Predicting the survival of kidney transplantation: design and evaluation of a smartphone-based application.

BACKGROUND: Prediction of graft survival for Kidney Transplantation (KT) is considered a risky task due to the scarcity of donating organs and the use of health care resources. The present study aimed to design and evaluate a smartphone-based application to predict the survival of KT in patients with End-Stage Renal Disease (ESRD). METHOD: Based on the initial review, a researcher-made questionnaire was developed to assess the information needs of the application through urologists and nephrologists. By using information obtained from the questionnaire, a checklist was prepared, and the information of 513 patients with kidney failure was collected from their records at Sina Urological Research Center. Then, three data mining algorithms were applied to them. The smartphone-based application for the prediction of kidney transplant survival was designed, and a standard usability assessment questionnaire was used to evaluate the designed application. RESULTS: Three information elements related to the required data in different sections of demographic information, sixteen information elements related to patient clinical information, and four critical capabilities were determined for the design of the smartphone-based application. C5.0 algorithm with the highest accuracy (87.21%) was modeled as the application inference engine. The application was developed based on the PhoneGap framework. According to the participants' scores (urologists and nephrologists) regarding the usability evaluation of the application, it can be concluded that both groups participating in the study could use the program, and they rated the application at a "good" level. CONCLUSION: Since the overall performance or usability of the smartphone-based app was evaluated at a reasonable level, it can be used with certainty to predict kidney transplant survival.

Living or deceased-donor kidney transplant: the role of psycho-socioeconomic factors and outcomes associated with each type of transplant.

BACKGROUND: Kidney transplant improves patients' survival and quality of life. Worldwide, concern about the equality of access to the renal transplant wait-list is increasing. In Iran, patients have the choice to be placed on either the living or deceased-donor transplant wait-list. METHODS: This was a prospective study performed on 416 kidney transplant recipients (n = 217 (52.2%) from living donors and n = 199 (47.8%) from deceased donors). Subjects were recruited from four referral kidney transplant centers across Tehran, Iran, during 2016-2017. The primary outcome was to identify the psycho-socioeconomic factors influencing the selection of type of donor (living versus deceased). Secondary objective was to compare the outcomes associated with each type of transplant. The impact of psycho-socioeconomic variables on selecting type of donor was evaluated by using multiple logistic regression and the effect of surgical and non-surgical variables on the early post-transplant creatinine trend was assessed by univariate repeated measure ANOVA. RESULTS: Based on standardized coefficients, the main predictors for selecting living donor were academic educational level (adjusted OR = 3.25, 95% CI: 1.176-9.005, p = 0.023), psychological status based on general health questionnaire (GHQ) (adjusted OR = 2.46, 95% CI: 1.105-5.489, p = 0.028), and lower monthly income (adjusted OR = 2.20, 95% CI: 1.242-3.916, p = 0.007). The waiting time was substantially shorter in patients who received kidneys from living donors (p < 0.001). The early post-transplant creatinine trend was more desirable in recipients of living donors (ß = 0.80, 95% CI: 0.16-1.44, p-value = 0.014), patients with an ICU stay of fewer than five days (ß = - 0.583, 95% CI: - 0.643- -0.522, p-value = < 0.001), and those with less dialysis duration time (ß = 0.016, 95% CI: 0.004-0.028, p-value = 0.012). Post-operative surgical outcomes were not different across the two groups of recipients (p = 0.08), however, medical complications occurred considerably less in the living-donor group (p = 0.04). CONCLUSION: Kidney transplant from living donors was associated with shorter transplant wait-list period and better early outcome, however, inequality of access to living donors was observed. Patients with higher socioeconomic status and higher level of education and those suffering from anxiety and sleep disorders were significantly more likely to select living donors.

An application of the theory of planned behavior to self-care in patients with hypertension.

