishima, Satoko Fujieda, Michiko Watari, Nobuhiro Takahashi, Hidefumi Tonoki, Osamu Moriwaka, Toshiaki Endo, Hiroki Kurahashi
January-February 2019, 21(1):101-103
DOI:10.4103/aja.aja_60_18  PMID:30147084
  - 919 171
Time trend and characteristics of prostate cancer diagnosed in Hong Kong (China) in the past two decades
Ho-Fai Wong, Chi-Hang Yee, Jeremy Y C Teoh, Samson Y S Chan, Peter K F Chiu, Ho-Yuen Cheung, Simon S M Hou, Chi Fai Ng
January-February 2019, 21(1):104-106
DOI:10.4103/aja.aja_75_18  PMID:30178778
  - 980 112
ORIGINAL ARTICLES
Sperm fine-needle aspiration (FNA) mapping after failed microdissection testicular sperm extraction (TESE): location and patterns of found sperm
Sheba Jarvis, Heather K Yee, Natalia Thomas, Imok Cha, Kedar Che Prasad, Jonathan W A Ramsay, Paul J Turek
January-February 2019, 21(1):50-55
DOI:10.4103/aja.aja_68_18  PMID:30178775
We sought to evaluate the ability of fine-needle aspiration (FNA) mapping to find sperm and to guide sperm retrieval after failed microdissection testicular sperm extraction (micro-TESE) in nonobstructive azoospermic men. In this study of consecutive male infertility cases, interventions included testicular FNA mapping and subsequent sperm retrieval. Outcomes included the frequency and location of found sperm on FNA maps after failed micro-TESE and the salvage sperm retrieval success. Among 548 patients undergoing FNA mapping from 2010 to 2016, 82 men with previous micro-TESE procedures were identified. The mean time between micro-TESE and FNA mapping was 2.2 years. A total of 2825 (1424 on right and 1401 on left) sites were mapped. At least one site revealed mature sperm in 24 (29.3%) of 82 men with prior failed micro-TESE procedures. There was an equal likelihood of detecting sperm in either testis (6.1% right; 5.7% left; P = 0.58). Digital “heat maps” revealed differences in sperm findings within the testis with mature sperm more likely found in the testis periphery rather than centrally. Fifteen (62.5%) patients subsequently underwent sperm retrieval procedures guided by FNA maps. Sufficient sperm were retrieved in all cases, and in 10 (66.7%) of 15 cases, extra sperm were frozen for future use. In a significant proportion of failed micro-TESE procedures representing the largest study to date, sperm were detected by FNA mapping and could be reliably retrieved through FNA map-guided surgical sperm retrieval. When present, sperm were more likely to be found in the testis periphery rather than centrally with FNA mapping.
  - 2,567 275
The role of vasoepididymostomy for treatment of obstructive azoospermia in the era of in vitro fertilization: a systematic review and meta-analysis
Young Eun Yoon, Hyung Ho Lee, Sung Yul Park, Hong Sang Moon, Dong Suk Kim, Seung-Hun Song, Dae Keun Kim
January-February 2019, 21(1):67-73
DOI:10.4103/aja.aja_59_18  PMID:30106012
This study comprises a systematic review and meta-analysis of microsurgical vasoepididymostomy outcomes in epididymal obstructive azoospermia. A comprehensive literature search was performed using Medline, Embase, and the Cochrane library that included all studies related to microsurgical vasoepididymostomy. Keywords included “vasoepididymostomy,” “epididymovasostomy,” “epididymal obstruction,” and “epididymis obstruction.” Event rate and risk ratio (RR) were estimated. Patency rate and pregnancy rate were investigated. The analysis comprised 1422 articles, including 42 observational studies with 2298 enrolled patients performed from November 1978 to January 2017. The overall mean patency rate was 64.1% (95% confidence interval [CI]: 58.5%–69.3%; I2=83.0%), and the overall mean pregnancy rate was 31.1% (95% CI: 26.9%–35.7%; I2=73.0%). We performed a meta-analysis comparing the patency rate of bilateral microsurgical vasoepididymostomy and unilateral microsurgical vasoepididymostomy and found an RR of 1.38% (95% CI: 1.21%–1.57%; P < 0.00001). A comparison of the site of microsurgical vasoepididymostomy showed that caudal or corpus area was favorable for patency rate (RR = 1.17%; 95% CI: 1.01%–1.35%; P = 0.04). Patients with motile sperm in epididymal fluid exhibited an RR of 1.53% (95% CI: 1.11%–2.13%; P = 0.01) with respect to patency rate. Microsurgical vasoepididymostomy is an effective treatment for epididymal obstructive azoospermia that can improve male fertility. We find that performing microsurgical vasoepididymostomy bilaterally, anastomosing a larger caudal area, and containing motile sperm in epididymis fluid can potentially achieve a superior patency rate.
