Targeting the PANoptosome with 3,4-Methylenedioxy-ß-Nitrostyrene, Reduces PANoptosis and Protects the Kidney against Renal Ischemia-Reperfusion Injury.

OBJECTIVES: The objectives of this study were a) to investigate the effect of targeting the PANoptosome with 3,4-methylenedioxy-ß-nitrostyrene (MNS) on PANoptosis in the Renal ischemia-reperfussion (RIR) model b) to investigate the kidney protective effect of MNS toward RIR injury. METHODS: Thirty-two rats were divided into four groups randomly. The groups were assigned as Control, Sham, DMSO (dimethyl sulfoxide) and MNS groups. The rats in the MNS group were intraperitoneally given 20 mg/kg of MNS 30 minutes before reperfusion. 2% DMSO solvent that dissolves MNS were given to the rats in DMSO group. Left nephrectomy was performed on the rats under anesthesia at the 6th hour after reperfusion. Glutathione peroxidase (GPx), malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD) and 8-Okso-2'-deoksiguanozin (8-OHdG) levels were measured. Immunohistochemical analysis, electron microscopic and histological examinations were carried out in the tissues. RESULTS: Total tubular injury score was lower in the MNS group (p < 0.001). Caspase-3, Gasdermin D and MLK (Mixed Lineage Kinase Domain Like Pseudokinase) expressions were considerably decreased in the MNS group (p < 0.001). Apoptotic index (AI) was found to be low in the MNS group (p < 0.001). CAT and SOD levels were higher in the MNS Group (p = 0.006, p = 0.0004, respectively). GPx, MDA, and 8-OH-dG levels were similar (p > 0.05) in all groups. MNS considerably improved the tissue structure, based on the electron microscopic analysis. CONCLUSIONS: Our results suggested that MNS administrated before the reperfusion reduces pyroptosis, apoptosis and necroptosis. These findings suggest that MNS significantly protects the kidney against RIR injury by reducing PANoptosis as a result of specific inhibition of Nod-like receptor pyrin domain-containing 3 (NLRP 3), one of the PANoptosome proteins.

Are there factors in the disease of peroneal necrotizing fasciitis which should be used when choosing the anesthetic technique?: Descriptive analysis of a cohort from two centers.

BACKGROUND: This study aims to examine the factors affecting the selection of anaesthesia method in Fournier's gangrene. METHODS: A retrospective evaluation was made of 113 patients operated on because of Fournier's gangrene between January-May 2019. The operations were performed under spinal anaesthesia in 78 cases (Group S) and under general anaesthesia in 35 cases (Group G). The patients were evaluated regarding age, gender, the anaesthesia method used (spinal, general) anaesthetic agent applied, presence of sepsis, and biochemical, hematological and inflammatory parameters. RESULTS: When the patients were evaluated regarding the Fournier Gangrene Severity Index (FGSI), patients in Group S had lower scores (p=0.001). Examination of the tomography images revealed that in 13 (37.1%) patients, air values were seen in the right or left gluteal area, or both, extending to the subcutaneous tissue. In the evaluation of the factors affecting the selection of general anaesthesia, a positive correlation was determined between an increase in FGSI (r=0.482, p=0.001) and the presence of sepsis (r=0.485, p=0.001) and gluteal region involvement (r=0.628, p<0.001). CONCLUSION: The selection of anaesthesia method in Fournier gangrene patients is a complex process affected by factors, such as the patients' general condition, sepsis, and whether or not there is bleeding diathesis. The risk -benefit balance in the selection of anaesthesia method should be evaluated individually for patients.

Pre-treatment Delta Neutrophil Index as a Predictive Factor in Renal Cell Carcinoma.