BACKGROUND: Self-care behaviors and positive changes in lifestyle are essential for successful hypertension control. We used a behavioral model based on the theory of planned behavior to assess which factors influence self-care behaviors for controlling hypertension. METHODS: In this cross-sectional study, five hundred patients with at leastaone-year history of diagnosed hypertension participated in this study. The data collection tool was designed based on the theory of planned behavior. Structural equation modeling was used to estimate the main parameters. RESULTS: For self-care behaviors, ninety-six (19.2%) and forty-five (9.1%) participants had good knowledge and acceptable behavior(≥8 out of 10 points). Having perceived behavioral control regarding quitting smoking and alcohol intake was associated with the patient's intention and behavior [b:1.283 ± .095 and b:1.59 ± .014 (p < .001)]. Having perceived behavioral control over the other self-care behaviors had a positive effect on the intention in female patients [b: .885 ± .442 (p = .045)]. Subjective norms had a positive effect on behavioral intention in younger patients [b:4.52 ± 2.24 (P = .04)]. CONCLUSIONS: Group-specific behavioral barriers are important when improving self-care behaviors in patients with hypertension. Perceived control over self-care behaviors is more important in vulnerable patients, such as the elderly and women.

Risk factors of severe peritoneal sclerosis in chronic peritoneal dialysis patients.

Peritoneal dialysis (PD) offers the healthiest way for starting renal replacement therapy (RRT) in End Stage Renal Disease patients, however exposes long-term PD patients to a dangerous complication named encapsulating peritoneal sclerosis (EPS). In this study, we searched for possible risk factors of EPS. Data were collected from two PD centers covering period 1995-2012 and comprised 464 patients. Control group defined as PD patients stayed on PD >42 month (n = 122), and case group was 12 confirmed EPS patients. Associations were analyzed using linear regression analysis. Prevalence and incidence of EPS were 2.59% and 8.9% with an incidence of 0.7% patient-years, respectively. The age at start of PD in EPS patients (32.75 ± 10.8 year) was significantly lower compared with control group (49.61 ± 16.18 year, p = .0001). The mean duration of PD in EPS and control group were 2494.4 ± 940.9 and 1890.2 ± 598.8 days (p = .002). Control group had 145 episodes of peritonitis during total duration of 7686 patient months (peritonitis rate of 1/53). This was 1/26 with a total 38 episodes of peritonitis during the total duration of 997 patient months (p = .01) for EPS group. In regression analysis, PD duration, age at PD start and duration of Ultrafiltration failure (UFF) were associated with EPS. Longer time being on PD, younger age, and higher UFF duration were the risk factors for EPS development.

Serum uric acid as a risk predictor for erectile dysfunction.

INTRODUCTION: Serum uric acid (UA) is now beginning to be considered a risk predictor for cardiovascular diseases. However, little is known about the effect of hyperuricemia on the risk of developing other systemic vascular disorders, especially erectile dysfunction (ED). AIM: To evaluate whether serum UA is a predicting factor for ED while adjusting for other common risk factors. METHODS: Two hundred fifty-one patients aged 45.2 ± 10.1 years with newly diagnosed and documented ED and 252 age-matched participants without ED (aged 45.1 ± 8.4 years) were enrolled in this case-control study. Univariate and multivariate logistic regression analysis were performed to assess the effect of serum UA on ED; odds ratio (OR) and 95% confidence interval (CI) were calculated. Adjustments were made for potential confounding factors, including obesity, hypertension, diabetes, dyslipidemia, serum triglyceride, and smoking. MAIN OUTCOME MEASUREMENT: Serum UA concentration and the distribution of potential ED risk factors (age, smoking, lipid profile, hypertension, obesity, and diabetes mellitus) were evaluated. Serum UA levels were organized into tertiles. The five-item International Index of Erectile Function was used to evaluate the presence and the severity of ED. RESULTS: The mean serum UA levels in ED-positive and ED-negative groups were 6.12 ± 1.55 mg/dL and 4.97 ± 1.09 mg/dL, respectively (P < 0.001). On analysis of unadjusted variables, statistically significant differences were found for all variables, including serum UA, between ED-positive and ED-negative groups. After adjustment for major risk factors, a significant trend of increasing risk was found for serum UA concentration (OR 5.95, 95% CI 2.96-11.97; P < 0.001, comparing the highest with the lowest tertile). An increase of 1 mg/dL in serum UA level was associated with an approximately twofold increase in risk of ED (OR 2.07; 95% CI 1.63-2.64). CONCLUSIONS: Our findings reveal that serum UA can be considered a risk predictor for ED. Furthermore, hyperuricemia can be regarded as an independent risk factor in addition to the established ones.

