Paternal thrombophilia and recurrent implantation failure: an exploratory case-control study.

OBJECTIVE: Many pieces of literature have reported that inherited and acquired thrombophilia might be a risk factor for recurrent implantation failure (RIF), however, most studies have only focused on RIF patients and not their male partners. We studied the possible association of paternal thrombophilia with RIF risk. METHODS: Forty-two male partners aged 20-45 suffered from RIF compared with 42 males from couples with at least one successful pregnancy. All participants were investigated for thrombophilia markers. RESULTS: The prevalence of coagulation Factor V activity was significantly higher in the case group (42.9%) than in the control group (16.7%) (p=0.008) (OR=3.75; 95% CI, 1.38, 10.12). The prevalence of protein C and protein S deficiencies in RIF patients were 4.8% and 2.4%, respectively, and 0% in the controls. The prevalence of antithrombin III (ATIII) deficiency was significantly higher in the case group (19%) than in the control group (2.4%) (p=0.01). None of MTHFR C677T and MTHFR A1298C were statistically significant between the two groups. Combined thrombophilia was 45.2% in the men of the RIF group when compared with the control, 14.2% (p=0.001) (OR = 4.95; 95% CI, 1.75-13.86). CONCLUSIONS: Paternal thrombophilia may be related to recurrent implantation failure, so evaluation of this factor in RIF patients could be used to identify relevant risk groups and may help in the proper management of these cases to enhance the chance of implantation.

The Correlation of Urine Bisphenol A with Semen Parameters in Men Referred to Infertility Centers: A Cross-Sectional Study.

BACKGROUND: Bisphenol A (BPA) is known as an endocrine disruptor that has harmful effects on general health. It is commonly used in various industrial products. In this study we tried to evaluate the amount of BPA in urine samples of the men referred to an infertility center. MATERIALS AND METHODS: The cross-sectional study population consisted of male partners of infertile couples, who were referred to infertility clinic in Mazandaran, a northern state of Iran. Questionnaires included demographic characteristics, medical history, lifestyle factors, physical examinations. A semen sample and a spot urine sample were taken from each participant. In the initial study group of 240 men, 3 groups were excluded, and 122 men remained for the analysis. Highperformance liquid chromatography (HPLC) was applied to measure the amount of BPA in the urine samples. RESULTS: BPA was not detected in about half of the samples (53.3%). Multiple linear regression analysis showed that no significant relationship existed between the urine concentrations of BPA, semen parameters and male reproductive hormones. However, in a comparison with semen parameters in people with detectable urine BPA versus nondetectable ones, an inverse association was noticed with sperm concentration. In other parameters, differences were not significant. Smoking had no effects on sperm parameters, but body mass index (BMI) ≥25 reduced the percentage of normal sperm parameters. CONCLUSION: In most participants, urinary BPA was not detected. Probably in this study low environmental exposure to BPA is the cause of lower urine BPA concentrations compared to other industrially developed countries. Therefore, no overall relationship was observed between BPA level and male infertility.

Investigation of biological activities of two cultivars of Cicer arietinum proteins mass associated with Alzheimer's disease.

Alzheimer's disease (AD) is the most common cause of dementia in the elderly, with some known classical factors. Cicer arietinum (Leguminosae) is a source of protein for humans and contains albumin, globulin, glutelin, and prolamin. The protein content of two cultivars of C. arietinum, Hashem and Mansour, was isolated to evaluate their inhibition activity against acetylcholinesterase (AChE), butyrylcholine esterase (BChE), and ß-amyloid peptide (ßA) aggregation. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and molecular docking were also applied to evaluate the content and determine the potential of each chickpea protein to interact with AChE, respectively. Obtained data showed that proteins from both cultivars could inhibit AChE with IC50 of 17.73 (0.03) and 22.20 (0.06) µg/mL, respectively, with no activity on BChE. The 50 µg/mL protein concentration of each cultivar suppressed ßA accumulation (Mansour: 25.66% and Hashem: 21.69%) and showed biometal chelating activity. SDS-PAGE analysis revealed relatively different protein patterns, though the Mansour cultivar contained some protein bands with molecular weights of 18, 24, and 70 kDa were estimated to belong to vicilin and legumin, which were absent in the Hashem protein mass. Molecular docking showed that legumin and especially vicilin have good potential to interact with AChE. The chickpea proteins showed inhibitory activity against AChE, which might be due to the vicilin and legumin fractions. The characterization of the inhibitory effect of each protein band could be promising in finding new therapeutic peptide candidates to treat Alzheimer's in the future, although more experimental work is needed in this issue.

