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   2022| March-April  | Volume 24 | Issue 2  
    Online since February 24, 2022

 
 
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INVITED OPINION
The new 6th edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen: is it a step toward better standard operating procedure?
Eric Chung, Mohamed Arafa, Florence Boitrelle, Hussein Kandil, Ralf Henkel, Ramadan Saleh, Rupin Shah, Paraskevi Vogiatzi, Armand Zini, Ashok Agarwal
March-April 2022, 24(2):123-124
DOI:10.4103/aja2021118  PMID:35017388
  4,568 277 -
ORIGINAL ARTICLES
Apalutamide for patients with metastatic castrationsensitive prostate cancer in East Asia: a subgroup analysis of the TITAN trial
Byung Ha Chung, Jian Huang, Zhang-Qun Ye, Da-Lin He, Hirotsugu Uemura, Gaku Arai, Choung Soo Kim, Yuan-Yuan Zhang, Yusoke Koroki, SuYeon Jeong, Suneel Mundle, Spyros Triantos, Sharon McCarthy, Kim N Chi, Ding-Wei Ye
March-April 2022, 24(2):161-166
DOI:10.4103/aja.aja_64_21  PMID:34259202
Ethnicity might be associated with treatment outcomes in advanced prostate cancer. This study aimed to evaluate the efficacy and safety of androgen deprivation therapy (ADT) combined with apalutamide in East Asians with metastatic castration-sensitive prostate cancer (mCSPC). The original phase 3 Targeted Investigational Treatment Analysis of Novel Anti-androgen (TITAN) trial was conducted at 260 sites in 23 countries. This subgroup analysis included patients enrolled in 62 participating centers in China, Japan, and Korea. Radiographic progression-free survival (PFS), time to prostate-specific antigen (PSA) progression, and PSA changes from baseline were compared between groups in the East Asian population. The intent-to-treat East Asian population included 111 and 110 participants in the apalutamide and placebo groups, respectively. The 24-month radiographic PFS rates were 76.1% and 52.3% in the apalutamide and placebo groups, respectively (apalutamide vs placebo: hazard ratio [HR] = 0.506; 95% confidence interval [CI], 0.302–0.849; P = 0.009). Median time to PSA progression was more favorable with apalutamide than placebo (HR = 0.210; 95% CI, 0.124–0.357; P < 0.001). Median maximum percentages of PSA decline from baseline were 99.0% and 73.9% in the apalutamide and placebo groups, respectively. The most common adverse event (AE) was rash in the apalutamide group, with a higher rate than that in the placebo group (37.3% vs 9.1%). The most common grade 3 or 4 AEs were rash (12 [10.9%]) and hypertension (12 [10.9%]) for apalutamide. The efficacy and safety of apalutamide in the East Asian subgroup of the TITAN trial are consistent with the global results.
  3,750 388 -
REVIEW
Severe male factor in in vitro fertilization: definition, prevalence, and treatment. An update
Rossella Mazzilli, Alberto Vaiarelli, Lisa Dovere, Danilo Cimadomo, Nicolò Ubaldi, Susanna Ferrero, Laura Rienzi, Francesco Lombardo, Andrea Lenzi, Herman Tournaye, Filippo Maria Ubaldi
March-April 2022, 24(2):125-134
DOI:10.4103/aja.aja_53_21  PMID:34259196
Infertility affects 10%–15% of couples worldwide. Of all infertility cases, 20%–70% are due to male factors. In the past, men with severe male factor (SMF) were considered sterile. Nevertheless, the development of intracytoplasmic sperm injection (ICSI) drastically modified this scenario. The advances in assisted reproductive technology (ART), specifically regarding surgical sperm retrieval procedures, allowed the efficacious treatment of these conditions. Yet, before undergoing ICSI, male factor infertility requires careful evaluation of clinical and lifestyle behavior together with medical treatment. Epidemiologically speaking, women whose male partner is azoospermic tend to be younger and with a better ovarian reserve. These couples, in fact, are proposed ART earlier in their life, and for this reason, their ovarian response after stimulation is generally good. Furthermore, in younger couples, azoospermia can be partially compensated by the efficient ovarian response, resulting in an acceptable fertility rate following in vitro fertilization (IVF) techniques. Conversely, when azoospermia is associated with a reduced ovarian reserve and/or advanced maternal age, the treatment becomes more challenging, with a consequent reduction in IVF outcomes. Nonetheless, azoospermia seems to impair neither the euploidy rate at the blastocyst stage nor the implantation of euploid blastocysts. Based on the current knowledge, the assessment of male infertility factors should involve: (1) evaluation – to diagnose and quantify seminologic alterations; (2) potentiality – to determine the real possibilities to improve sperm parameters and/or retrieve spermatozoa; (3) time – to consider the available “treatment window”, based on maternal age and ovarian reserve. This review represents an update of the definition, prevalence, causes, and treatment of SMF in a modern ART clinic.