Phoenix dactylifera L. pollen versus pentoxifylline on improvement of sperm parameters in idiopathic male infertility: A randomized clinical trial.

ETHNOPHARMACOLOGICAL RELEVANCE: Phoenix dactylifera L. pollen is the male reproductive dust of palm flowers known as a natural product that is considered a strong stimulant of sexual potency and fertility in Iranian traditional medicine (ITM). In this regard, no evidence-based medications are empirically prescribed to treat IMI. However, applying traditional medicine for the treatment of male infertility has attracted more attention in recent years. AIM OF THE STUDY: Phoenix dactylifera L. pollen was compared with pentoxifylline (PTX) to evaluate its efficacy on sperm parameters. MATERIALS AND METHODS: During this parallel randomized controlled trial, 80 adult men with asthenozoospermia, oligozoospermia, or teratozoospermia (age 20-35 years) were enrolled. In two separate groups of participants with a 1:1 ratio, participants received either 6 g of Phoenix dactylifera L. pollen powder daily or 400 mg of PTX tablets daily for 90 days. We measured the sperm parameters as well as the serum sex hormones in the sample. ANCOVA and t-tests were used to compare groups. RESULTS: There was no significant difference between the study groups in terms of baseline characteristics or demographic characteristics. According to the results, participants who took Phoenix dactylifera L. pollen powder had significantly improved sperm concentration (p = 0.016), morphology (p = 0.029), sperm counts (p = 0.012), progressive motility (p = 0.016), total motility (p = 0.018), and reduced immotile sperms (p = 0.014) compared to those who took PTX. CONCLUSIONS: In light of these results, Phoenix dactylifera L. pollen is recommended as a treatment factor for ameliorating IMI by enhancing sperm functional capacity and semen parameters.

Serum calcium concentration and prostate cancer risk: a multicenter study.

This study sought to further evaluate the possible effects of serum calcium level on prostate cancer (PC) risk, with considering the age, body mass index (BMI), and sex steroid hormones. Using data from a prospective multicenter study, serum calcium concentration, as well as thorough demographic and medical characteristics, were determined in 194 cases with newly diagnosed, clinicopathologically confirmed PC and 317 controls, without any malignant disease, admitted to the same network of hospitals. Serum total and ionized calcium levels were categorized into tertiles. Multivariate logistic regression model was used to estimate odds ratios (OR) and corresponding 95% confidence intervals (CI) after adjustment for major potential confounders, including age, BMI, smoking, alcohol, education, occupation, marital status, family history of PC, and sex hormones level. The mean serum calcium level (±SD) in case and control groups was 9.22 (±0.46) mg/dl and 9.48 (±0.51) mg/dl, respectively (P < 0.001). After adjustment for mentioned confounders, a significant trend of decreasing risk was found for serum total calcium concentration (OR = 0.27, 95% CI = 0.12-0.59, comparing the highest with the lowest tertile) and ionized calcium (OR = 0.25, 95% CI = 0.10-0.58). An increase of 1 mg/dl in serum calcium level was associated with a significant decrease in PC risk (OR = 0.52; 95% CI = 0.34-0.76). Our findings reveal the inverse association between serum total and ionized concentrations and PC risk, which supports the hypothesis that calcium may protect against PC. Furthermore, no evidence was found regarding age, BMI, and sex steroid hormones to modify the association between serum calcium and PC risk.

Regulatory T-cell subset analysis and profile of interleukin (IL)-10, IL-17 and interferon-gamma cytokine-producing cells in kidney allograft recipients with donor cells infusion.