OBJECTIVE: To determine the diagnostic value of the pre-treatment delta neutrophil index (DNI) before treatment in patients with renal cell carcinoma (RCC) and to compare this marker with other routine inflammation markers, such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Urology, Kahramanmaras Sutcu Imam University, Turkey, from February 2017 to January 2020. METHODOLOGY: Data of patients who underwent radical nephrectomy for RCC, were evaluated. For comparison, healthy individuals were included in the study as a control group. Demographic data, such as age, gender, routine laboratory tests, DNI, NLR, and PLR levels of the groups were recorded and compared. RESULTS: There were 73 patients in the RCC group and 71 healthy individuals in the control group. DNI, NLR and PLR levels were significantly higher in the RCC group (p <0.001, each). DNI and NLR were significantly higher in patients with advanced stage (T3-T4) and high grade (G3-G4). In univariate logistic regression analysis hemoglobin (p=0.023), neutrophil (p<0.001), lymphocyte (p=0.009), platelet (p<0.001), DNI (p<0.001), NLR (p<0.001) and PLR (p<0.001) were identified as predictors for RCC. In multivariate logistic regression analysis, DNI and NLR (p<0.001, each) were found to be the predictors of RCC. Cut-off values were 0.45% for DNI, 1.80 for NLR, and 130.09 for PLR. CONCLUSION: DNI is a new inflammatory marker, which is included in complete blood count parameters; and does not require any additional calculation, unlike NLR and PLR. It can be used in the prediction of RCC. Key Words: Renal cell carcinoma, Delta neutrophil index, Neutrophil-lymphocyte ratio, Platelet-lymphocyte ratio.

At What Age Threshold does the Decline in Semen Parameters Begin?

OBJECTIVE:  To analyse changes in semen parameters according to different age groups in men presenting to an infertility clinic, and determine the age threshold for decline in semen quality. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Andrology Laboratory, Department of Urology, Kahramanmaras Sütçü Imam University, Turkey, from January 2018 to December 2019. METHODOLOGY: Semen analysis records of infertile men, who were referred to Andrology Laboratory, were retrospectively evaluated. The age groups were categorised as 20-29, 30-34, 35-39, 40-44, and 45-55 years. Each group was completed to 100 semen samples retrospectively and sequentially without any preferences. The differences of semen parameters between age groups were analysed with the one-way ANOVA test. Linear relationship was checked by ANOVA. RESULTS: The mean age of 500 patients was 37.18 ± 8.11 years. While no linear relationship was observed in semen volume, concentration, and total sperm count with age (p=0.133, p=0.290 and p=0.261, respectively). A linear decline was observed in progressive motility, vitality, and morphology parameters with advancing age (all, p<0.001). In linear contrast analysis according to the 20-29 age group; significant decline in progressive sperm motility, morphology, and vitality started and continued in the 35-39 age group (all, p<0.001). CONCLUSION: With advancing age, a significant linear decrease in sperm motility, morphology and vitality was observed in infertile men. This significant decline in sperm motility, morphology and vitality continues at age 35 and over. Therefore, infertile men who plan to postpone paternity should consider the age factor. Key Words: Aging, infertility, Paternal age, Semen analysis, Sperm.

The Delta Neutrophil Index is an Early Predictive Marker of Acute Pyelonephritis in Patients with Ureteral Stone.