  3,374 335 -
ORIGINAL ARTICLES
Modified malleable prosthesis with a fixed mesh: case series for the Ghattas technique
Osama Ghattas, Mohamed Fahmy Doheim, Hossam Kotb, Arthur L Burnett
March-April 2022, 24(2):167-170
DOI:10.4103/aja.aja_55_21  PMID:34213492
Penile prosthetic implantation represents a cornerstone for patients with organic erectile dysfunction (ED) that is refractory, unsatisfactory, or contra-indicated for other approved medical or mechanical options. In this study, we introduce the “Ghattas technique,” wherein we constructed a polypropylene mesh sheath that surrounds and is fixed to a 13-mm malleable prosthesis cylinder, which can increase the cylinder diameter for cases that need a larger prosthesis. All patients underwent preoperative evaluation and completed the five-item International Index of Erectile Function questionnaire (IIEF-5). Postoperative outcomes were evaluated by IIEF-5 and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires at final follow-up. The mean age of the 23 included patients was 57.9 (standard deviation [s.d.]: 11.4) years and the mean duration of ED was 8.5 (s.d.: 7.9) years. Erection improvement was determined by comparing mean preoperative and postoperative IIEF-5 scores (8.3 [s.d.: 3.9] vs 24.6 [s.d.: 0.6], P < 0.001). High treatment satisfaction was determined according to a mean EDITS score of 94.9 (s.d.: 9.9). The proposed Ghattas technique was safe and effective in our patients, and provides opportunity for cases that need a diameter larger than 13 mm. Further studies are needed to confirm these results.
  3,324 132 -
Human umbilical cord Wharton's jelly-derived mesenchymal stem cell transplantation could improve diabetic intracavernosal pressure
Jian-Hong Wu, Dong-Ya Wang, Lu Sheng, Wei-Qing Qian, Shu-Jie Xia, Qi Jiang
March-April 2022, 24(2):171-175
DOI:10.4103/aja.aja_33_21  PMID:33975986
Mesenchymal stem cells (MSCs) secrete various cytokines with angiogenic and neuroprotective effects. This study aimed to assess the effects of human umbilical cord Wharton's jelly-derived MSCs (hWJ-MSCs) on diabetes-related intracavernosal pressure (ICP) impairment in rats. hWJ-MSCs were isolated from human umbilical cord Wharton's jelly and transplanted into the corpus cavernosum of streptozotocin (STZ)-induced diabetic rats by unilateral injection. The erectile function was evaluated at 4 weeks, as well as the expression levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), endothelial nitric oxide synthase (eNOS), and insulin-like growth factor 1 (IGF1). STZ-induced diabetic rats showed impaired ICP, which was significantly improved by hWJ-MSC treatment. VEGF, eNOS, IGF1, and bFGF expression levels were higher in hWJ-MSC injection sites than those in control ones in STZ-induced diabetic rats. These results suggest that hWJ-MSC transplantation might improve diabetic erectile dysfunction through increased production of paracrine growth factors, highlighting a novel potential therapeutic option for erectile dysfunction.