BACKGROUND: This pilot study aimed to assess whether the perioperative infusion of donor bone marrow cells (DBMC) in renal allograft recipients can affect the appearance of peripheral regulatory T-cell subsets and the profile of cytokine-producing cells [interferon-gamma (IFN-γ), interleukin (IL)-17 and IL-10] 2 years after transplantation. METHODS: Fresh blood samples were collected from 14 kidney recipients who received infusion and from 13 kidney recipients without infusion who served as controls at the end of the second post-transplantation year. Initially the percentages of CD4(+)CD25(+)FoxP3(+) T cells and CD3(+)CD8(+)CD28(-) T cells were quantified using flowcytometry. Thereafter, the frequencies of IL-10-, IL-17- and IFN-γ-producing cells were determined separately using the ELISPOT technique with peptides corresponding to mismatched donor HLA-DR molecules and phytohemagglutinin (PHA). RESULTS: The mean numbers of IFN-γ- and IL-17-producing cells in response to PHA were lower in infused patients than in controls (P = 0.02 and P = 0.18, respectively); however, an increased frequency of IL-10-producing cells was observed compared to controls (P = 0.07). Furthermore, the ratio of IL-10/IFN-γ-producing cells was significantly higher in the DBMC-infused group versus controls (P = 0.01). There was a negative correlation between the percentage of CD3(+)CD8(+)CD28(-)T cells and IL-17-producing cells in the infused group (r = -0.539, P = 0.04). The mean levels and the frequency of microchimerism within the first post-transplantation year were also significantly higher in infused patients than in controls (P = 0.007 and P = 0.001, respectively). CONCLUSION: Our findings suggest that DBMC infusion could partially stimulate the regulatory mechanisms against alloimmune responses in kidney allograft recipients

Overexpression of long intergenic noncoding RNAs in bladder cancer: A new insight to cancer diagnosis.

There is increasing evidence that show long noncoding RNAs including long intergenic noncoding RNAs (lincRNA) play a pivotal regulatory role in the biological processes. Differential expression of lincRNAs can be utilized for cancer diagnosis, prognosis, and targeted therapy. Little is known about their expressions in urothelial tumors. Concerning the potential role of lincRNAs in cancer development, we aimed to investigate the expression levels of LINC00958 and DNM3OS in bladder cancer. Fifty tumor and 50 adjacent non-tumor tissue samples along with their clinicopathological parameters were obtained from bladder cancer patients. Expressions of LINC00958 and DNM3OS were analyzed by Real-time PCR. ROC curve analysis was used to evaluate the diagnostic power of LINC0095 and DNM3OS for BC. Expression level of LINC00958 was considerably increased in cancerous tissues (P < 0.001) and in correlation with cigarette smoking (P = 0.043). DNM3OS expression was higher in the tumor tissues than normal tissues (P < 0.001) and showed a significant association with age (P = 0.038). By using the ROC curve, the diagnostic power of LINC00958 and DNM3OS transcript levels in bladder cancer were estimated to be 87% and 75%, respectively. Our findings offer some important intuitions into the oncogenic role of LINC00958 and DNM3OS in bladder cancer and suggest that they can be candidate biomarkers and may provide new approaches for the diagnosis and therapy if being validated in a larger sample size of clinical samples as well as functional studies.

The influence of socioeconomic factors on deceased organ donation in Iran.

Background: There is a large gap between the number of patients on organ waiting lists and the number of available organs for donation. This study investigated the socioeconomic factors in Iran that influenced decisions for organ donation among the families of brain-dead donors. Methods: This retrospective cross-sectional study was performed among the families of 333 organ donors in Iran. Two trained researchers interviewed family members about the donor's age, sex, cause of brain death, education level, marital status, number of children, history of addiction, the financial status of the donor's family, and reasons for which they considered refusing organ donation. Results: The mean age of the donors was 37.23±16.59 years. During 2017-2019, significant differences were found according to income (P<0.001), marital status (P<0.001), sex (P=0.04), and occupation (P=0.04). More than half of the organ donors were of low socioeconomic status, and nearly half were the sole income earners of large families. Trauma was the most common cause of death (44.6%). The most common reasons for which the families considered refusing organ donation were unfamiliarity with the concept of brain death, denial, and the expectation of a miracle. Conclusions: The donor's socioeconomic status and availability of social services, such as insurance coverage, psychological services, and mourning therapy courses, play an important role in organ donation. Adequate support for the deceased's family after organ donation is imperative.