OBJECTIVE: To determine the predictive value of the delta neutrophil index (DNI) for acute pyelonephritis (APN), which increases in conditions of infection and inflammation. STUDY DESIGN: Observational, comparative cross-sectional study. PLACE AND DURATION OF STUDY: Department of Urology, Kahramanmaras Sütçü Imam University, Turkey, from December 2014 to November 2019. METHODOLOGY: The data of 205 patients, diagnosed with ureteral stone and urinary tract infection (UTI), were evaluated. For comparison, patients were categorised into two groups: those with lower UTI (LUTI) and those with APN. Together with demographic data of patients and ureteral stone, DNI, C-reactive protein (CRP), white blood cell (WBC) and other biochemical parameters were analysed. RESULTS: There were 165 patients (80.5%) in the LUTI group and 40 patients (19.5%) in the APN group. In univariate analysis, age (p=0.023), creatinine (p=0.001), PT/INR (p=0.007), WBC (p <0.001), CRP (p=0.002) and DNI (p <0.001) were identified as predictors of APN. In multivariate analysis, CRP (p=0.019) and DNI (p=0.009) were significantly associated with the predictors of APN. Cut-off values were 11.75 mm3 for WBC, 22.2 mg/dL for CRP, and 1.3% for DNI. DNI value was positively correlated with WBC and CRP (r=0.369 vs. 0.740 and p <0.001, each). CONCLUSION: As an infection marker that can be monitored with a complete blood count and does not require additional costs, DNI can be used as an early predictor of APN. Patients with a DNI value of >1.3% should be considered for early intervention. Key Words: Ureteral stone, Acute pyelonephritis, Delta neutrophil index, C-reactive protein, White blood cell.

Relationship between the G protein-coupled oestrogen receptor and spermatogenesis, and its correlation with male infertility.

The aim of this study was to investigate the diagnostic value of serum G protein-coupled oestrogen receptor (GPER) levels and their correlation with semen parameters in men with infertility. The participants were divided into two groups as follows: 76 fertile control men (Group 1) and 77 infertile men (Group 2). Semen analysis, hormonal evaluation, serum GPER level and scrotal ultrasound of the participants were evaluated. Follicle-stimulating hormone and total testosterone levels were not significantly different between the groups (p = .413 and p = .535 respectively). The oestradiol level in Group 1 was significantly lower than that in Group 2 (p < .001). The serum GPER level was found to be significantly higher in Group 1 than that of Group 2 (p < .001). GPER levels were positively correlated with the total sperm count, sperm concentration, motility and morphology in Group 2 (r = 0.303, 0.345, 0.260 and 0.322, respectively, p < .001). In this study, GPER levels were positively correlated with sperm parameters, and it was hypothesised that the decrease in GPER expression might be associated with male infertility by adversely affecting spermatogenesis.

Ziziphus jujube ameliorated cavernosal oxidative stress and fibrotic processes in cavernous nerve injury-induced erectile dysfunction in a rat model.

The aim of this study was to investigate potential antioxidant and antifibrotic effects of Ziziphus jujube (ZJ) in a cavernosal nerve injury (CNI)-induced erectile dysfunction (ED) rat model. Forty-eight male rats were assigned to six-sized groups as group 1: sham-operated; group 2: sham-operated + low-dose ZJ (200 mg/kg); group 3: sham-operated + high-dose ZJ (400 mg/kg); group 4: CNI + distilled water; group 5: CNI + low-dose ZJ; and group 6: CNI + high-dose ZJ. At the end of 2 weeks, intracardiac blood was taken and rats were sacrificed. For biochemical analysis, cavernosal transforming growth factor-beta-1, collagen type I and type 3, fibronectin, α and ß actin were examined in plasma and cavernosa. Superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA) and prolidase levels were measured in serum to evaluate antioxidant effect of ZJ. Histopathological examination of tissues revealed that highest fibrosis rate was in group 4 (66.84%). Collagen 1 and 3, alpha and beta actin, fibronectin levels were significantly different among groups (p < .05). Differences between plasma SOD, CAT, MDA and prolidase were also significant among those groups (p < .05). In this study, antioxidant and antifibrotic effects of ZJ were determined in the corporal tissue after CNI. It is thought that ZJ may be beneficial on ED patients especially after radical pelvic surgeries.

