Considerations for study design in the DAHANCA 35 trial of protons versus photons for head and neck cancer.

Proton radiotherapy offers a dosimetric advantage compared to photon therapy in sparing normal tissue, but the clinical evidence for toxicity reductions in the treatment of head and neck cancer is limited. The Danish Head and Neck Cancer Group (DAHANCA) has initiated the DAHANCA 35 randomised trial to clarify the value of proton therapy (NCT04607694). The DAHANCA 35 trial is performed in an enriched population of patients selected by an anticipated benefit of proton therapy to reduce the risk of late dysphagia or xerostomia based on normal tissue complication probability (NTCP) modelling. We present our considerations on the trial design and a test of the selection procedure conducted before initiating the randomised study.

Coenzyme Q10 reduces expression of apoptotic markers in adult rat nucleus accumbens dopaminergic neurons treated with methamphetamine.

BACKGROUND: Abuse of addictive drugs such as methamphetamine (METH) has become a global problem, leading to many social, economic, and health disturbances, including neurological and cognitive disorders. Neuronal damage is reported in chronic METH abusers. The neuroprotective role of CoQ10 has been shown in many studies. In the present study, we aimed to assess the pre and post-efficacy of CoQ10 on the dopaminergic neurons of the Nucleus Accumbens (de Miranda et al. in Food Res Int 121:641-647, 2019) in the male adult rats treated with METH. METHODS: 80 rats were randomly divided into eight groups (n = 10), including: negative control (intact), positive control (received 5 mg/kg/day METH/IP), three post-treatment groups (METH + 5, 10, 20 mg/kg CoQ10) and three pre-treatment groups (received 5, 10, 20 mg/kg CoQ10 as pre-treatment for 14 days before METH injection). The expression of Bax, Bcl-2, Bax/Bcl-2 ratio, P53, Caspase-3 and tyrosine hydroxylase in NAc studied using western blotting. Nissl staining was used to study the neuronal density of NAc. RESULTS: Our results showed that the different doses of CoQ10 in METH-treated animals significantly changed pro-apoptotic proteins' expression in the benefit of neuronal survival of NAc (P < 0.05). Neuronal density in NAc were significantly lower in the METH group compared to the control and CoQ10 treated groups. Pre- and post-treatment with different doses of CoQ10 restored the neuronal damage in NAc. CONCLUSIONS: CoQ10 could decrease the activation of pro-apoptotic proteins and reduce the neurodegenerative effects induced by METH. From a clinical point of view, it seems that certain antioxidants such as CoQ10 should receive more attention in clinical trial research. We believe that antioxidants could be the promising for drug abuse treatment in the future.

Vestibular evaluation following cochlear implantation in patients with inner-ear anomalies.

OBJECTIVE: This cross-sectional study investigated vestibular function outcomes after cochlear implantation in patients with inner-ear anomalies. METHODS: Twenty-two patients with bilateral symmetric inner-ear anomalies and 28 patients with normal inner ears were included. All were congenitally or progressively deaf persons implanted unilaterally during the previous 15 years. Vestibular system function was assessed by vestibular-evoked myogenic potential and bithermal caloric tests. RESULTS: The vestibular-evoked myogenic potential abnormality rate in implanted ears with an inner-ear anomaly was 81.8 per cent, compared with 39.3 per cent in implanted ears with normal anatomy. In the non-implanted sides, the rate was 45.5 per cent (10 out of 22 cases) in the inner-ear anomaly patients compared with 17.9 per cent in patients with normal inner-ear structure. The respective abnormal caloric test rates in inner-ear anomaly versus normal anatomy patients were 81.8 per cent and 17.9 per cent (implanted ears), 77.3 per cent and 14.3 per cent (non-implanted sides). CONCLUSION: Inner-ear anomaly and implantation were both associated with more vestibular-evoked myogenic potential abnormalities; when occurring together, these factors showed a synergistic effect. Caloric test abnormality is mainly dependent on the presence of an inner-ear anomaly, but implantation is not associated with caloric abnormality.

The outcome of olfactory impairment in patients with otherwise paucisymptomatic coronavirus disease 2019 during the pandemic.