Comparison of the Effect of Ceratonia siliqua L. (Carob) Syrup and Vitamin E on Sperm Parameters, Oxidative Stress Index, and Sex Hormones in Infertile Men: a Randomized Controlled Trial.

Herbal products with an antioxidant capacity can boost male reproductive functions. The empiric use of Ceratonia siliqua (carob) for its antioxidant properties is common among infertile men in Iran and Turkey. The objective of this study is to investigate the effects of C. siliqua (carob) on semen parameters, oxidative stress markers, and pregnancy rate in a parallel randomized, controlled study. A total of 60 infertile men with oligozoospermia, asthenospermia, and teratospermia were recruited from April 2018 to March 2019. Participants were divided randomly into the following two groups: carob syrup twice a day or vitamin E 100 mg twice a day for 3 months. Semen analysis was performed and hormonal levels and stress oxidative markers were measured in each treatment arm after 3 months. The quality of semen parameters improved in the carob group compared with Vit E semen count (p = 0.04 Cohen's d = .51), morphology (p = 0.001 Cohen's d = .93) and motility parameters (p = 0.002 Cohen's d = .90) were significantly higher in the carob group. No significant difference can be detected in post-treatment hormonal parameters and oxidative markers between groups, except for total antioxidant capacity(TAC) which was higher after post-treatment in carob group. A significantly higher pregnancy rate was found among the carob group. The administration of carob may be an effective agent for the improvement of semen parameters, probably related both to its involvement in the changing of testosterone level and to its antioxidant properties. Nevertheless, additional studies to evaluate the optimal dose and duration of treatment are needed. The trial has been registered in the Iranian Registry of Clinical Trials (Registration number: IRCT20171209037794N1.

Superglue self-insertion into the male urethra - A rare case report.

BACKGROUND: Foreign body insertion in the urethra and bladder are relatively rare. These patients usually insert foreign body in urethra for eroticism, inquisitiveness, or as a consequence of disinhibited or disturbed behavior. CASE PRESENTATION: Herein, we report a case of 41-year-old man presented with weak stream and suprapubic pain. Due to incontinence, he instilled superglue into his urethra. On perineal examination, a foreign body was palpable in the penile urethra. A 10 cm dried superglue block got out with incision at glance. CONCLUSION: Urethral foreign bodies are mostly found on physical examination and clinical history. Although imaging modalities are commonly used for FBs detection, the necessity of imaging modalities are still a controversy.

Effect of Ceratonia siliqua (Carob) syrup and vitamin E on sperm parameters, oxidative stress index and sex hormones in infertile men: Protocol for a randomized controlled trial.

BACKGROUND: Spermatogenesis is a necessary process in fertility and reproductive capacity of humans. In view of the relative high prevalence of spermatogenesis disorders in men and the failure of treatments provided in conventional medicine, new therapeutic approaches are being considered. This study will be designed to investigate the effect of Ceratonia siliqua (Carob) syrup and vitamin E on sperm parameters, oxidative stress index and reproductive hormones in infertile men. METHODS: This randomized controlled trial protocol will be set in Babol Uuniversity of Medical Sciences. The proposed sample size is 60 men with oligozoospermia and teratospermia with 30 men in the experimental group taking Carob syrup while 30 men in the comparison group receiving vitamin E. The primary outcome measure is the change in semen parameters and secondary outcome measures including change in endocrine parameters and stress oxidative markers. This research was registered in the website of Iranian Registry of Clinical Trials as IRCT20171209037794N1identification number. CONCLUSION: If the beneficial effect of this herb can be confirmed, it will provide a cost-effective method for helping infertile men and provide evidence-based references for the treatment of male infertility in future.