Antimicrobial susceptibility testing and molecular characterization of Neisseria gonorrhoeae in Tehran, Iran.

Gonorrhea is a sexually transmitted infection occurring worldwide. Antimicrobial resistance (AMR) surveillance in Neisseria gonorrhoeae and associated molecular epidemiological studies are crucial to ascertain the spread of antibiotic-resistant and developing the local treatment guidelines. This study was performed to determine the antimicrobial susceptibility testing (AST) and molecular epidemiology of N. gonorrhoeae isolates in Tehran, Iran. During 1 July 2018-30 July 2020, a total of 500 urogenital (468 endocervical, 32 urethral) swabs were collected from patients with signs and symptoms of genitourinary infections presenting to two women's hospitals and one health center located center and south of Tehran. Specimens were cultured and examined for the presence of N. gonorrhoeae isolates by biochemical tests. MIC Test Strip determined the MICs of ceftriaxone, azithromycin, and ciprofloxacin. Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) was also performed. A total of 38 N. gonorrhoeae isolates were identified. The proportions of resistant N. gonorrhoeae isolates were as follows: ceftriaxone (MIC ≥0.125 µg/mL) 10.5% (4/38), azithromycin (MIC >1 µg/mL) 34% (13/38), and ciprofloxacin (MIC ≥1 µg/mL) 31.5% (12/38). In total, 25 different NG-MAST STs were identified. The STs comprised 1-4 isolates each, and the predominant ST was ST266 (n = 4). Our study demonstrates a diverse gonococcal population with high rates of resistance to azithromycin and evidence of resistance to ceftriaxone. The results have potential implications for antibiotic choice for the gonococcal treatment and highlight the need to broaden gonococcal AMR monitoring in Iran.

Major dietary factors and prostate cancer risk: a prospective multicenter case-control study.

The association between diet and prostate cancer (PC) risk, although suggestive, still remains largely elusive particularly in the Asian population. This study sought to further evaluate the possible effects of different dietary factors on risk of PC in Iran. Using data from a prospective hospital-based multicenter case-control study, dietary intakes of red meat, fat, garlic, and tomato/tomato products, as well as thorough demographic and medical characteristics, were determined in 194 cases with the newly diagnosed, clinicopathologically confirmed PC and 317 controls, without any malignant disease, admitted to the same network of hospitals. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were obtained after adjustment for major potential confounders, including age, body mass index, smoking, alcohol, education, occupation, family history of PC, and total dietary calories. Comparing the highest with the lowest tertile, a significant trend of increasing risk with more frequent consumption was found for dietary fat (OR: 1.79, 95% CI: 1.71-4.51), whereas inverse association was observed for tomato/tomato products (OR: 0.33, 95% CI: 0.16-0.65). A nonsignificant increase in PC risk was revealed for dietary red meat (OR: 1.69, 95% CI: 0.93-3.06). For garlic consumption, a borderline reduction in risk was observed (OR: 0.58, 95% CI: 0.32-1.01; P = 0.05). In conclusion, our study supports the hypothesis that total fat may increase PC risk and tomatoes/tomato products and garlic may protect patients against PC.

Effect of penile-extender device in increasing penile size in men with shortened penis: preliminary results.