OBJECTIVE: This study aimed to measure the duration and recovery rate of olfactory loss in patients complaining of recent smell loss as their prominent symptom during the coronavirus disease 2019 outbreak. METHOD: This was a prospective telephone follow-up observational study of 243 participants who completed an online survey that started on 12 March 2020. RESULTS: After a mean of 5.5 months from the loss of smell onset, 98.3 per cent of participants reported improvement with a 71.2 per cent complete recovery rate after a median of 21 days. The chance of complete recovery significantly decreased after 131 days from the onset of loss of smell (100 per cent sensitive and 97.7 per cent specific). Younger age and isolated smell loss were associated with a rapid recovery, whereas accompanying rhinological and gastrointestinal symptoms were associated with longer loss of smell duration. CONCLUSION: Smell loss, occurring as a prominent symptom during the coronavirus disease 2019 pandemic, showed a favourable outcome. However, after 5.5 months from the onset, around 10 per cent of participants still complained of moderate or severe hyposmia.

Early Mortality after Radical Radiotherapy in Head and Neck Cancer - A Nationwide Analysis from the Danish Head and Neck Cancer Group (DAHANCA) Database.

AIMS: Curative-intent radiotherapy (RT) or chemoradiation (CRT) of squamous cell carcinoma of the head and neck (HNSCC) produces high survival rates, but is associated with substantial toxicity. However, there are no commonly accepted quality metrics for early mortality in radiation oncology. To assess the applicability of early mortality as a clinical quality indicator, this study investigated the temporal distribution, risk factors and trends of 90- and 180-day overall and non-cancer mortality in a nationwide cohort of HNSCC patients treated with RT/CRT. MATERIALS AND METHODS: Information on all HNSCC patients treated with curative-intent RT/CRT in Denmark between 2000 and 2017 was obtained from the national Danish Head and Neck Cancer Group clinical database. Deaths in patients with residual or recurrent disease after RT/CRT were classified as cancer-related. Possible risk factors were investigated using logistic regression analysis. RESULTS: Data from 11 419 patients were extracted. In total, 90- and 180-day mortality risks were 3.1% and 7.1%, respectively. There was a uniform temporal distribution of 180-day mortality. In multivariable analysis, increasing age, stage, performance status, earlier treatment year and hypopharyngeal cancer were significantly associated with an increased risk (P < 0.05). Risk factor estimates were comparable for 90- versus 180-day mortality as well as for overall versus non-cancer mortality. Between 2000 and 2017 there was a significant decrease in 180-day mortality, which was driven by a reduction in cancer-related events. CONCLUSION: The distribution of 180-day overall and non-cancer mortality did not indicate a well-defined early high-risk period. Moreover, risk factor estimates were highly similar across risk periods and groups. Taken together, our findings question the applicability of early mortality as a standard metric for treatment-associated toxicity.

Antiamyloidogenic Effects of Ellagic Acid on Human Serum Albumin Fibril Formation Induced by Potassium Sorbate and Glucose.

Oxidative stress has the main role in protein conformational changes and consequent direct involvement in different kind of diseases. Potassium sorbate as a widespread industrial preservative and glucose are two important oxidants that can be involved in oxidative stress. In this study the effect of ellagic acid as a phenolic antioxidant on amyloid fibril formation of human serum albumin upon incubation of potassium sorbate and glucose was studied using thioflavin T assay, surface tension, atomic force microscopy, Amadori product, and carbonyl content assays. The thioflavin T assay and atomic force microscopy micrographs demonstrated the antiamyloidogenic effect of ellagic acid on the human serum albumin fibril formation. This antioxidant also had the repair effect on surface tension of the modified human serum albumin (amyloid intermediates), which was destructed, caused by potassium sorbate and glucose. This mechanism takes place because of potent carbonyl stress suppression effect of ellagic acid, which was strengthening by potassium sorbate in the presence and absence of glucose.

Effectiveness of group dialectical behavior therapy (based on core distress tolerance and emotion regulation components) one expulsive anger and impulsive behaviors.