The role of apoptosis and the effect of epidermal growth factor on proapoptotic BNIP 3 in an experimental rat priapism model

Background/aim: This study aimed to investigate the effects of apoptosis-inducing Bcl-2/adenovirus E1B 19 kDa-interacting protein 3 (BNIP 3) and antiapoptotic epidermal growth factor (EGF) on the pathophysiology of experimental low-flow priapism. Materials and methods: Twenty-four adult Sprague-Dawley rats were divided into four equal groups. Group I was the control group. Ischemic priapism was induced for 4 h in Group II rats. In Group III, intraperitoneal EGF at 10 µg/kg was given for 7 days before induction of ischemic priapism for 4 h. In Group IV, intraperitoneal EGF at 20 µg/kg was given for 7 days before induction of ischemic priapism for 4 h. The western blot method was used to determine BNIP 3 expression levels and the TUNEL method was used to determine the apoptotic cells in the cavernosal tissue samples. Results: Although BNIP 3 expression levels were significantly higher in all three study groups compared to the controls, BNIP 3 was significantly higher in EGF-administered groups when compared to Group II (P < 0.05). The TUNEL score of group II was significantly higher than those of the other groups. Conclusion: Decreased apoptosis in cavernosal tissues obtained by antagonizing the apoptotic effect of BNIP 3 with EGF may facilitate the development of new conservative treatment methods via those pathways.

Role of percutaneous posterior tibial nerve stimulation either alone or combined with an anticholinergic agent in treating patients with overactive bladder.

OBJECTIVE: To evaluate the efficacy of percutaneous tibial nerve stimulation (PTNS), either alone or combined with an anticholinergic agent, in treating patients with an overactive bladder (OAB) in whom previous conservative treatment failed. MATERIAL AND METHODS: In this study, we included a total of 30 female patients with OAB in whom all conventional therapies failed between January 2010 and April 2011. Patients were randomly divided into three groups: Group 1, PTNS group; Group 2, patients receiving an anticholinergic agent; and Group 3, patients receiving both PTNS and anticholinergic agent. PTNS treatment continued for 12 weeks with each session lasting 30 min. RESULTS: All parameters of the bladder diary significantly improved in all groups (p<0.05). Similarly, all scores measured by questionnaires (UDI-6, IIQ-7, and OABSS) revealed significant improvements in all groups. When the improvements in symptoms were compared among the groups, there was a statistically significantly higher improvement in groups 1 and 3 than in Group 2. CONCLUSION: PTNS is a safe, simple, and minimally invasive treatment modality in patients with OAB, and it may be suggested either alone or in combination with anticholinergics when conventional treatments fail.

Endoscopic removal of intravesical polypropylene suture with plasmakinetic resection after abdominal hysterectomy.

INTRODUCTION: Intravesical foreign substances such as mesh or suture are among the rare reasons of recurrent urinary tract infections. Anti-incontinence and prolapsus procedures are associated with mesh/suture extrusion into the bladder, however, this complication is uncommon with abdominal hysterectomy. PRESENTATION OF CASE: A 61-year-old female, obese patient admitted to our clinic with recurrent urinary tract infections and voiding symptoms which were worsened after abdominal hysterectomy. Radiological evaluation revealed an intravesical foreign material within the bladder. The cytoscopy was performed and a polypropylene suture which was inserted from dome, passed through the base and exited from the dome of bladder during abdominal hysterectomy. Transurethral plasmakinetic resection of superficial layer of urothelium between suture entrance and exit sites was performed and suture was removed from the bladder. DISCUSSION: Urogynecological procedures are associated with the increased risk of urethral or ureteral injury, intravesical mesh or suture erosion and fistulae formation. Many different techniques including open, laparoscopic and transvaginal approaches were described for the removal of intravesical mesh/suture extrusion in the literature. Transurethral approach with its minimally invasive and safe nature was used to remove suture in this patient. This technique with the use of plasmakinetic energy has the advantage of decreased risk of bleeding and urothelial injury when compared to monopolar cautery. It also avoids the need for open or extensive surgery which may have a high rate of complications. CONCLUSION: Transurethral resection is the treatment of choice for the removal of intravesical foreign substances. Use of plasmakinetic energy will decrease the risk of complications and avoid the need for open interventions.