Embryological basis of polyorchidism including classification, reproductive potential, and risk of malignancy: A review

Polyorchidism, a congenital malformation characterized by supernumerary testes (SNTs), is usually revealed incidentally during ultrasound or open scrotal surgery. In the approximately 200 cases so far published in the literature, the left side is affected more often than the right. Despite the rarity of this anomaly, a surgeon must have basic knowledge of its embryological basis and classifications to implement proper treatment and avoid overlooking it, since the consequences could harm the patient. This review summarizes previous classifications. It can be assumed that determining the risk of malignancy, and the level of reproductive potential based on location, vascularization, ductus deferens drainage, and environmental factors (e.g., temperature) affecting the SNTs, indicates the best approach to management. Therefore, we have created a new classification based on previous ones, addressing the aforementioned issues, which will guide the clinician to select the most appropriate treatment.

Scapular foramina - a systematic review with meta-analysis based on 3316 scapulae

PURPOSE

In the present study, we want to systematize the previous studies on the scapular foramina (SF) and nutrient foramina (NF) with emphasis on the clinical relevance of this topic. Although seemingly not important, radiologists, clinicians and surgeons should be aware of the presence and characteristics of the SF and NF and look out for possible mistakes that may cause harm to the patients during either the diagnostic process or surgery.

METHODS

A comprehensive search was conducted in multiple databases, including PubMed, Scopus, Web of Science, Embase, Cochrane Library and Google Scholar. The whole process was divided into three stages. In the first stage, the following search terms were used: ((scapular foramina) or (scapular foramen) or (scapular nutrient foramina) or (scapular nutrient foramen) or (scapula foramen) or (scapula foramina) or (scapula nutrient foramina)).

RESULTS

The results of the present meta-analysis were based on a total of 3316 studied scapulae. A pooled prevalence of scapulae in which at least one SF was found was set to be 11.29%. The most common localization of the SF was found to be the infraspinous fossa, in which the SF occurred with the prevalence of 52.31%. Subsequently, a pooled prevalence of scapulae in which at least one NF occurs was established at 74.23%.

CONCLUSION

The presented data contribute to a comprehensive understanding of the prevalence, distribution, and characteristics of suprascapular and nutrient foramina in scapulae, considering different topographical areas, genders, and sides.

Exploring the clinical characteristics and prevalence of the annular pancreas: a meta-analysis

BACKGROUND

The annular pancreas (AP) is a rare gastrointestinal congenital malformation, in which malrotation of the pancreatic ventral bud in the seventh week of embryonic development manifests in a partial or complete ring of tissue around the second part of the duodenum.

METHODS

The main online medical databases such as PubMed, ScienceDirect, Wiley online library, Web of Science, and EBSCO discovery service were used to gather all relevant studies on the AP.

RESULTS

A total of 12,729,118 patients were analyzed in relation to the prevalence of AP. The pooled prevalence of AP was 0.0045% (95% CI: 0.0021%-0.0077%). The most frequent comorbidity in adults and children was duodenal obstruction, with a pooled prevalence of 24.04% and 52.58%, respectively (95% CI: 6.86%-46.48% and 35.56%-69.31%, respectively). The most frequent operation in adult patients with AP was duodenojejunostomy, with pooled prevalence established at 3.62% (95% CI: 0.00%-10.74%).

CONCLUSION

The diagnostic complexity of AP is accentuated by its nonspecific clinical symptoms, making accurate identification reliant on imaging studies. Therefore, having a thorough knowledge of the clinical characteristics of the AP and its associated anomalies becomes paramount when faced with this rare congenital condition.

Pelvic cavity and its spaces - anatomical overview

Anatomical nomenclature commonly does not follow changes in the clinical language and demands. Therefore we tried to explain the pelvic relationships based on the changes that occur in the pelvis as well as to compare different nomenclatural strategies used in every day language. Courses of fasciae in the male and female pelvis are also considered.

Reappraisal of the variational anatomy of the vermiform appendix and their possible clinical applicability: a cadaveric analysis

BACKGROUND

The anatomical variations in the position, length, arterial supply and extension of mesoappendix of the vermiform appendix (VA) are pivotal to establishing a standard pattern in the study population of known ethnicity and their clinical applicability.

MATERIALS AND METHODS

The present study was conducted on 47 adult human cadavers, thirty-five males and twelve female subjects of North Indian ethnicity.