  2,738 197 -
Predictors of efficacy of corticosteroid switching from abiraterone plus prednisone to dexamethasone in patients with metastatic castration-resistant prostate cancer
Yu-Chao Ni, Jin-Ge Zhao, Meng-Ni Zhang, Yi-Jun Zhang, Zhen-Yu Yang, Ni Chen, Jun-Ru Chen, Peng-Fei Shen, Guang-Xi Sun, Xing-Ming Zhang, Yong-Hong Li, Hao Zeng
March-April 2022, 24(2):154-160
DOI:10.4103/aja202143  PMID:34380864
Corticosteroid switching can reverse abiraterone resistance in some patients with metastatic castration-resistant prostate cancer (mCRPC). Here, we investigated the potential biomarkers for predicting the efficacy of corticosteroid switching during treatment with abiraterone acetate (AA). We retrospectively analyzed 101 mCRPC patients receiving corticosteroid switching from West China Hospital and Sun Yat-Sen University Cancer Center between January 2016 and December 2018. All cases received AA plus prednisone as first-line therapy during mCRPC. Primary end points were biochemical progression-free survival (bPFS) and overall survival (OS). The risk groups were defined based on multivariate analysis. A total of 42 (41.6%) and 25 (24.8%) patients achieved 30% and 50% decline in prostate-specific antigen (PSA), respectively, after corticosteroid switching. The median bPFS and median OS on AA plus dexamethasone were 4.9 (95% confidence interval [CI]: 3.7–6.0) months and 18.8 (95% CI: 16.2–30.2) months, respectively. Aldo-keto reductase family 1 member C3 (AKR1C3) expression (hazard ratio [HR]: 2.15, 95% Cl: 1.22–3.80, P = 0.008) and baseline serum alkaline phosphatase (ALP; HR: 4.95, 95% Cl: 2.40–10.19, P < 0.001) were independent predictors of efficacy before corticosteroid switching in the multivariate analysis of bPFS. Only baseline serum ALP >160 IU l−1 (HR: 3.41, 95% Cl: 1.57–7.38, P = 0.002) together with PSA level at switch ≥50 ng ml−1 (HR: 2.59, 95% Cl: 1.22–5.47, P = 0.013) independently predicted poorer OS. Based on the predictive factors in multivariate analysis, we developed two risk stratification tools to select candidates for corticosteroid switching. Detection of serum ALP level, PSA level, and tissue AKR1C3 expression in mCRPC patients could help make clinical decisions for corticosteroid switching.
  2,466 221 -
BOOK REVIEW
A cultural biography of the prostate
Ericka Johnson
March-April 2022, 24(2):228-228
DOI:10.4103/aja.aja_61_21  PMID:34259201
  2,226 170 -
ORIGINAL ARTICLES
High IL-23+ cells infiltration correlates with worse clinical outcomes and abiraterone effectiveness in patients with prostate cancer
Zheng Liu, Jun-Yu Zhang, Yun-Jie Yang, Kun Chang, Qi-Feng Wang, Yun-Yi Kong, Bo Dai
March-April 2022, 24(2):147-153
DOI:10.4103/aja202173  PMID:34755700
Individualized treatment of prostate cancer depends on an accurate stratification of patients who are sensitive to various treatments. Interleukin-23 (IL-23) was reported to play a significant role in prostate cancer. Here, we aimed to explore the clinical value of IL-23-secreting (IL-23+) cells in prostate cancer patients. We evaluated interleukin-23A (IL-23A) expression in The Cancer Genome Atlas database and retrospectively enrolled 179 treatment-naïve metastatic prostate cancer patients diagnosed in our institute between June 2012 and December 2014. IL-23+ cells were stained and evaluated via immunohistochemistry. Further, survival and multivariate Cox regression analyses were conducted to explore the prognostic value of IL-23+ cells. We found that IL-23A expression correlated with disease progression, while IL-23+ cells were clearly stained within prostate cancer tissue. Patients with higher Gleason scores and multiple metastatic lesions tended to have more IL-23+ cell infiltration. Further analyses showed that patients with higher levels of IL-23+ cells had significantly worse overall survival (hazard ratio [HR] = 2.996, 95% confidence interval [95% CI]: 1.812–4.955; P = 0.001) and a higher risk of developing castration resistance (HR = 2.725, 95% CI: 1.865–3.981; P = 0.001). Moreover, subgroup analyses showed that when patients progressed to a castration-resistant status, the prognostic value of IL-23+ cells was observed only in patients treated with abiraterone instead of docetaxel. Therefore, we showed that high IL-23+ cell infiltration is an independent prognosticator in patients with metastatic prostate cancer. IL-23+ cell infiltration may correlate with abiraterone effectiveness in castration-resistant prostate cancer patients.
