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PURPOSE: Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice. MATERIALS AND METHODS: Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured. RESULTS: The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%). CONCLUSIONS: This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial.
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BACKGROUND: Renal failure is a global medical problem. The use of mesenchymal stem cells (MSCs) for preservation and regeneration of renal tissue in acute and chronic kidney diseases has recently been the focus of investigation. OBJECTIVE: To evaluate the protective effect of MSC injections in a rat model of kidney obstruction. DESIGN SETTING AND PARTICIPANTS: We assigned 15 male Wistar rats to three separate groups: the normal group underwent left nephrectomy; the control group underwent laparotomy and left ureter ligation followed by saline injection into the aorta; and the study group received MSCs injected into the aorta inferior to the left renal artery after ligation of the left ureter. Kidneys were harvested 4 wk later and renal parenchyma samples were used for trichrome staining and for expression analyses. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The degree of kidney fibrosis was assessed on pathology. Real-time polymerase chain reaction was used to determine expression levels of VEGF, TNF-α, and E-cadherin, and ΔCT and ΔΔCT values were calculated. Data were analyzed using SPSS v19 with paired t tests and nonparametric independent-sample Kruskal-Wallis tests. RESULTS AND LIMITATIONS: Fibrosis in the study group decreased from grade 3 or 4 to grade 1. In the control group, TNF-α expression increased and E-cadherin expression decreased. After MSC injection into obstructed kidneys, TNF-α and E-cadherin expression levels decreased and increased respectively, reaching similar levels to those in the normal group. No correlation between tissue regeneration and VEGF levels was observed. More research is needed to focus on other angiogenic factors. CONCLUSIONS: MSC injection could prevent fibrosis in obstructed rat kidney via alterations in TNF-α and E-cadherin expression. PATIENT SUMMARY: We investigated the effect of stem cell injection in rats with kidney obstruction. The treatment led to changes in the levels of two biomarkers and reduced the amount of kidney fibrosis caused by kidney obstruction.
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BACKGROUND: Candida species are normal mycoflora of human body which are capable to cause urinary tract infection (UTI). Mannose-binding lectin (MBL) is a kind of innate immune system and decreasing plasma levels of MBL may disrupt the natural immune response and increase susceptibility to infections. OBJECTIVES: The aim of the present study was to assess MBL in the serum of patients with candiduria and compare them with control. PATIENTS AND METHODS: The blood and urine samples were collected from 335 patients (hospitalized in Golestan hospital, Ahvaz) using standard methods and the growing colonies on CHROMagar were identified using routine diagnostic tests. MBL activity in the serum of 45 patients with candiduria and 45 controls was measured using Eastbiopharm enzyme-linked immunosorbent assay (ELISA) kit. RESULTS: In this study, 45 (13.4 %) urine samples were positive for Candida species (17 males and 28 females). The most common isolated yeast was Candida albicans (34%), followed by C. glabrata (32.1%), C. tropicalis (9.4%), other Candida species (22.6%), and Rhodotorula species (1.9%). The mean serum levels of MBL were 0.85 ± 0.01 ng/mL and 1.02 ± 0.03 ng/mL among candiduric patients and controls, respectively, and there was no significant difference between the two groups (P = 0.6). CONCLUSIONS: Our results showed that there was no significant relationship between MBL serum levels and candiduria.
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PURPOSE: Cigarette smoking contributes to a number of health-related problems, but its impact on allograft survival in kidney recipients is not clear. This study was performed to evaluate the relationship between smoking and graft survival. MATERIALS AND METHODS: A total of 199 adult kidney recipients were enrolled in this study. All transplantations had been done in our center and all grafts had been taken from living donors. The patients were asked about their cigarette smoking behavior before transplantation and assessed for diabetes mellitus, hypertension, and hyperlipidemia, pre- and post-operatively. RESULTS: Of 199 recipients, 142 (71.4%) were male and 57 (28.6%) were female. They were 40.45 (range 18 to 65) years old. Forty-one recipients (20.6%) were smokers before kidney transplantation that 87.7% of them continued smoking after transplantation. Mean pack-year smoking was 13.2. Of the patients, 32.7% and 33.7% had hypertension, 19.3% and 23.1% had diabetes mellitus, and 46.2% and 42.2% had hyperlipidemia, before and after transplantation, respectively, showing no significant difference. Pretransplant smoking was significantly associated with reduced overall graft survival (P = 0.01), but no correlation between smoking cessation after transplantation with survival graft was found. CONCLUSION: Cigarette smoking before kidney transplantation contributes significantly to allograft loss. However, smoking is not associated with increase in rejection episodes. Although we could not prove it, smoking cessation after renal transplantation may have beneficial effects on graft survival. These effects should be emphasized for patients with end-stage renal disease who are candidates for kidney transplantation.