RESULTS

Retrocaecal appendix was found in 23 cases (48.9%) followed by pelvic in 13 (27.7%), three cases each of pre-ileal, post-ileal, and promontoric (6.4%), one case (2.1%) each of paracaecal and subcaecal reported. The length of VA varied from three to ten centimetres, averaging about 7.37±1.67 cm, both the shortest (2.9 cm) (female) and longest (10 cm) (male) were of retrocaecal type. The main appendicular artery (MAA) showed a widely varied branching pattern within the mesoappendix, ranging from three to seven. Fourteen cases (29.78%) showed the accessory appendicular artery (AAA) or dual arterial supply, arising from the ileocolic artery in ten (21%) and in four from the post-caecal (9%). In the specimens with dual arterial supply, the estimated portions of the VA supplied by the MAA also vary with distal ¾th being supplied in 57.14%. In ten cases (21%), the mesoappendix failed to reach the tip of the VF.

CONCLUSIONS

Knowledge of anatomical diversities in position, length, course, arterial supply, branching pattern, and mesoappendix is potentially crucial in avoiding surgical catastrophes. Atypical positions of the organ can cause diagnostic confusion and result in delayed treatment. VF supplied by an end artery is one of the causes of the occurrence of appendicitis and mesoappendix not reaching the tip making the organ more vulnerable to necrosis. Vascular variations and anomalies involving the main or accessory appendicular artery are critical to prevent haemorrhage or faulty ligatures.

Testicular Metastasis from Renal Cell Carcinoma: A Systematic Review

Approximately one-third of renal cell carcinoma (RCC) is recognized in its metastatic stage. This systematic review aimed to summarize knowledge on the occurrence and treatment of testicular RCC metastasis. The literature search was performed by two authors independently, with the use of main electronic medical databases (Science Direct, Web of Science, and PubMed) until March 2023 to identify relevant articles that could potentially contribute to this review. Neither language nor publication dates were set as limits. Although we found a total of 51 case reports, only 31 of them contained all the required information. Testicular metastasis in patients with RCC suggests a late stage of the disease. Moreover, it usually does not present typical systemic or specific symptoms except for swelling and enlargement of the affected testis. Knowledge of the possibility of such variants of RCC metastases will allow a clinician to make an appropriate diagnosis and implement adequate treatment without delay, which is crucial in the management of neoplastic disease.

Morphology of the Sella Turcica: A Meta-Analysis Based on the Results of 18,364 Patients

BACKGROUND

This meta-analysis aimed to present data on the sella turcica (ST) morphology and variations. Furthermore, a detailed morphometric analysis of the ST was conducted.

METHODS

Major online databases such as PubMed, Scopus, Embase, Web of Science, and the Cochrane Library were searched through. The overall search process was conducted in three stages.

RESULTS

This meta-analysis was based on the results of 18,364 patients and demonstrates the most up-to-date and relevant data regarding the morphology of the ST in the available literature. Four classification methods of the ST shape can be distinguished, in which the most commonly occurring variants are the normal ST (55.56%), the U-shaped ST (73.58%), the circular type of ST (42.29%), and non-bridging ST (55.64%). The overall midpoint height of the ST was 6.59 mm (SE = 0.13). The overall length of the ST was 9.06 mm (SE = 0.15). The overall volume of the ST was 845.80 mm3 (SE = 288.92). Four main classification methods of ST morphology can be distinguished in the available literature. Various morphometric characteristics of the ST may be applied in clinical practice to evaluate its shape, dimensions, and normal or pathological variants.

Serum Oxidative and Nitrosative Stress Markers in Clear Cell Renal Cell Carcinoma