  2,156 166 -
Assessment of SARS-CoV-2 RNA shedding in semen of 36 males with symptomatic, asymptomatic, and convalescent infection during the first and second wave of COVID-19 pandemic in Italy
Carlo Pavone, Giovanni M Giammanco, Andrea Pio Cascino, Davide Baiamonte, Mirko Pinelli, Enrico Cangelosi, Chiara Filizzolo, Giuseppa Sciortino, Simona De Grazia, Floriana Bonura
March-April 2022, 24(2):135-138
DOI:10.4103/aja2021103  PMID:35017385
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) receptor, angiotensin-converting enzyme 2 (ACE2), has been identified in the human testis, but the risk of transmission of SARS-CoV-2 through sexual intercourse still needs to be defined. The goal of our study was to determine if SARS-CoV-2 is detectable in the semen of patients suffering or recovering from coronavirus disease-19 (COVID-19), still testing positive at nasopharyngeal swabs but showing mild or no symptoms at the time of sampling. Detection of SARS-CoV-2 RNA in semen was performed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) and nested PCR targeting open reading frame (ORF) 1ab. Medical history of the enrolled patients was taken, including COVID-19-correlated symptoms, both at the time of diagnosis and at the time of interview. Results of real-time RT-PCR and nested PCR in semen showed no evidence of SARS-CoV-2 RNA in the 36 patients suffering or recovering from COVID-19 but still positive in a nasopharyngeal swab, from over 116 patients enrolled in the study. SARS-CoV-2 detection and persistence in semen would have an impact on both clinical practice and public health strategies, but our results would suggest that SARS-CoV-2 is not present in the semen of men recovering from COVID-19.
  2,104 202 -
LETTER TO THE EDITOR
Postcircumcision psoriatic balanoposthitis: an undescribed expression of Koebner's phenomenon
Juan Ortiz-Alvarez, Juan Carlos Hernández-Rodríguez, Julián Conejo-Mir Sánchez, Román Barabash-Neila
March-April 2022, 24(2):219-220
DOI:10.4103/aja.aja_65_21  PMID:34380863
  2,110 78 -
INVITED COMMENTARY
Dexamethasone use in metastatic castration-resistant prostate cancer patients treated with abiraterone acetate: this “cort” is not out of order!
Charles Van Praet, Valérie Fonteyne, Nicolaas Lumen
March-April 2022, 24(2):225-225
DOI:10.4103/aja202155  PMID:34472452
  2,028 159 -
ORIGINAL ARTICLES
Contrast-enhanced ultrasound as a valuable imaging modality for characterizing testicular lesions
Jie Yu, Xin-Hui Jiang, Lian-Fang Du, Min Bai, Zhao-Jun Li, Qiu-Sheng Shi, Qi Jiang, Fan Li
March-April 2022, 24(2):201-206
DOI:10.4103/aja202158  PMID:34528518
Contrast-enhanced ultrasound (CEUS) is a new form of ultrasound (US) that can dynamically display microvessels in a highly sensitive manner. The purpose of this study was to investigate the efficacy of CEUS for characterizing testicular lesions in comparison with conventional US. Forty-seven patients with testicular lesions were enrolled. The histopathology results revealed that 31 cases were neoplastic (11 cases of seminomas, 8 nonseminomatous germ cell tumors, 8 lymphomas, 2 Leydig cell tumors, and 2 nonspecific tumors), and 16 cases were nonneoplastic (8 cases of infarctions, 3 epidermoid cysts, and 5 inflammation). The indicators of shallow lobulated morphology and cystic-solid echogenicity on conventional US were suggestive of germ cell tumors. More indicators on CEUS were found to be useful for characterizing testicular lesions. All the neoplastic lesions showed hyperenhancement on CEUS. Moreover, germ cell tumors presented with heterogeneous enhancement (73.7%, 14/19), a twisted blood vessel pattern, rapid wash-in and wash-out, and peripheral rim hyperenhancement signs. Lymphoma was characterized by nonbranching linear vessel patterns (87.5%, 7/8), rapid wash-in and slow wash-out. In nonneoplastic lesions, infarction and epidermoid cysts showed no enhancement, and abscesses were observed with marginal irregular enhancement. The sensitivity, specificity, and accuracy of CEUS for differentiating between neoplastic and nonneoplastic lesions were 100%, 93.8%, and 97.9%, respectively, and these values were higher than those for conventional US (90.3%, 62.5%, and 80.9%, respectively). CEUS can sensitively reflect the microvascular perfusion in testicular lesions and offers high accuracy for characterizing them.