INTRODUCTION: It has been suggested that the application of penile-extender devices increases penile length and circumference. However, there are a few scientific studies in this field. AIMS: The aim of this study was to assess the efficacy of a penile-extender (Golden Erect(®) , Ronas Tajhiz Teb, Tehran, Iran) in increasing penile size. METHODS: This prospective study was performed on subjects complaining about "short penis" who were presented to our clinic between September 15, 2008 and December 15, 2008. After measuring the penile length in flaccid and stretched forms and penile circumference, patients were instructed to wear Golden Erect(®) , 4-6 hours per day during the first 2 weeks and then 9 hours per day until the end of the third month. The subjects were also trained how to increase the force of the device during determined intervals. The patients were visited at the end of the first and third months, and penile length and circumference were measured and compared with baseline. MAIN OUTCOME MEASURES: The primary end point of the study was changes in flaccid and stretched penile lengths compared with the baseline size during the 3 months follow-up. RESULTS: Twenty-three cases with a mean age of 26.5 ± 8.1 years entered the study. The mean flaccid penile length increased from 8.8 ± 1.2 cm to 10.1 ± 1.2 cm and 10.5 ± 1.2 cm, respectively, in the first and third months of follow-up, which was statistically significant (P < 0.05). Mean stretched penile length also significantly increased from 11.5 ± 1.0 cm to, respectively, 12.4 ± 1.3 cm and 13.2 ± 1.4 cm during the first and second follow-up (P < 0.05). No significant difference was found regarding proximal penile girth. However, it was not the same regarding the circumference of the glans penis (9.3 ± 0.86 cm vs. 8.8 ± 0.66 cm, P < 0.05). CONCLUSION: Our findings supported the efficacy of the device in increasing penile length. Our result also suggested the possibility of glans penis girth enhancement using penile extender. Performing more studies is recommended.

Circulating sex hormones play no role in the association between sexual activity and the risk of prostate cancer.

INTRODUCTION: High sexual activity (SA) has been reported to reduce the risk of prostate cancer (PC). The role of sex hormones (SHs) in this regard remains controversial. AIMS: To determine the impact of SA and SHs on PC development. METHODS: In a multicentric hospital-based case-control study, 194 newly diagnosed PC patients along with 317 age-matched controls were studied. Sociodemographic and medical characteristics of participants were recorded. History of vasectomy and sexually transmitted infection (STI), marital status, age at first intercourse, premarital sex, and the current frequency of sexual intercourses per month (SPM) were evaluated. Total testosterone (TT), free testosterone (FT), estradiol (ES), sex hormone binding globulin, and albumin were also measured. Logistic regression model was used to identify independent risk factors for PC. MAIN OUTCOME MEASURES: (i) The association between SA, SHs, and the risk of PC; (ii) The correlation between SHs and SA; (iii) The interaction between SHs and SA and established risk factors for PC and erectile dysfunction in determining the risk of PC; and (iv) The correlation between SHs and SA in determining the risk of PC in different decades of life. RESULTS: Vasectomy, STI, and marital status did not differ significantly between two cohorts. Controls reported premarital sex more commonly than cases (P < 0.001). Cases had the first intercourse at older age (P = 0.03) and had less SPM (P < 0.001). TT, FT, and ES were higher in controls (P < 0.001). In multivariate analysis, TT, calculated FT, SPM >4, and age at time of marriage <24 were protective against PC. The protective effect of high SA and SHs increased as patients' age increased. CONCLUSIONS: High SA as well as TT and FT were protective against PC. Their protective role enhances by each decade of increasing age. The protective effect of high SA was independent from circulating levels of SHs.

Living versus deceased kidney transplantation: Comparison of complications.

INTRODUCTION: It is assumed that the outcome of kidney transplantation from living donors is more favorable than deceased donors. However, over the years there has been an overall improvement in transplant survival from both living and deceased donors. In this article we have evaluated and compared the most recent results in living and deceased donor kidney transplantations. PATIENTS AND METHODS: Four hundred and forty six patients underwent kidney transplantation in our center from September 2009 to March 2014. The patients divided in two groups living (group A) and deceased (group B) donor transplantation groups. The patients were followed until September 2016. Acute rejection, graft survival, delayed graft function, renal artery thrombosis, graft nephrectomy, ureterocutaneous fistula, postoperative hypertension, mortality, hospital stay, hyperlipidemia, post transplantation diabetes and lymphocele rate measured and compared in two groups. RESULTS: Most variables were not different between the two groups except lymphocele and delayed graft function. Lymphocele was more prevalent in group A (13.8% vs 3.1%, p-value = 0.02) and delayed graft function results were more desirable in living donor transplantation group (group B). CONCLUSION: Although, delayed graft function was less common in transplantation from living donors, short, and long term graft survival was not significantly different in this study.