  - 1,229 237
G protein-coupled receptor kinase 2 inhibition improves erectile function through amelioration of endothelial dysfunction and oxidative stress in a rat model of type 2 diabetes
Zhi-Hua Wan, Yuan-Jie Zhang, Lin Chen, Yong-Lian Guo, Guo-Hao Li, Ding Wu, Yong Wang
January-February 2019, 21(1):74-79
DOI:10.4103/aja.aja_69_18  PMID:30226217
Type 2 diabetes mellitus (T2DM) is a common cause of erectile dysfunction (ED). It has been demonstrated that G protein-coupled receptor kinase 2 (GRK2) overexpression contributes to diabetic endothelial dysfunction and oxidative stress, which also underlies ED in T2DM. We hypothesized that GRK2 overexpressed and attenuated endothelial function of the cavernosal tissue in a rat model of T2DM. T2DM rats were established by feeding with a high-fat diet (HFD) for 2 weeks and then administering two intraperitoneal (IP) injections of a low dose of streptozotocin (STZ), followed by continuous feeding with a HFD for 6 weeks. GRK2 was inhibited by IP injection of paroxetine, a selective GRK2 inhibitor, after STZ injection. Insulin challenge tests, intracavernous pressure (ICP), GRK2 expression, the protein kinase B (Akt)/endothelial nitric oxide synthase (eNOS) pathway, nicotinamide adenine dinucleotide phosphate (NADPH) oxidase subunit gp91phox, nitric oxide (NO), reactive oxygen species (ROS) production, and apoptosis in cavernosal tissue were examined. Less response to insulin injection was observed in T2DM rats 2 weeks after HFD. Markedly increased GRK2 expression, along with impaired Akt/eNOS pathway, reduced NO production, increased gp91phox expression and ROS generation, increased apoptosis and impaired erectile function were found in T2DM rats. Inhibition of GRK2 with paroxetine ameliorated Akt/eNOS signaling, restored NO production, downregulated NADPH oxidase, subsequently inhibited ROS generation and apoptosis, and ultimately preserved erectile function. These results indicated that GRK2 upregulation may be an important mechanism underlying T2DM ED, and GRK2 inhibition may be a potential therapeutic strategy for T2DM ED.
  - 1,167 204
Does prostate-specific antigen (PSA) mass or free PSA mass improve the accuracy of predicting total prostate volume in relation to obesity in men with biopsy-proven benign prostatic hyperplasia?
Jin-Woo Jung, Young Dong Yu, Young Ju Lee, Jung Jun Kim, Hak Min Lee, Jong Jin Oh, Sangchul Lee, Sang Wook Lee, Sang Eun Lee, Seong Jin Jeong
January-February 2019, 21(1):86-91
DOI:10.4103/aja.aja_66_18  PMID:30178776
We evaluated whether the prostate-specific antigen (PSA) mass or free PSA (fPSA) mass (i.e., absolute amount of total circulating PSA or fPSA protein, respectively), versus serum PSA or fPSA concentration, improves the accuracy of predicting the total prostate volume (TPV) in relation to obesity. Among men whose multicore (≥12) transrectal prostate biopsy was negative, 586 who had a PSA of ≤10 ng ml−1 and underwent the fPSA test prior to biopsy were enrolled. The PSA mass or fPSA mass (μ g) was calculated by multiplying the serum level by plasma volume. At each TPV cut-off point (30 ml, 40 ml, and 50 ml), the areas under the receiver operating characteristics curve (AUCs) of each variable were compared in obesity-based subgroups. AUCs of fPSA and fPSA mass for predicting TPV were significantly larger than those for PSA and PSA mass by 8.7%–12.1% at all cut-off points. Subgroup analyses based on obesity showed that, although PSA mass and fPSA mass enhanced accuracy by 4% (P = 0.031) and 1.8% (P = 0.003), respectively, for determining TPVs of ≥30 ml and ≥50 ml in obese and overweight men, they did not improve the accuracy in most other combinations of the degrees of obesity with TPV cut-off points. Thus, compared with serum PSA or fPSA, the absolute amount of PSA or fPSA protein mass improved the accuracy of predicting TPV in obese men very minimally and only for certain TPV cut-off points. Hence, these indicators may not provide clinically meaningful improvement in predicting TPV in obese men.
  - 1,209 149
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