Oxidative stress is believed to be a factor in the development and progression of renal cell carcinoma (RCC). The identification of the oxidative and nitrosative modification of proteins and the definition of their roles in clear cell RCC (ccRCC) may be helpful in the elaboration of targeted therapeutic approaches to mitigate protein damage. This study aimed to investigate the status of oxidative/nitrosative stress and to explore its role in the development and progression. The studied group consisted of 48 newly diagnosed ccRCC and 30 healthy controls. Serum levels of oxidative stress markers-advanced oxidation protein products (AOPP), thiol groups, Amadori reaction products, 3-nitrotyrosine, nitrate/nitrite, malondialdehyde (MDA), 4-hydroxy-2-nonenal and total antioxidant capacity (TAC)-were determined. Additionally, associations between tumour stage assessed according to TNM classification, histological grade, and the effect of the presence of angioinvasion on the level of stress markers were evaluated. The levels of Amadori products, 3-nitrotyrosine, and nitrate/nitrite were elevated, while the levels of thiol groups and TAC decreased in the ccRCC group. The levels of AOPP, Amadori, and 3-nitrotyrosine increased, and thiol groups and TAC levels decreased with the increasing pathological stage of the tumour. In the case of advanced histological assessment of the tumour, we found decreasing levels of thiol groups and increasing levels of MDA. In patients with angioinvasion, nitrate/nitrite and MDA levels were significantly elevated compared to those in patients without angioinvasion. Oxidative stress increased with the progression of the disease assessed according to the TNM and histological grade. These results demonstrate systemic oxidative stress in ccRCC, suggesting the therapeutic application of antioxidants.

Thoracolumbar fascia in the lumbar region: anatomical description and topographical relationships to the cutaneous nerves: a preliminary study

BACKGROUND

The study aims to determine principal topographical relations between thoracolumbar fascia (TLF) and lateral branches derived from the dorsal (posterior) rami of lumbar spinal nerves and elucidate their potential link to lumbar region pain. The research protocol involves basic TLF morphological description, evaluating its relation to the nerves, and examining general histology.

MATERIALS AND METHODS

The research was conducted on four male cadavers fixed in 10% neutral buffered formalin.

RESULTS

The dorsal rami of the spinal nerves branched into medial and lateral divisions. The lateral divisions were about 1 mm thick and mainly visible in the subcutaneous tissue during stratigraphic dissection. They pierced the TLF superficial layer. They descended sidewards and downwards within the superficial fascia (laterally to the erector spinae muscle) to provide sensory innervation to the skin.

CONCLUSIONS

Anatomical relationships between TLF, deep (intrinsic or true) back muscles, and dorsal rami of the spinal nerves are complex and may be clinically involved in low back pain etiopathogenesis.

A Prospective Study of Renal Blood Flow during Retrograde Intrarenal Surgery

(I) Introduction: The use of Doppler ultrasound allows us to indirectly assess the effect of increased intrarenal pressure on renal blood flow during retrograde intrarenal surgery (RIRS). On the basis of vascular flow spectra from selected blood vessels in the kidney, it is possible to determine Doppler parameters that reflect the renal perfusion status, which indirectly shows the degree of vasoconstriction and reflects the resistance of kidney tissue. (II) Materials and methods: A total of 56 patients were included in the study. The study assessed the changes of three Doppler parameters of intrarenal blood flow: resistive index-RI, pulsatility index-PI, and acceleration time-AT in the ipsilateral and contralateral kidneys during RIRS. The effects of mean stone volume, energy used, and pre-stenting were examined as predictors and calculated at two time intervals. (III) Results: The mean value of RI and PI was significantly higher in the ipsilateral kidney than in the contralateral kidney just after RIRS. The mean value of the acceleration time was not significantly different before and after RIRS. The values of all three parameters 24 h after the procedure were comparable to their values immediately after the RIRS. The size of the stone exposed to laser lithotripsy, the value of the energy used, and pre-stenting are not factors that significantly influence Doppler parameters during RIRS. (IV) Conclusions: The significant increase in RI and PI after RIRS in the ipsilateral kidney suggests a vasoconstriction of the interlobar arteries generated by increased intrarenal pressure during the procedure.

Bilateral absence of the deep brachial artery

The aim of the following study was to present and comprehensively describe a case of a bilateral absence of the deep brachial artery (DBA). Furthermore, its embryology and clinical significance will also be discussed. During routine dissection, a 71-year-old male cadaver with a bilateral abnormality in the DBA and its branches was found. The first branch of the brachial artery (BA) was found to be the radial collateral artery, which passed behind the radial nerve. Furthermore, the middle collateral artery originated distal to the radial collateral artery and gave off first a singular, minor muscular branch and then the superior ulnar collateral artery. Later, the preceding nutrient arteries of the humerus and the deltoid branch consecutively branched off from the middle collateral artery. Subsequently, the middle ulnar collateral artery, the inferior ulnar collateral artery, the deltoid artery, the radial artery, and the ulnar artery branched off from the BA, as adapted in the current knowledge regarding the anatomy of the upper extremity. Furthermore, detailed measurements of the distances between the mentioned arteries were carried out. In the present study, a bilateral absence of the DBA was demonstrated. Meta-analysis focusing on the anatomy of this artery has shown how variable its characteristics are. However, our case report is the first in the literature to present this extremely rare variation. Having adequate knowledge regarding the anatomy of the arteries of the proximal arm is of immense importance when performing orthopaedic and reconstructive surgeries in this area.