Evaluation of Thymic Output and Regulatory T Cells in Kidney Transplant Recipients with Chronic Antibody-Mediated Rejection.

BACKGROUND: Regulatory T cells (Tregs) and recent thymic emigrants (RTEs) have an essential role in the regulation of allogeneic immune responses. However, their mechanisms of action in chronic antibody-mediated rejection (cAMR) are still unclear. In this study, we aimed to compare Treg and RTE levels between stable graft function (SGF) patients and cAMR subjects after kidney transplantation. METHOD: Mononuclear cells (MNs) were separated from peripheral blood, and flow cytometry analysis was performed for detection of CD4+ and CD25high as Treg markers and CD4+, CD31+, and CD45RA+ as RTE immunophenotyping markers. RESULT: The level of peripheral Treg cells was significantly lower in cAMR subjects in comparison to stable graft function patients. Moreover, SGF patients who had received cyclosporine A had a higher level of Treg in comparison to the tacrolimus recipients. Nevertheless, the RTE level between SGF and cAMR patients did not show any significant differences. CONCLUSION: It seems that Treg cells are significantly associated with transplant outcomes in cAMR patients, and prescribed immunosuppressive drugs can influence the frequency of this crucial subset of T cells. Although these drugs are beneficial and inevitable for allograft maintenance, more investigations are needed to elucidate their complete effects on different immune cell subsets which some of them like Tregs are in favor of transplant tolerance. Besides, the thymic output is seemingly not a beneficial biomarker for predicting cAMR; however, more in vivo and in vitro studies are needed for revealing the precise role of Tregs and RTEs in the transplantation context.

Complications and outcomes following extracorporeal shock wave lithotripsy: a prospective study of 3,241 patients.

Extracorporeal shock wave lithotripsy (SWL) has become the least invasive treatment modality with high success rates for urinary calculi; however, its established efficacy has been associated with a number of side effects and complications. This study sought to further evaluate the incidence rate and management of the post-SWL complications and also the efficiency of procedure in a large scale of patients. During a 51-month period, 3,241 consecutive adult patients with the mean age of 38.1 years (range 15-75) and urinary calculi (>or=4 mm) underwent SWL at our referral center and were followed for 3 months prospectively. Overall, 3,614 stones [kidneys (83.5%), ureters (15.8%) and bladder (0.7%)] in 3,241 patients were treated requiring 7,245 SWL sessions. Stone-free state occurred in 71.5% calculi and success rate in 79.8% patients. The re-treatment was necessary in 37.2% patients. Auxiliary procedure and efficiency quotient were 5.6% and 0.50, respectively. SWL success rate decreased as the stone size increased (P < 0.0001). The stone-free rate was correlated with the location of the stone. During the study period, 4,075 complications occurred in our patients. Colicky pain (40%) was the most frequent symptom followed by gross hematuria (32%) and steinstrasse (24.2%). Symptomatic bacteriuria developed in 9.7% patients; Escherichia coli (30.4%) was the most causative organism. In conclusion, the complication rate following SWL was high in our study; however, the majority was mild and managed conservatively or with the minimal intervention. Moreover, the management of urinary calculi in adults using SWL was proved to be safe and efficient, particularly for ureteral stones <10 mm, renal pelvic stones <20 mm, and bladder stones <30 mm.

Intraprostatic botulinum toxin type A injection for the treatment of benign prostatic hyperplasia: Initial experience with Dysport.