Transhiatal versus Left Transthoracic Esophagectomy for Gastroesophageal Junction Cancer; The Impact of Surgical Approach on Postoperative Complications.

BACKGROUND Esophagectomy is the mainstay of treatment for esophageal cancer. Although different surgical approaches have been described, choosing the most appropriate technique is still on debate. We compared the complications of transhiatal esophagectomy (THE) versus left transthoracic esophagectomy (LTE) among a group of Iranian patients with gastroesophageal junction cancer. METHODS This was a retrospective study between 2011 and 2013 on 40 patients with gastroesophageal cancer. 23 patients underwent THE and the others underwent LTE. 30-day postoperative mortality, complications, duration of hospital stay, and number of dissected lymph nodes were studied. RESULTS 37.5% of the patients had squamous cell carcinoma. No mortality was seen. Totally, 10 patients suffered from complications. Cardiac and pulmonary complications occurred in eight and six patients, respectively. No patients suffered from vocal cord injuries and anastomotic leakage. The mean duration of postoperative hospital stay was 11.82 ± 3.8 days, and the mean number of dissected lymph nodes was 8.2 ± 3.9. No significant difference was seen between the two groups (p > 0.05). CONCLUSION Choosing between the approaches for resection of gastroesophageal cancer may not impact the complications and mortality rates. We propose that LTE approach could be used safely in comparison with THE, and that selecting between THE and LTE may be based on the surgeon's preference and experience.

Outcomes of Neoadjuvant Chemoradiation in Patients with Gastro-esophageal Junction Adenocarcinoma: a Retrospective Cohort Study in Iran.

PURPOSE: The optimal treatment for locally advanced GEJ and cardia adenocarcinoma is controversial. Several studies have shown that treating these patients with neoadjuvant chemoradiotherapy followed by surgery leads to survival benefits, and there are also studies that have declared conflicting results. It seems that there is still room for discussion. We calculated the survival rates and pathologic responses in our patients with characteristics which we mentioned above. METHODS: Patients with locally advanced, non-metastatic GEJ and cardia adenocarcinomas (only patients with Siewert's type I and II), who were referred to Imam Khomeini hospital (Institute of cancer) between 2005 and 2014 and received neoadjuvant chemoradiation and underwent surgery were enrolled in this retrospective cohort study. Evaluations were done every 3 months. RESULTS: Thirty-two patients enrolled in this study. Median follow up time was 23 months (Reverse Kaplan-Meier method). The rates of 1-year survival, 2-year survival, 3-year survival, 4-year survival, and 5-year survival were 75%, 52%, 52%, 37%, and 37%, respectively. No local recurrences occurred among patients; however, four patients experienced distal recurrence in the following locations: two cases (6.3%) in the liver, one case (3.1%) in the lung, and one case (3.1%) in the peritoneum. The rate of complete pathologic response (T0N0) was 21.9%. CONCLUSIONS: Neoadjuvant chemoradiation in patients with locally advanced GEJ and cardia adenocarcinoma will lead to a survival benefit.

PRELIMINARY INVESTIGATION OF NORMOGLYCEMIC, ANTI-HYPERGLYCEMIC AND DYSLIPIDEMIC ACTIVITIES OF DIFFERENT EXTRACTS OF TINOSPORA CRISPA ON DIABETIC RAT.