The subscapularis muscle: A meta-analysis of its variations, prevalence, and anatomy

BACKGROUND

The subscapularis (SSC) is the largest rotator cuff muscle and is involved in the medial rotation, abduction, adduction, and anterior stabilization of the shoulder. It is anatomically variable, as is the morphology and prevalence of the accessory SSC (aSSC), a rare muscle slip attached to the SSC. There is no current review investigating the prevalence and morphometrics of the SSC and aSSC.

PURPOSE

To investigate the prevalence of the morphological variants of the SSC and aSSC via meta-analysis and review the relevant literature involving cadaveric, magnetic resonance imaging, and ultrasonographic studies.

STUDY DESIGN

Meta-analysis.

MATERIALS AND METHODS

Literature data reporting the prevalence rates and morphometrics of the SSC and aSSC and their variants were pooled. Literature searches and data analyses were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Anatomical Quality Assurance guidelines.

RESULTS

Forty-six studies, totaling 2166 shoulders, were assessed. The SSC showed an overall length, thickness, cross-sectional area, and volume of 152.2 mm (95% confidence interval, CI, 103.8-200.5 mm), 5.6 mm (95% CI, 4.6-6.6 mm), 18.1 cm² (95% CI, 14.2-22.0 cm² ), and 126.9 cm³ (95% CI, 87.2-166.5 cm³ ), respectively. The SSC displayed substantial variations in its origin and insertion points and in the composition of its tendon. The aSSC had an overall pooled prevalence of 24.6% (95% CI, 0.0%-76.9%).

CONCLUSIONS

The SSC and aSSC have been implicated in multiple shoulder pathologies, including muscle and tendon ruptures and neurovascular compromise. A better understanding of SSC and aSSC variants when diagnosing and treating their related pathologies will reduce patient morbidity and improve treatment regimens.

A three-headed piriformis muscle: an anatomical case study and narrative review of literature

The piriformis muscle (PM) is found in the gluteal region, exiting the pelvis through the greater sciatic foramen and dividing it into the suprapiriform and infrapiriform foramina. The piriformis works as part of the hip external rotator muscle group, and is responsible for rotation of the femur upon hip extension and abduction of the femur during flexion of the hip joint. The aim of the present report is to describe a very rare case of the primary three-headed PM. To the best knowledge of the authors, the said variant has not yet been described in the existing literature. The 71-year-old male formalin-fixed cadaver was subjected to routine dissection. After careful removal of the connecting tissue, three separate, primary heads of the PM were identified. The lower head of the PM arose from the middle part of the sacral bone; 87.56 mm long and 9.73 mm wide. The medial head was attached to the internal part of the posterior inferior iliac spine; 121.6 mm long and 20.97 mm wide. The upper head was attached to the external part of the posterior inferior iliac spine; 78.89 mm long and 23.94 mm wide. All heads converged into a common tendon which inserted onto the greater trochanter. The clinical importance of this work comes down to the fact that the aberrant PM may be the reason behind the piriformis syndrome and its associated symptoms. Moreover, knowledge regarding the variant anatomy of the PM is of immense importance to, e.g. anaesthesiologists performing computed tomography- or ultrasound-guided sciatic nerve injection for local anaesthesia, radiologists interpreting imaging studies, and surgeons, especially during posterior approaches to the hip and pelvis.

Distribution and Morphological Characteristics of Oligodendrocytes in Selected Areas of the Brain of Male and Female Red Kangaroos (Macropus rufus)

This study was carried out on six adult red kangaroos of both sexes. To determine the location of the oligodendrocytes (OLGs) of the hippocampus (Hip) and corpus callosum (CC), the method of impregnation of the neuroglia with silver salts was applied. The iron distribution in the OLGs was determined by the histochemical method. The Nissl method was used to determine the location of the brain structure and to analyze the number of OLGs. In the Hip, these cells are located one beside another, mainly in blood vessels and neurons; in the neocortex (NC), they are located in layers I–VI; and in the CC, they are arranged in characteristic rows and accompany both nerve fibers and blood vessels. The analysis of the results obtained by the chosen methods in the Hip, NC, and CC in males and females did not show statistically significant differences in the distribution and location of the red kangaroo OLGs. The involvement of these cells is a physiological process that proceeds in a similar manner throughout the life of individuals and actively influences the metabolism of neurons and myelin.