INTRODUCTION: The purpose of this study is to measure Effectiveness of group dialectical behavior therapy (based on core distress tolerance and emotion regulation components) on Expulsive Anger and Impulsive Behaviors. MATERIALS & METHODS: Research method is a semi experimental socio-statistic approach consisting of experimental group (dialectical behavior therapy) and control group. Participants were patients referred to Amir Kabir Hospital in Arak who suffered from Expulsive Anger and Impulsive Behaviors. Based on stratified random sampling, 16 patients (women) were placed in each group. Research tools included the structured diagnosis interview according to DSM-IV-TR (2000), Barrat impulsivity scale(1994) Distress Tolerance Scale (2005) Difficulties of Emotion Regulation Scale (2004) and dialectical behavior therapy were done for two months,8 group-sessions). FINDINGS: Dialectical behavior therapy was effective on Expulsive Anger and Impulsive Behaviors. DISCUSSION & CONCLUSION: Distress tolerance and emotion regulation components were effective on Expulsive Anger and Impulsive Behaviors.

Hemoglobin fructation promotes heme degradation through the generation of endogenous reactive oxygen species.

Protein glycation is a cascade of nonenzymatic reactions between reducing sugars and amino groups of proteins. It is referred to as fructation when the reducing monosaccharide is fructose. Some potential mechanisms have been suggested for the generation of reactive oxygen species (ROS) by protein glycation reactions in the presence of glucose. In this state, glucose autoxidation, ketoamine, and oxidative advance glycation end products (AGEs) formation are considered as major sources of ROS and perhaps heme degradation during hemoglobin glycation. However, whether fructose mediated glycation produces ROS and heme degradation is unknown. Here we report that ROS (H2O2) production occurred during hemoglobin fructation in vitro using chemiluminescence methods. The enhanced heme exposure and degradation were determined using UV-Vis and fluorescence spectrophotometry. Following accumulation of ROS, heme degradation products were accumulated reaching a plateau along with the detected ROS. Thus, fructose may make a significant contribution to the production of ROS, glycation of proteins, and heme degradation during diabetes.

Antiglioma activity of GoPI-sugar, a novel gold(I)-phosphole inhibitor: chemical synthesis, mechanistic studies, and effectiveness in vivo.

Glioblastoma, an aggressive brain tumor, has a poor prognosis and a high risk of recurrence. An improved chemotherapeutic approach is required to complement radiation therapy. Gold(I) complexes bearing phosphole ligands are promising agents in the treatment of cancer and disturb the redox balance and proliferation of cancer cells by inhibiting disulfide reductases. Here, we report on the antitumor properties of the gold(I) complex 1-phenyl-bis(2-pyridyl)phosphole gold chloride thio-ß-d-glucose tetraacetate (GoPI-sugar), which exhibits antiproliferative effects on human (NCH82, NCH89) and rat (C6) glioma cell lines. Compared to carmustine (BCNU), an established nitrosourea compound for the treatment of glioblastomas that inhibits the proliferation of these glioma cell lines with an IC50 of 430µM, GoPI-sugar is more effective by two orders of magnitude. Moreover, GoPI-sugar inhibits malignant glioma growth in vivo in a C6 glioma rat model and significantly reduces tumor volume while being well tolerated. Both the gold(I) chloro- and thiosugar-substituted phospholes interact with DNA albeit more weakly for the latter. Furthermore, GoPI-sugar irreversibly and potently inhibits thioredoxin reductase (IC50 4.3nM) and human glutathione reductase (IC50 88.5nM). However, treatment with GoPI-sugar did not significantly alter redox parameters in the brain tissue of treated animals. This might be due to compensatory upregulation of redox-related enzymes but might also indicate that the antiproliferative effects of GoPI-sugar in vivo are rather based on DNA interaction and inhibition of topoisomerase I than on the disturbance of redox equilibrium. Since GoPI-sugar is highly effective against glioblastomas and well tolerated, it represents a most promising lead for drug development. This article is part of a Special Issue entitled: Thiol-Based Redox Processes.

Investigation of thermal reversibility and stability of glycated human serum albumin.

Protein glycation, the process by which carbohydrates attach to proteins upon covalent binding, can alter protein thermal reversibility and stability. Protein stability and reversibility have important role in protein behavior and function. Also they are benefit properties for drug produce and protein industrial applications. In this research the thermal reversibility and stability changes in human serum albumin (HSA) were studied upon incubation with glucose (GHSA) under physiological conditions for 21 and 35 days. The thermal reversibility and stability changes in GHSA were evaluated using circular dichroism (CD), UV-vis spectroscopy, fluorescence spectroscopy and differential scanning calorimetry (DSC). Our results showed that the glycation of HSA increased its thermal reversibility and stability, but decreased its conformational entropy compared to fresh native HSA and untreated HSA. Free lysine content assay (TNBSA test) indicated glucose can bind to protein covalently. These alterations were mainly attributed to the formation of crosslink between the lysine residues of HSA upon incubation with glucose.