  2,017 149 -
MBOAT1 homozygous missense variant causes nonobstructive azoospermia
Yang-Yang Wan, Lan Guo, Yao Yao, Xiao-Yun Shi, Hui Jiang, Bo Xu, Juan Hua, Xian-Sheng Zhang
March-April 2022, 24(2):186-190
DOI:10.4103/aja202160  PMID:34596601
Nonobstructive azoospermia (NOA) is a common cause of infertility and is defined as the complete absence of sperm in ejaculation due to defective spermatogenesis. The aim of this study was to identify the genetic etiology of NOA in an infertile male from a Chinese consanguineous family. A homozygous missense variant of the membrane-bound O-acyltransferase domain-containing 1 (MBOAT1) gene (c.770C>T, p.Thr257Met) was found by whole-exome sequencing (WES). Bioinformatic analysis also showed that this variant was a pathogenic variant and that the amino acid residue in MBOAT1 was highly conserved in mammals. Quantitative polymerase chain reaction (Q-PCR) analysis showed that the mRNA level of MBOAT1 in the patient was 22.0% lower than that in his father. Furthermore, we screened variants of MBOAT1 in a broader population and found an additional homozygous variant of the MBOAT1 gene in 123 infertile men. Our data identified homozygous variants of the MBOAT1 gene associated with male infertility. This study will provide new insights for researchers to understand the molecular mechanisms of male infertility and will help clinicians make accurate diagnoses.
  1,962 176 -
Adolescent male genitalia dissatisfaction: a surgical perspective
Nicola Zampieri, Ilaria Dando, Francesco Saverio Camoglio
March-April 2022, 24(2):176-179
DOI:10.4103/aja.aja_60_21  PMID:34259198
Genital dissatisfaction is well known in female and adults. Less is known about male adolescents and their genital satisfaction. The aim of this study was to investigate and report the role of surgery in male adolescents to improve the evaluation of their genitalia. We considered all patients treated for external genital pathology in the period of adolescence. Inclusion and exclusion criteria were created. Patients underwent an evaluation test before and after surgery. During the study period, 137 patients were treated, and at the end of the study, 98 cases were considered for analysis. The most frequent pathologies were webbed penis and penile curvature. A postoperative score improvement was noted and patients with concealed penis and webbed penis showed a better postoperative outcome. Overweight was considered an important factor associated with a worse preoperative score. Evaluation of the external genitalia is important in adolescents, and it is an understudied problem. Overweight may be associated with a worse evaluation of one's genital and should be clinically considered to avoid related social problems in adulthood. Therefore, cosmetic genital surgery should be considered even in male adolescents.