Tinospora crispa is an indigenous medicinal plant belonging to Menispermaceae family, known localy as "akar patawali" or as "akar seruntum". Different parts of this plant are used for various therapeutic purposes for treatment of hypertension, stimulation of appetite, protection from mosquito bites and to treat ailments like jaundice, wounds, intestinal worms and skin infections, tooth and stomach aches, coughs, asthma and pleurisy. The stems were washed, dried, pulverized using Wiley Laboratory Mill apparatus and stored in dry air-tight plastic containers until use. Then, they were extracted successively with petroleum ether, chloroform, methanol and finally with water by maceration. The solvent was evaporated from each extract (using rotary evaporator), dried extract were stored at -4°C until used. Animals were randomly divided into six groups and each group having 6 animals for two sets of experiments. In the first test, healthy rats were treated orally with the plant extracts (1 g/kg) suspended in Tween 80. In the second test, the diabetic rats were fasted overnight. The test groups of 6 diabetic rats were treated orally with extracts of Tinospora crispa (1 g/kg), glibenclamide (10 mg/kg) and 10% Tween 80, (10 mL/kg), respectively. In these results, there was no significant effect on blood glucose levels in normal rats treated with different extracts of Tinospora crispa. The water extract of Tinospora crispa decreased the glucose levels in diabetic rats and has the ability to reduce lipid profile in diabetic rats as compared to control diabetic rats.

Short- and long-term survival of esophageal cancer patients treated at the Cancer Institute of Iran.

INTRODUCTION: Little data is available on the prognosis of esophageal cancer (EC) in Iran. We studied the short- and long-term survival of EC patients treated at the Cancer Institute of Iran. METHODS: 619 patients were followed who had been operated in the years 1997-2006. The 1-month to 5-year survival rates of EC and hazard ratios (HR) for different prognostic factors were estimated. RESULTS: Median survival was 11.5 months and 5-year survival was 10%. Patients at the advanced stage had a 2.1-fold higher risk of mortality compared to the early stage (95% CI 1.2-3.4). One-month mortality decreased from 12.2 in 1997-1999 to 9.1% in 2003-2006. In the first month, patients who were diagnosed in 2003-2006 had a significantly (60%) lower HR compared to 1997-1999 (HR = 0.4, 95% CI 0.1-0.9). In addition, patients with cardiopulmonary complications had an 11.7-fold higher HR compared to patients without complications (95% CI 4.7-29.3). CONCLUSIONS: The 5-year survival rate for operated EC patients was considerably low in Iran. Cardiopulmonary complications were the strong prognostic factors for first-month mortality. We suggest improving the pre- and postoperative care of EC to control these complications. Regular monitoring of patient survival is recommended to evaluate the effect of this intervention.

Gastrointestinal tumor board: an evolving experience in Tehran Cancer Institute.

Gastrointestinal (GI) cancers are a significant source of morbidity and mortality in Iran, with stomach adenocarcinoma as the most common cancer in men and the second common cancer in women. Also, some parts of Northern Iran have one of the highest incidences of esophageal cancer in the world. Multi-disciplinary organ-based joint clinics and tumor boards are a well-recognized necessity for modern treatment of cancer and are routinely utilized in developed countries, especially in major academic centres. But this concept is relatively new in developing countries, where cancer treatment centres are burdened by huge loads of patients and have to cope with a suboptimum availability of resources and facilities. Cancer Institute of Tehran University of Medical Sciences is the oldest and the only comprehensive cancer treatment centre in Iran, with a long tradition of a general tumor board for all cancers. But with the requirements of modern oncology, there has been a very welcome attention to sub-specialized organ-based tumor boards and joint clinics here in the past few years. Considering this, we started a multi-disciplinary tumor board for GI cancers in our institute in early 2010 as the first such endeavor here. We hereby review this 2-year evolving experience. The process of establishment of a GI tumor board, participations from different oncology disciplines and related specialties, the cancers presented and discussed in the 2 years of this tumor board, the general intents of treatment for the decisions made and the development of interest in this tumor board among the Tehran oncology community will be reviewed. The GI tumor board of Tehran Cancer Institute started its work in January 2010, with routine weekly sessions. A core group of 2 physicians from each surgical, radiation and medical oncology departments plus one gastroenterologist, GI pathologist and radiologist was formed, but participation from all interested physicians was encouraged. An electronic database was kept from the beginning. The number of patients presented in the tumor board increased from 4 in January 2010 to 16 in December 2011. Most patients were presented by radiation oncology department (38%) and then surgical (36%) and medical oncology (20%) departments. Physicians' participation also grew from an average of 8 each session to 12 in the same months, with a number of cancer specialists taking part from other university hospitals in Tehran. A total number of 225 patients were presented with a treatment decision made in this 2-year period. The majority of cases were colorectal (32%), stomach (23%), and esophageal (17%) cancers. The number of pancreatic (7%) and hepatobiliary (6%) cancers were much smaller. Most decisions were for a primary treatment (surgery or radiochemotherapy) and then a neoadjuvant approach.  Tehran Cancer Institute's GI tumor board is one of the first multi-disciplinary organ-based tumor boards in Iran, and as such has made a successful start, establishing itself as a recognized body for clinical decisions and consultations in GI oncology. This experience is growing and evolving, with newer presentation and discussion formats and adapted guidelines for treatment of GI cancers in Iran sought.