Potassium sorbate as an AGE activator for human serum albumin in the presence and absence of glucose.

Advanced glycation end products (AGEs) are the predominant intermediates of glycation process, and mediate oxidative stress and complications of diabetes. Potassium sorbate (PS) as a widespread preservative is an oxidative agent and used in different dairy and drug products, which can readily enter biological matrices. Here we studied the PS interference with glycation of human serum albumin (HSA) in the presence of glucose (Glc) using various techniques. These included TNBSA assay, circular dichroism, fluorescence spectroscopy, differential scanning calorimetry (DSC), Th T assay, and atomic force microscopy. Our results indicated that HSA glycation was accelerated in the presence of PS. Furthermore, PS produced AGEs in the absence of glucose. Secondary and tertiary structural changes were also observed in HSA incubated with glucose in the presence or absence of PS through beta-sheet inducing effects. Th T assay demonstrated the role of PS in HSA fibril formation in the presence or absence of glucose. Atomic force microscopy determined different amyloid fibril formation in HSA incubated with PS in the presence or absence of glucose. Together our results indicated that PS has a stimulatory effect on glycation and fibrillation of HSA in the presence or absence of glucose, and could exacerbate complication of diabetes.

Role of spirometry in detection of nasal obstruction.

BACKGROUND: A subjective feeling of nasal airflow obstruction is a common symptom. An objective method for quantitative measurement of nasal airflow has long been desired. Rhinomanometry and acoustic rhinometry have been developed for anatomical and physiological evaluation of nasal obstruction. This study was designed to determine the usefulness of a portable spirometer in assessing upper airway obstruction. METHODS: One hundred and ninety-six patients were assessed with nasal inspiratory spirometry to determine nasal airflow. All patients also underwent paranasal sinus computed tomography to determine anatomical abnormalities. Spirometry was performed on each nostril separately. RESULTS: Sensitivity and specificity levels were high. This portable and easy to use device may be useful in respiratory assessment. Correlation between anatomical obstructions and subjects' complaints was statistically significant (p < 0.001), but no definite correlation between septal deviation severity and spirometric values was found. CONCLUSION: Portable spirometry is an objective and useful method of evaluating nasal obstruction, but needs more investigation to establish a standardised test.

A novel missense mutation in exon 7 of the ECM1 gene in an Iranian lipoid proteinosis patient.

Lipoid proteinosis (LP) is a rare autosomal recessive disorder. Classical clinical features include warty skin infiltration, papules on the eyelids, skin scarring, as well as extracutaneous abnormalities such as hoarseness of the voice, epilepsy, and neuropsychiatric abnormalities. A defect in the ECM1 gene is responsible for this disease. A 21-year-old female patient from consanguineous parents (first cousins) was referred to our clinic with many symptoms of LP, such as hoarse voice from infancy, diffuse acneiform scars on her face, and hyperkeratosis on her knees and elbows. The entire ECM1 gene was screened using PCR and sequencing. A novel missense mutation was found in exon 7 of this patient. We report a novel missense mutation in exon 7 of the ECM1 gene found in an Iranian LP patient that causes a C269Y amino acid exchange.

Intensive Care Unit nosocomial sinusitis at the Rasoul Akram Hospital: Tehran, Iran, 2007-2008.

BACKGROUND: Nosocomial rhino sinusitis causes major problems in all Intensive Care Units (ICUs). OBJECTIVE: To describe incidence, epidemiologic, clinical manifestations, and microbiologic findings in ICUs admitted cases with nosocomial sinusitis. METHODS#ENTITYSTARTX00026; MATERIALS: A prospective, cross sectional study done in Pediatric & Adult ICUs in Rasoul Akram Hospital; Tehran Iran (2007-2008). Para-nasal sinus computed tomography (CT) was performed in all adults with fever of unknown origin (FUO) within 48h of admission and repeated thereafter (4-7 days). Infectious sinusitis was diagnosed by microbiological analysis of sinus fluid aspirates. RESULTS: Acute bacterial nosocomial sinusitis proved in 82% (51/ 63) of all cases. Head trauma was the most common cause; (n = 22, 45%) of cases. The results of culture were positive for 45 cases (82%). Of 45 culture positives, 19 yielded Gram negative organisms (41%) and 9 (22%) gave Gram positives (S. aureous, Streptococus spp). The remainders (n = 17, 37%) consisted of mixed aerobic/anaerobic bacteria. Seven cases, were positive in gram staining of sinus drainage and these were positive in culture for S. pneumonia (n = 5), Hemophilus influenza (n = 2). The type of organisms were not related to Glasgow Coma Scale in cases (P = 0.3). CONCLUSION: Nosocomial organisms isolated were quite different from community acquired rhino sinusitis cases. Investigation of CT scan and drainage of Para-nasal sinuses would be helpful in undiagnosed FUO cases, especially in traumatic patients. Optimal treatment usually consists of removal of the tubes, mobilizing the patient, and administration the broad-spectrum antibiotics.