Structural and Metabolic Changes in Bone

Simple Summary

Bone is an extremely metabolically active tissue that is regenerated and repaired over its lifetime by bone remodeling. Most bone diseases are caused by abnormal restructure processes that undermine bone structure and mechanical strength and trigger clinical symptoms, such as pain, deformity, fracture, and abnormalities of calcium and phosphate homoeostasis. The article examines the main aspects of bone development, anatomy, structure, and the mechanisms of cell and molecular regulation of bone remodeling.

Abstract

As an essential component of the skeleton, bone tissue provides solid support for the body and protects vital organs. Bone tissue is a reservoir of calcium, phosphate, and other ions that can be released or stored in a controlled manner to provide constant concentration in body fluids. Normally, bone development or osteogenesis occurs through two ossification processes (intra-articular and intra-chondral), but the first produces woven bone, which is quickly replaced by stronger lamellar bone. Contrary to commonly held misconceptions, bone is a relatively dynamic organ that undergoes significant turnover compared to other organs in the body. Bone metabolism is a dynamic process that involves simultaneous bone formation and resorption, controlled by numerous factors. Bone metabolism comprises the key actions. Skeletal mass, structure, and quality are accrued and maintained throughout life, and the anabolic and catabolic actions are mostly balanced due to the tight regulation of the activity of osteoblasts and osteoclasts. This activity is also provided by circulating hormones and cytokines. Bone tissue remodeling processes are regulated by various biologically active substances secreted by bone tissue cells, namely RANK, RANKL, MMP-1, MMP-9, or type 1 collagen. Bone-derived factors (BDF) influence bone function and metabolism, and pathophysiological conditions lead to bone dysfunction. This work aims to analyze and evaluate the current literature on various local and systemic factors or immune system interactions that can affect bone metabolism and its impairments.

COVID-19 infection as a new risk factor for penile Mondor disease

Background

Penile Mondor disease is a superficial dorsal vein thrombophlebitis of the penis, which mainly affects young and middle-aged men. It generally manifests as a visible painful cord located along the dorsal surface of the penis with signs of skin inflammation. The condition is usually self-limiting, but in severe cases a surgical procedure may be necessary in addition to pharmacological treatment. Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is associated with a frequent incidence of thrombophilia; therefore, such a prothrombotic state during infection may be a significant risk factor for penile Mondor disease.

Case presentation

The 34-year-old patient reported moderate pain felt on the surface of the penis. During the medical interview, the patient did not admit significant risk factors for Mondor Disease, apart from the previous, a month earlier COVID-19 disease. Examination revealed swelling erythema and a thick indurated cord on the surface of the penis. Color Doppler ultrasound was performed to confirm assumptions and exclude thrombosis of other penile vessels. Based on visible clots in the course of the superficial penile vein and after exclusion of vasculitis due to autoimmune disease the diagnosis of penile Mondor disease was made. Pharmacological therapy was implemented to further break down the clot and prevent rethrombosis in the penile vessels. The patient did not report any treatment complications and returned for a control visit, which revealed complete clot dissolution on ultrasound; therefore, complete recovery was stated.

Conclusions

This case report presents the correlation between SARS-Cov-2 infection and penile Mondor disease, based on the confirmed influence of COVID-19 on the pathophysiology of thrombosis. It can be concluded that COVID- 19 is a risk factor for Mondor disease, as in the presented case the virus was the only prothrombotic risk factor for the patient. Consequently, the possibility of developing thrombosis in the form of penile Mondor disease should be taken into account among patients with post-COVID-19 and active SARS-Cov-2 infection.