  1,954 156 -
Prostate-derived IL-1β upregulates expression of NMDA receptor in the paraventricular nucleus and shortens ejaculation latency in rats with experimental autoimmune prostatitis
Jie Yang, Jiao-Chen Luan, Jian-Huai Chen, Qi-Jie Zhang, Jian-Xin Xue, Ya-Min Wang, Guo-Qing Zhu, Ning-Hong Song, Zeng-Jun Wang, Jia-Dong Xia
March-April 2022, 24(2):213-218
DOI:10.4103/aja202142  PMID:34396994
Experimental autoimmune prostatitis (EAP)-induced persistent inflammatory immune response can significantly upregulate the expression of N-methyl-D-aspartic acid (NMDA) receptors in the paraventricular nucleus (PVN). However, the mechanism has not yet been elucidated. Herein, we screened out the target prostate-derived inflammation cytokines (PDICs) by comparing the inflammatory cytokine levels in peripheral blood and cerebrospinal fluid (CSF) between EAP rats and their controls. After identifying the target PDIC, qualified males in initial copulatory behavior testing (CBT) were subjected to implanting tubes onto bilateral PVN. Next, they were randomly divided into four subgroups (EAP-1, EAP-2, Control-1, and Control-2). After 1-week recovery, EAP-1 rats were microinjected with the target PDIC inhibitor, Control-1 rats were microinjected with the target PDIC, while the EAP-2 and Control-2 subgroups were only treated with the same amount of artificial CSF (aCSF). Results showed that only interleukin-1β(IL-1β) had significantly increased mRNA-expression in the prostate of EAP rats compared to the controls (P < 0.001) and significantly higher protein concentrations in both the serum (P = 0.001) and CSF (P < 0.001) of the EAP groups compared to the Control groups. Therefore, IL-1β was identified as the target PDIC which crosses the blood-brain barrier, thereby influencing the central nervous system. Moreover, the EAP-1 subgroup displayed a gradually prolonged ejaculation latency (EL) in the last three CBTs (all P < 0.01) and a significantly lower expression of NMDA NR1 subunit in the PVN (P = 0.043) compared to the respective control groups after a 10-day central administration of IL-1β inhibitors. However, the Control-1 subgroup showed a gradually shortened EL (P < 0.01) and a significantly higher NR1 expression (P = 0.004) after homochronous IL-1β administration. Therefore, we identified IL-1β as the primary PDIC which shortens EL in EAP rats. However, further studies should be conducted to elucidate the specific molecular mechanisms through which IL-1β upregulates NMDA expression.
  1,959 151 -
A novel mouse model simulating transurethral laser vaporization prostatectomy
Heng Zhang, Ye Tian, Bing Yang, Ling-Yue An, Shu-Jie Xia, Guang-Heng Luo
March-April 2022, 24(2):191-194
DOI:10.4103/aja.aja_59_21  PMID:34259200
Benign prostatic hyperplasia (BPH) is a common disease in elderly men, and transurethral laser prostatectomy (TULP) has been widely used in the clinic to remove bladder outlet obstruction caused by BPH. Previous animal models for wound repair after prostatectomy have many limitations, and there have been no previous reports of a mouse model of TULP. Therefore, this study aimed to establish a novel mouse model of TULP. Twelve healthy adult Kunming (KM) mice received transurethral laser vaporization prostatectomy with a 200-μm thulium laser. The mice were sacrificed, and wound specimens from the prostatic urethra and bladder neck were harvested at 1 day, 3 days, 5 days, and 7 days after surgery. Hematoxylin-eosin (HE) and immunohistochemistry were applied to confirm the establishment of the mouse TULP model. One day after the surgery, urothelium expressing uroplakin (UPK) was absent in the urethral wound site, and a large number of necrotic tissues were found in the wound site. There was no UPK-positive urothelium in the wound 3 days after surgery. At 5 days after surgery, monolayer urothelium expressing UPK was found in the wound site, indicating that the re-epithelization of the wound had been completed. On the 7th day after surgery, there were multiple layers of urothelium with UPK expression, indicating that the repair was completed. It is feasible to establish a mouse TULP model by using a microcystoscope system and a 200-μm thulium laser.