Prevalence of GJB2-associated deafness and outcomes of cochlear implantation in Iran.

OBJECTIVES: To investigate the prevalence of mutations in the coding exon of the GJB2 gene in Iranian children with cochlear implants, and to compare the outcomes of auditory perception and speech production in cochlear-implanted children with and without GJB2 mutation. MATERIALS AND METHODS: One hundred and sixty-six prelingually deaf children who had undergone cochlear implantation at the Iranian Cochlear Implant Center, Tehran, were selected from a pool of 428 implanted children. The prevalence of GJB2 gene mutations was assessed using nested polymerase chain reaction and direct sequencing. To enable comparisons, we also identified 36 implanted children with non-GJB2 deafness. Patients' speech perception and speech production were assessed using the Categorization of Auditory Performance and Speech Intelligibility Rating scales. RESULTS: Thirty-three of 166 probands (19.9 per cent) were found to have GJB2 deafness-causing allele variants and were diagnosed with DFNB1 deafness. Results also indicated a significant improvement in speech perception and production scores in both GJB2 and non-GJB2 patients over time. CONCLUSION: Children with GJB2-related deafness benefit from cochlear implantation to the same extent as those with non-GJB2-related deafness.

Use of image guidance in endoscopic endonasal surgeries: a 5-year experience.

PROBLEMS/OBJECTIVES: Endoscopic endonasal surgery (EES) is standard practice in sinonasal disease and is becoming more accepted in the performance of anterior skull base resections. We report our experience with image-guided surgery (IGS) in difficult cases of paranasal sinus (PNS) and skull base pathologies and discuss advantages and disadvantages of this technique. METHODOLOGY: A retrospective chart review was performed for the period 2004-2009. Degree of PNS involvement, indication for IGS, incidence of major complications, need for revision surgery, and technical data regarding the system were gathered. RESULTS: Sixty-two of 86 patients were followed for at least one year and therefore included in the analysis. Indications for IGS were mostly revision surgery for polyposis (42%), chronic rhinosinusitis (CRS) of frontal and/or sphenoid sinuses (14.5%), skull base tumours (30.6%), and foreign body removal (4.8%). Revision rates after IGS in polyposis, CRS, and benign skull base tumours were 7.7%, 11.11%, and 7.1%, respectively. CONCLUSIONS: IGS is of particular benefit in the management of sinonasal polyposis, benign skull base tumours, palliative surgery, and foreign body removal. IGS may avoid trauma to the orbit and anterior skull base and reduces the rate of revision surgeries rendering more meticulous and complete operations possible. We also think it could be helpful for foreign body removal.

Immunoasssay chromatographic antigen test for rapid diagnosis of Group A beta hemolytic Streptococcus pharyngitis in children: A cross/ sectional study.

BACKGROUND AND OBJECTIVE: Group A beta-hemolytic streptococcus (GABHS) is an important pharyngotonsillitis etiologic agent in children. The objective of this study was diagnosis of streptococcal pharyngitis based on rapid antigen detection test and conventional pharyngeal culture. MATERIALS AND METHODS: The rapid GABHS antigen detection test was compared to culture on blood agar, the gold standard for the diagnosis of this etiologic agent. RESULTS: Streptococcal antigen was detected in pharyngeal specimens of 34.5% of cases by rapid strip test. We detected group A Streptococcus in 17.2% of pharyngeal culture. There was no agreement between two methods ( PV < 0.1). The negative pharyngeal culture results are probably due to antibiotic usage in 43.2% of patients. Positive rapid test results in pharyngeal swab was age dependent ( P < 0.05). There was good correlation between observing the "petechia in pharynx of patients" and positive rapid test in pharyngeal swab (P < 0.004). Throat culture results were relatated to previous antibiotic usage ( P < 0.03). CONCLUSION: The rapid test in pharyngeal swab is helpful for rapid diagnosis and treatment of GABHS pharyngitis. Diagnosis of GABHS pharyngitis based on soley clinical findings is misleading in the majority of cases. Petechia observed in pharynx of the cases was highly predictive of streptococcal pharyngitis.