Characterisation of Selected Materials in Medical Applications

Tissue engineering is an interdisciplinary field of science that has developed very intensively in recent years. The first part of this review describes materials with medical and dental applications from the following groups: metals, polymers, ceramics, and composites. Both positive and negative sides of their application are presented from the point of view of medical application and mechanical properties. A variety of techniques for the manufacture of biomedical components are presented in this review. The main focus of this work is on additive manufacturing and 3D printing, as these modern techniques have been evaluated to be the best methods for the manufacture of medical and dental devices. The second part presents devices for skull bone reconstruction. The materials from which they are made and the possibilities offered by 3D printing in this field are also described. The last part concerns dental transitional implants (scaffolds) for guided bone regeneration, focusing on polylactide–hydroxyapatite nanocomposite due to its unique properties. This section summarises the current knowledge of scaffolds, focusing on the material, mechanical and biological requirements, the effects of these devices on the human body, and their great potential for applications.

Does SARS-CoV-2 affect male urogenital system?

BACKGROUND

Widely known fact about Sars-Cov-2 infection's impact on urogenital system may play relevant role in under-standing, diagnose and future prevention of male urological disorders. Sars-CoV-2 attacks vascular endothelium of the entire organism therefore infection complications are visible in various organs. Relatively small number of original studies on Sars-cov-2 infection and the effect on the reproductive system and fertility in men. The vast majority of publications focus only on discussing the effects of Covid-19 infection on just one aspect of male urology or fertility.

OBJECTIVE

The aim of this review was to present the current understanding of the effects of Covid-19 infection on the male genitourinary system in the context of nephrological and reproductive system complications in men, considering the potential pathomechanisms causing significant nephrological disorders in the course of viral infection, as well as long-term effects of Sars-cov-2 infection. We tried to make clinicians aware of urogenital complications in the course of COVID-19 occurrence and encourage to create preventive procedures.

METHODS

The article presented by us has been classified by us as "review" Of course, when searching for publications and making their critique, we focused primarily on the words: "Sars-cov-2" "male urogenital system", "male infertility", "lower urinary tract symptoms". Therefore, there was no explicit and rigorous work selection methodology. Search strategies were based on the experience of the authors of the work. In order to select articles for the systematic review, literature searches were conducted on PubMed (https://pubmed.ncbi.nlm.nih.gov) using the following keywords: "Sars-cov-2" AND "male urogenital system" OR "male infertility" The search results were retrieved and manually screened for duplicate removal. Then abstracts and titles were checked for relevance. The articles were selected if they met the following inclusion criteria: human studies, focus on Sars-cov-2 and male urogenital system or male infertility, published from 2020 to 2021, written in English, free full-text available. We included clinical trial, meta-analysis, randomized controlled studies, review, systematic review.

RESULTS

After the literature search, a total of 267 articles were retrieved, including 153 reviews, 53 systematic-reviews, 61 original articles. Eventually, after abstract and title screening, 2 original articles, 29 reviews and 8 systematic reviews were accepted. In our review paper, we presented data from 2 systematic reviews, 17 reviews, 2 meta-analyses, 1 case study, and 18 original articles, including 3 animals studies, 2 in vitro studies and 14 human studies.

CONCLUSION

Serious concern for urologists among COVID-19 patients should be mainly orchitis, male infertility, priapism, erectile dysfunction and lower urinary tract symptoms. It seems that the conclusions drawn should be treated with caution because, as mentioned above, in a pandemic, urinary complications are underdiagnosed and there are too few clinical trials and case reports.

Management of Incidental Finding of Triorchidism Diagnosed During Routine Hernia Repair

Polyorchidism is a rare congenital anomaly which refers to the presence of more than two intra- or extrascrotal testicles. Triorchidism, the presence of one extra testicle is the most common type. This report describes the case of a 29-year-old male who was found to have a right supernumerary undescended testis encountered incidentally during hernia repair. With this in mind, the current knowledge of management of supernumerary testis was analysed, including potential scenarios, to delineate what a urologist should do when a supernumerary testis is found during routine surgical procedures such as orchidopexy or hernia repair.

The Glucose Metabolic Pathway as A Potential Target for Therapeutics: Crucial Role of Glycosylation in Alzheimer's Disease