Epidemiology of infertility: a population-based study in Babol, Iran.

The aim of researchers in the present study was to determine the prevalence of infertility and self-reported cause of infertility in Babol, Iran and then identify the factors associated with infertility. A retrospective epidemiologic study was conducted of characteristics of urban and rural women related to infertility. A total of 1,140 women aged 20-45 years were selected using cluster sampling. Of these 1,140 women, 59 (5.2%) (CI 4.2, 6.2) were voluntarily childless. Of the remaining 1,081 women, 913 (84.5%) (CI 82.5, 86.5) reported no difficulties in having children, and the remaining 168 (15.5%) (CI 13.5, 17.5) experienced difficulty conceiving at some stage in their lives. The prevalence of ever having primary infertility was 4.3% (CI 2.3, 6.3). The most frequently self-reported causes of infertility in this study were ovulation problems (39.2%). Infertile women were significantly more likely to have a higher age at marriage (p = 0.001), lower education (p = 0.006), higher body mass index (p = 0.0001), long-term health problems (p = 0.0001), a partner who smoked (p = 0.029), and past history of tubal or ectopic pregnancy (p = 0.002). These risk factors may help inform reproductive health clinics and primary healthcare centers about factors associated with infertility.

Cytokine response following transthoracic and transhiatal esophagectomy in patients with esophageal cancer.

Curative esophageal resection is usually performed using either a transthoracic (TT) or transhiatal (TH) approach. Forty patients with esophageal squamous cell carcinoma who underwent esophagectomies (24 TT and 16 TH), 12 patients who underwent surgery for gastric cancer, and 16 healthy individuals were enrolled in this study. Blood samples were taken from the patients, pre- and post-surgery. The levels of synthesis of T-helper 1 and 2 cytokines were assessed in vitro in the presence of mitogen. Our initial data indicated that at admission, 24 h before surgery, blood cells from both groups of esophageal cancer patients produced significantly lower levels of the Th1 cytokines, IFN-gamma and IL-2 than those from cells of healthy donors. Cells collected from gastric cancer patients prior to surgery produced intermediate levels of IFN-gamma and IL-2: significantly lower than healthy donors, and slightly more (non-significant) than esophageal cancer patients. These results contrast with those for the production of Th2 cytokines prior to surgery, which did not differ significantly between any groups: either the esophageal or gastric cancer patients, or healthy donors. Th1 and Th2 cytokine production was then studied using blood cells collected seven days after surgery. Cells from both groups of esophageal cancer patients, undergoing either TT or TH surgery, produced significantly lower levels of the Th1 cytokines, IFN-gamma and IL-2 than those from cells of gastric cancer patients who had undergone surgery. Postoperative and preoperative production was compared. For patients who had undergone TT esophageal resection, we observed that the post-operative production of IL-2, IL-5 and IL-13 was significantly lower than the pre-operative production of those cytokines. Such reduced post-operative compared to pre-operative production was only significant in patients who had undergone TT esophagectomy. A similar, but non-significant trend was observed in patients who had undergone either TH esophagectomy, or gastrectomy. The results indicate that digestive tract cancer patients, both esophageal and gastric, have (prior to surgery), a significantly reduced, basal, mitogen-induced production of Th1 but not of Th2 cytokine. Post-operatively, a significantly reduced production of Th1 and Th2 cytokines, except for IFN-gamma, was observed only in patients who had undergone surgical esophageal resection using the TT method.