Viral infections detected by serology and PCR of perilymphatic fluid in children with idiopathic sensorineural hearing loss.

The etiology of sensorineural hearing loss (SNHL) in children may be viral. This cross-sectional study aimed to determine the role of viral infectious agents in children with idiopathic SNHL. Of 119 children with SNHL aged 3-168 months undergoing cochlear implant surgery at a hospital in Tehran, no cause could be established in 18 cases (15.1%). Cytomegalovirus (CMV) and herpes simplex virus (HSV) active infections (detected by DNA-PCR, confirmed by serology) were found in the perilymphatic fluid of 16.7% (3/18) cases of idiopathic SNHL. Serology was performed on blood samples from 11 of these cases: specific antibodies against CMV, Toxoplasma spp., HSV and rubella were determined in all cases; acute T. gondii infection was detected in 7 cases and rubella IgG was found in only 1 case. Neonatal screening for CMV, HSV and T gondii may be helpful in the Islamic Republi of Iran.

Viral infections detected by serology and PCR of perilymphatic fluid in children with idiopathic sensorineural hearing loss

The etiology of sensorineural hearing loss [SNHL] in children may be viral. This cross-sectional study aimed to determine the role of viral infectious agents in children with idiopathic SNHL Of 119 children with SNHL aged 3-168 months undergoing cochlear implant surgery at a hospital in Tehran, no cause could be established in 18 cases [15.1%]. Cytomegalovirus [CMV] and herpes simplex virus [HSV] active infections [detected by DNA-PCR, confirmed by serology] were found in the perilymphatic fluid of 16.7% [3/18] cases of idiopathic SNHL Serology was performed on blood samples from 11 of these cases: specific antibodies against CMV, Toxoplasmo spp., HSV and rubella were determined in all cases; acute T. gondii infection was detected in 7 cases and rubella IgG was found in only 1 case. Neonatal screening for CMV, HSV and T. gondii may be helpful in the Islamic Republic of Iran

Perineal mesh rectopexy with sterile talc in children with rectal prolapse.

BACKGROUND: With such a wide variety of treatment options available for rectal prolapse and a variable success rate, the optimal treatment for this condition in children is still debated. In this study, we evaluated a technique of perineal mesh rectopexy with a sterile talc-soaked mesh and compared the success rates and complications of this method with those of abdominal rectopexy. METHODS AND MATERIALS: To examine the effect of therapeutic interventions, a randomized control trial (children were randomized into the case group or the control group) was carried out. In the control group, children were operated on by abdominal posterior mesh rectopexy. In the case group, a 30-cm sterile asbestos-free talc-soaked mesh was placed in the presacral space in a spiral fashion with the end exiting from the perineal incision. From 5 (th) day after surgery onward, the mesh was gradually extracted (10 cm per day) and completely removed by the 7 (th) postoperative day. On postoperative assessment, the duration of hospitalization, the postoperative complications and the success rates after surgery were compared. Patients were followed up for one year. RESULTS: In this study we evaluated 120 children. Mean age of the patients was 5.1±0.081 years in the case group and 4.91±0.59 years in the control group (p=NS). 34 patients in the case group were male vs. 41 patients in the control group. Results indicated that there was no statistically significant difference in postoperative complications between groups. The infection rate was 1.6% in the case group and 6.6% in the control group (p=NS).There was a higher resolution of constipation in the perineal rectopexy group (68.4% in the control group and 96.8% in the case group; p=0.002). The duration of hospitalization was 6.34±0.28 days in the case group and 6.68±0.31 days in the control group (p=NS). CONCLUSION: Our findings suggest that perineal mesh rectopexy with sterile talc can be an alternative approach to abdominal surgery and offers an acceptable outcome with a low rate of complications.