Glucose uptake in the brain decreases because of normal aging but this decline is accelerated in Alzheimer’s disease (AD) patients. In fact, positron emission tomography (PET) studies have shown that metabolic reductions in AD patients occur decades before the onset of symptoms, suggesting that metabolic deficits may be an upstream event in at least some late-onset cases. A decrease in availability of glucose content induces a considerable impairment/downregulation of glycosylation, which is an important post-translational modification. Glycosylation is an important and highly regulated mechanism of secondary protein processing within cells and it plays a crucial role in modulating stability of proteins, as carbohydrates are important in achieving the proper three-dimensional conformation of glycoproteins. Moreover, glycosylation acts as a metabolic sensor that links glucose metabolism to normal neuronal functioning. All the proteins involved in β-amyloid (Aβ) precursor protein metabolism have been identified as candidates of glycosylation highlighting the possibility that Aβ metabolism could be regulated by their glycosylation. Within this framework, the present review aims to summarize the current understanding on the role of glycosylation in the etiopathology of AD, emphasizing the idea that glucose metabolic pathway may represent an alternative therapeutic option for targeting AD. From this perspective, the pharmacological modulation of glycosylation levels may represent a ‘sweet approach’ to treat AD targeting new mechanisms independent of the amyloid cascade and with comparable impacts in familial and sporadic AD.

The impact of selected modifiable lifestyle factors on male fertility in the modern world

Introduction

The modern man during his reproductive period is exposed to the negative influence of widespread lifestyle-related habits. The available studies show a significant decline in the quality of young men's sperm, which results in male and female infertility factors being given equal consideration. The progressive decline of sperm quality has lowered the spermiogram parameters proposed by the World Health Organization.

Material and methods

We performed a review of the literature on the most common unhealthy habits in the modern world, such as obesity, mobile phone usage, smoking and alcohol intake, and their reported effects on male fertility. Several papers including original, review and meta-analysis were searched using the ScienceDirect and Web of Science databases.

Results

All the factors under analysis contribute to a significant deterioration of sperm quality, mainly through decreased sperm concentration, vitality, motility and morphology.

Conclusions

Lifestyle-related factors are a significant cause of male infertility in the world today. Studies have shown that sperm quality is essentially determined by: obesity, nicotine addiction, heavy exposure to electromagnetic compatibility radiation-emitting devices and alcohol consumption. Weight loss and cessation or limitation of unhealthy lifestyle-related factors might represent the best course of action for any couple trying to achieve pregnancy.

The Dual Role of Glutamatergic Neurotransmission in Alzheimer's Disease: From Pathophysiology to Pharmacotherapy

Alzheimer's disease (AD) is an age-related dementia and neurodegenerative disorder, characterized by Aβ and tau protein deposition impairing learning, memory and suppressing synaptic plasticity of neurons. Increasing evidence suggests that there is a link between the glucose and glutamate alterations with age that down-regulates glucose utilization reducing glutamate levels in AD patients. Deviations in brain energy metabolism reinforce the development of AD by hampering glutamate levels in the brain. Glutamate is a nonessential amino acid and the major excitatory neurotransmitter synthesized from glucose. Alterations in cerebral glucose and glutamate levels precede the deposition of Aβ plaques. In the brain, over 40% of neuronal synapses are glutamatergic and disturbances in glutamatergic function have been implicated in pathophysiology of AD. Nevertheless, targeting the glutamatergic system seems to be a promising strategy to develop novel, improved therapeutics for AD. Here, we review data supporting the involvement of the glutamatergic system in AD pathophysiology as well as the efficacy of glutamatergic agents in this neurodegenerative disorder. We also discuss exciting new prospects for the development of improved therapeutics for this devastating disorder.

Testicular microlithiasis: what urologists should know. A review of the current literature

Introduction

Testicular microlithiasis is a finding incidental to the ultrasound examination of the scrotum. This article presents some new data regarding the etiopathology of testicular microliths. As there is a growing body of literature available, which associates testicular microlithiasis with a testicular germ cell tumor or male infertility, our review focuses on these relations (based on a new meta-analysis and retrospective follow-up programs). The purpose of this review is to summarize the knowledge about testicular microlithiasis and discuss the latest recommendations.

Material and methods

A comprehensive literature review was performed using Science Direct and Scopus with MeSH terms and keywords 'testicular microlithiasis', testicular tumor', male infertility'.

Results

The clinical consequences of testicular microlithiasis depend on the co-occurrence of specific risk factors. The presence of testicular microlithiasis alone in the absence of risk factors is not an indication for further investigation.

Conclusions

A link between testicular microlithiasis and testicular cancer as well as male infertility has been analyzed. Follow-up is only recommended where risk factors of testicular cancer other than testicular microlithiasis are present.