  1,800 146 -
Experimental investigation of early assessment of corpora cavernosa fibrosis with two-dimensional shear wave elastography
Li Yu, Wan-Ting Rao, Jing-Dong Tang, Jin-Fang Xing
March-April 2022, 24(2):207-212
DOI:10.4103/aja202147  PMID:34494557
This study explored the usefulness of two-dimensional shear wave elastography (2D-SWE) in the early assessment of corpora cavernosa fibrosis (CCF). New Zealand male rabbits were randomly assigned to an experimental group or a control group. Recombinant human transforming growth factor beta 1 (TGF-β1) was injected into the dorsal penis tissue of rabbits in the experimental group. Conventional ultrasound and 2D-SWE examinations were performed before and 20 days after injection. Penile histological analysis was performed by hematoxylin–eosin staining, sirius red staining, and immunohistochemistry. Measurement of 2D-SWE examination results was performed using shear wave elastography quantitative measurement (SWQ). Histological analysis outcomes were the proportion of smooth muscle cells (SMCs), collagen fibers (CFs), collagen type I (Col I), and collagen type III (Col III), as well as the SMCs/CFs ratio, measured by sirius red staining. Other histological analysis outcomes were the positive area proportion (PAP) of TGF-β1 (PAPT), fibronectin (PAPF), and Col III (PAPC), measured by immunohistochemistry. After recombinant human TGF-β1 injection, SWQ was higher in the experimental group than that in the control group (P < 0.001); however, there were no differences in conventional ultrasound results. There were significant differences in histological outcomes between the two groups (all P < 0.05). These results indicated that 2D-SWE was superior for identifying early histological changes in CCF.
  1,840 95 -
Clinical application of free/total PSA ratio in the diagnosis of prostate cancer in men over 50 years of age with total PSA levels of 2.0–25.0 ng ml-1 in Western China
Xue-Dan Gao, Qiang Miao, Jun-Long Zhang, Jian-Zhao Zhai, Xue-Mei Gui, Yi-Han Cai, Qian Niu, Bei Cai
March-April 2022, 24(2):195-200
DOI:10.4103/aja202182  PMID:34916475
The goal of this study was to investigate the clinical application of free/total prostate-specific antigen (F/T PSA) ratio, considering the new broad serum total PSA (T-PSA) “gray zone” of 2.0–25.0 ng ml−1 in differential diagnosis of prostate cancer (PCa) and benign prostate diseases (BPD) in men over 50 years in Western China. A total of 1655 patients were included, 528 with PCa and 1127 with BPD. Serum T-PSA, free PSA (F-PSA), and F/T PSA ratio were analyzed. Receiver operating characteristic curves were used to assess the efficiency of PSA and F/T PSA ratio. There were 47.4% of cancer patients with T-PSA of 2.0–25.0 ng ml−1. When T-PSA was 2.0–4.0 ng ml−1, 4.0–10.0 ng ml−1, and 10.0–25.0 ng ml−1, the area under the curve (AUC) of F/T PSA ratio was 0.749, 0.769, and 0.761, respectively. The best AUC of F/T PSA ratio was 0.811 when T-PSA was 2.0–25.0 ng ml−1, with a specificity of 0.732, a sensitivity of 0.788, and an optimal cutoff value of 15.5%. The AUC of F/T PSA ratio in different age groups (50–59 years, 60–69 years, 70–79 years, and ≥80 years) was 0.767, 0.806, 0.815, and 0.833, respectively, and the best sensitivity (0.857) and specificity (0.802) were observed in patients over 80 years. The T-PSA trend was in accordance with the Gleason score, tumor node metastasis (TNM) stage, and American Joint Committee on Cancer prognosis group. Therefore, the F/T PSA ratio can facilitate the differential diagnosis of PCa and BPD in the broad T-PSA “gray zone”. Serum T-PSA can be a Gleason score and prognostic indicator.