OBJECTIVE: To evaluate the effect of intraprostatic botulinum toxin type A (BoNTA, Dysport) injection on lower urinary tract symptoms, prostate-specific antigen (PSA), prostate volume (PV), peak urine flow rate (Q(max)) and postvoiding residue (PVR), and to evaluate the role of PV in the treatment outcome. MATERIAL AND METHODS: Seventy-two men with PSA < 4 ng/ml, International Prostate Symptom Score (IPSS) > or = 8, Q(max) < 12 ml/s and PV < 60 ml were enrolled. A total of 300-600 U Dysport was injected transperineally under transrectal ultrasound guidance. Initial IPSS, quality of life (QoL) score, Q(max) and PVR were compared with their measures at 1, 6 and 12 months after the injection. Initial PSA and PV were compared with their values after 6 months. Parameters were also compared between patients with PV < or = 30 ml and those with PV > 30 ml. RESULTS: The mean age of participants was 63.5 years. At follow-up sessions, IPSS and QoL score were significantly decreased (p < 0.001). PVR reduced significantly and Q(max) increased considerably (p < 0.001). PSA and PV substantially decreased after 6 months (p < 0.001). No serious complications were reported. Similar to patients with larger prostates, IPSS and QoL score decreased statistically significantly after 12 months in those with PV < or = 30 ml; however, changes in PV, PSA, PVR and Q(max) did not persist during 12 months' follow-up. CONCLUSIONS: The procedure is safe and efficacious and the results are comparable to previous experiences with Botox. It seems that the toxin efficacy depends directly on PV in prostates < 60 ml.

Early Conversion to Tacrolimus Vs Cyclosporine Continuation in Normally Functioning Kidney Allograft: A Single-Center Study.

This study evaluated the effectiveness of early pre-emptive conversion from cyclosporine to tacrolimus in kidney transplant patients with normal graft function and in the absence of adverse effects of the initial cyclosporine. A historical cohort study of 166 patients who received deceased-donor kidney transplant between 2011 to 2017 was conducted. All the patients had been treated with cyclosporine (Sandimmune®) during their immediate post-transplantation period. At the time of hospital discharge, the patients were divided into 2 groups: patients with continued cyclosporine (Sandimmune®) treatment (n = 125) and the patients whose treatments converted from cyclosporine to tacrolimus (Prograf®) at discharge (n = 41). The 1-year graft function (p = 0.074), acute rejection (p = 0.566), and graft loss (p = 0.566) were not significantly different between two groups. The patients on tacrolimus had lower levels of cholesterol (p = 0.002) and diastolic blood pressure (p = 0.015). The long-term follow-up showed no significant difference in graft loss (p = 0.566). The patients received tacrolimus had higher all-cause mortality within the first year posttransplantation (p = 0.002) as well as long-term follow-up (p = 0.001). The continuation of initial cyclosporine might be a good option when the graft function is acceptable and the adverse effects are absent.

Tumor-derived urinary exosomal long non-coding RNAs as diagnostic biomarkers for bladder cancer.

Bladder cancer (BC) is the sixth most common malignancy in men and 17th in women. Exosomal long non-coding RNAs (lncRNAs) have been defined as a novel biomarker for BC. The aim of this study is to evaluate the clinical significance of urine exosomal PVT-1, ANRIL and PCAT-1 as a biomarker in BC patients with tumors classified as T1 or T2. Exosomes were isolated from urine of BC patients and healthy donors, then characterized according to their shape, size, and exosome markers by Electron Microscopy, Dynamic light scattering, and Western blotting. Exosomal lncRNAs extraction was done to determine the expression levels of PVT-1, ANRIL and PCAT-1 by qRT-PCR. ANRIL and PCAT-1 expression was significantly higher in BC patients compared to normal subjects. To evaluate the performance of the identified lncRNAs for BC detection, we performed ROC curves analysis. The diagnostic accuracy of ANRIL and PCAT-1, measured by AUC, was 0.7229 (sensitivity = 46.67 % and specificity = 87.5 %) and 0.7292 (sensitivity = 43.33 % and specificity = 87.5 %). Transcript levels of lncRNAs in urinary exosomes are potential diagnostic biomarkers in bladder cancer.