Analysis of the repeatability of the exhaust pollutants emission research results for cold and hot starts under controlled driving cycle conditions

Measurement of car engines exhaust pollutants emissions is very important because of their harmful effects on the environment. This article presents the assessment of repeatability of the passenger car engine exhaust pollutants emission research results obtained in the conditions of a chassis dynamometer. The research was conducted in a climate chamber, enabling the temperature conditions to be determined from - 20 to + 30 °C. The emission of CO, CH₄, CO₂, NO_X, THC, and NMHC was subjected to the analysis. The aim of the research is to draw attention to the accuracy of the pollutant emission research results in driving cycles, and the comparison of pollutant emission results and their repeatability obtained in successive NEDC cycles under cold and hot start conditions. The results of the analysis show that, in the case of a small number of measurements, the results repeatability analysis is necessary for a proper interpretation of the pollutant emission results on the basis of the mean value. According to the authors' judgment, it is beneficial to determine the coefficient of variation for a more complete assessment of exhaust emission result repeatability obtained from a small number of measurements. This parameter is rarely presented by the authors of papers on exhaust components emission research.

Evaluation of selected Doppler parameters of renal blood flow in patients undergoing extracorporeal shock wave lithotripsy

Introduction

Despite the risk of complications, which does not exceed several percent, extracorporeal shock wave lithotripsy (ESWL) causes morphological and functional changes in kidneys as a result of the effect of the generated shock wave energy on the renal parenchyma structure.

Material and methods

Forty-two patients were included in the study. The mean age in the studied group was 50.9 years (SD ±13.7). Extracorporeal lithotripsy treatments were carried out during the period from January 2014 to April 2014 using an electromagnetic shock wave generator. The spectrum of blood flow of the interlobar arteries of both the treated and the opposite kidney was investigated. On the basis of these spectrums, parameters such as: resistive index (RI), pulsatility index (PI) and acceleration time (AT) were calculated.

Results

The ESWL treatment causes a statistically significant increase of the RI parameter in the ipsilateral kidney (p <0.0001) as well as in the opposite kidney (p <0.0001). The RI value decreases after 92 hours after the treatment, reaching statistical significance in both kidneys (p <0.005). The PI parameter substantially increases after treatment in both kidneys (p <0.0001), and decreases after 92 hours (p <0.0001). Statistically significant correlations are shown between RI as well as the PI parameters and the patient's age.

Conclusions

Extracorporeal shock wave lithotripsy (ESWL) of renal stones causes temporary impairment of the renal perfusion in both ipsilateral and contralateral kidneys. The main factor that determines the value of the RI and PI parameters is the patient's age.

The impact of pelvicalyceal anatomy on the stone formation in patients with lower pole renal stones

BACKGROUND

The aim of our study was to determine whether various anatomic factors constitute a predisposition to a lower pole renal stones.

MATERIALS AND METHODS

We analysed the computed tomography (CT) urography of 75 patients with a single lower pole stone. Measurements were taken of the infundibulopelvic angle (IPA), infundibular width (IW), infundibular length (IL) and calyceopelvic height (CPH).

RESULTS

The mean patient age was 50 years (range 17-79 years). The mean stone size was 11.9 mm. The mean IPA using Sampaio method in affected kidney was 113.4 ± 15.3o (range 80-139o), 59.5 ± 17.3o using Elbahnasy method. The values of IPA on the contralateral kidney were 119.86 ± 15.37o (range 79-141o; p = = 0.001) using Sampaio method of measurement and 59.78 ± 12o (range 34-90 o; p = 0.465) using the method described by Elbahnasy. We reported statistically significant differences between stone-bearing kidney and contralateral kidney in measurement IPA using only Sampaio method. The mean infundibular width was 4.22 ± 1.81 mm on the affected kidney and 3.72 ± 2.5 mm on the contralateral side (p = 0.164). The mean infundibular length was 15.37 ± 4.57 mm on the affected kidney and 14.66 ± 4.35 mm on the unaffected side (p = 0.329). The CPH was 10.19 ± 4.05 mm on the affected kidney and 10.44 ± 3.83 mm on the normal side (p = 0.688).

CONCLUSIONS

Pelvicalyceal morphology of the kidney is one of the factors that determine the risk of developing kidney stones. Out of the analysed morphological parameters of kidney IPA is a statistically significant risk factor to form lower pole kidney stones. Other anatomic parameters did not seem to have a significant role in predisposing to form lower pole kidney stone. (Folia Morphol 2018; 77, 1: 16-21).