  1,787 131 -
INVITED COMMENTARY
Impact of IL-23 in prostate cancer
Bhalchandra Mirlekar
March-April 2022, 24(2):223-224
DOI:10.4103/aja2021100  PMID:34850747
  1,730 131 -
ORIGINAL ARTICLES
Local renin angiotensin system and sperm DNA fragmentation
María Victoria Aparicio Prieto, María Victoria Rodríguez Gallego, Asier Valdivia Palacín, Yosu Franco Iriarte, Gotzone Hervás Barbara, Enrique Echevarría Orella, Luis Casis Saenz
March-April 2022, 24(2):139-146
DOI:10.4103/aja202150  PMID:34494558
The renin angiotensin system (RAS) appears to influence male fertility at multiple levels. In this work, we analyzed the relationship between the RAS and DNA integrity. Fifty male volunteers were divided into two groups (25 each): control (DNA fragmentation ≤20%) and pathological (DNA fragmentation >20%) cases. Activities of five peptidases controlling RAS were measured fluorometrically: prolyl endopeptidase (which converts angiotensin [A] I and A II to A 1–7), neutral endopeptidase (NEP/CD10: A I to A 1–7), aminopeptidase N (APN/CD13: A III to A IV), aminopeptidase A (A II to A III) and aminopeptidase B (A III to A IV). Angiotensin-converting enzyme (A I to A II), APN/CD13 and NEP/CD10 were also assessed by semiquantitative cytometry and quantitative flow cytometry assays, as were the receptors of all RAS components: A II receptor type 1 (AT1R), A II receptor type 2 (AT2R), A IV receptor (AT4R or insulin-regulated aminopeptidase [IRAP]), (pro)renin receptor (PRR) and A 1–7 receptor or Mas receptor (MasR) None of the enzymes that regulate levels of RAS components, except for APN/CD13 (decrease in fragmented cells), showed significant differences between both groups. Micrographs of RAS receptors revealed no significant differences in immunolabeling patterns between normozoospermic and fragmented cells. Labeling of AT1R (94.3% normozoospermic vs 84.1% fragmented), AT4R (96.2% vs 95.3%) and MasR (97.4% vs 87.2%) was similar between the groups. AT2R (87.4% normozoospermic vs 63.1% fragmented) and PRR (96.4% vs 48.2%) were higher in non-fragmented spermatozoa. These findings suggest that fragmented DNA spermatozoa have a lower capacity to respond to bioactive RAS peptides.
  1,351 212 -
LETTER TO THE EDITOR
Outcomes of the study of intracytoplasmic sperm injection (ICSI) and sperm motility with microdissection testicular sperm extraction
Yuuka Arai, Hiroe Ueno, Mizuki Yamamoto, Haruna Izumi, Kazumi Takeshima, Tomonari Hayama, Hideya Sakakibara, Yasushi Yumura, Etsuko Miyagi, Mariko Murase
March-April 2022, 24(2):221-222
DOI:10.4103/aja202152  PMID:34558458
  1,411 95 -
ORIGINAL ARTICLES
Neoadjuvant chemotherapy for patients with locally advanced penile cancer: an updated evidence
Xian-Yan-Ling Yi, De-Hong Cao, Ping-Hong You, Xing-Yu Xiong, Xiao-Nan Zheng, Ge Peng, Da-Zhou Liao, Hong Li, Lu Yang, Jian-Zhong Ai
March-April 2022, 24(2):180-185
DOI:10.4103/aja202188  PMID:34975068
Neoadjuvant chemotherapy (NAC) has shown promising results in patients with locally advanced penile cancer. However, no consensus exists on its applications for locally advanced penile cancer. Thus, it is unclear which kind of chemotherapy regimen is the best choice. Consequently, a systematic search of PubMed, Web of Science, and EMBASE was performed in March 2021 to assess the efficacy and safety of NAC for the treatment of patients with locally advanced penile cancer. The Newcastle–Ottawa Scale was used to assess the risk of bias in each study. This study synthesized 14 published studies. The study revealed that patients who achieved an objective response to NAC obtained a better survival outcome compared with those who did not achieve an objective response. In addition, the objective response rates (ORRs) and pathological complete response (pCR) rates were 0.57 and 0.11, respectively. The incidence of grade ≥3 toxicity was 0.36. Subgroup analysis found that the ORR and pCR of the taxane–platinum (TP) regimen group performed better than those of the nontaxane–platinum (NTP) regimen group (0.57 vs 0.54 and 0.14 vs 0.07, respectively). Moreover, the TP regimen group had more frequent toxicity than the NTP regimen group (0.41 vs 0.26). However, further studies were warranted to confirm the findings.
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INVITED COMMENTARY
Commentary on: “Human umbilical cord wharton's jelly-derived mesenchymal stem cell transplantation could improve diabetic intracavernosal pressure”
Fotios Dimitriadis, Vasileios Palapelas, Athanasios Zachariou, Ioannis Sokolakis
March-April 2022, 24(2):226-227
DOI:10.4103/aja.aja_52_21  PMID:34213491
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