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We compared the impact of surface broadcasted N-Viro biosolids and inorganic fertilizer (16.5% Ammonium sulphate, 34.5% Diammonium phosphate, 4.5% Potash, and 44.5% s and/or clay filler) applications on soil properties and nutrients, leaf nutrient concentration, and the fruit yield of lowbush blueberry under irrigated and nonirrigated conditions during 2008-2009 at Debert, NS, Canada. Application rates of N-Viro biosolids were more than double of inorganic fertilizer applied at a recommended N rate of 32 kg ha-1. The experimental treatments NI: N-Viro with irrigation, FI: inorganic fertilizer with irrigation, N: N-Viro without irrigation, and F: inorganic fertilizer without irrigation (control) were replicated four times under a randomized complete block design. The NI treatment had the highest OM (6.68%) followed by FI (6.32%), N (6.18%), and F (4.43%) treatments during the year 2008. Similar trends were observed during 2009 with the highest soil OM values (5.50%) for NI treatment. Supplemental irrigation resulted in a 21% increase in the ripe fruit yield. Nonsignificant effect of fertilizer treatments on most of the nutrient concentrations in soil and plant leaves, and on ripe fruits yield reflects that the performance of N-Viro was comparable with that of the inorganic fertilizer used in this study. [ABSTRACT FROM AUTHOR]

This paper compared dairy and hen manure P recovery relative to fertilizer P recovery for two Nova Scotia soils with different antecedent soil test P (STP), incubated for 5, 15, 30, 60, and 110 days. Fertilizer equivalence of manure P was expressed as P recovery ratio in percentage points (%PRR). Repeated measures analysis with soil pH covariate revealed: (1) manure %PRR averaged 72% (low-STP soil) and 80% (medium-STP soil), (2) there were no significant differences in %PRR between dairy and hen manure, and (3)manure %PRR decreased with incubation time for the low-STP soil but not for the medium-STP soil. The soil pH covariate was significant for both low- and medium-STP soils, and the relationship with %PRR was positive for low- but not for the medium-STP soil. [ABSTRACT FROM AUTHOR]

The MTCP1 gene is involved in the t(X;14)(q28;q11) translocation associated with T-cell prolymphocytic leukemia and related conditions. This gene is unusual in that it codes for two distinct proteins: a small mitochondrial protein, p8MTCP1, and a putative oncogenic protein, p13MTCP1. Scarcity of material from t(X;14)-associated proliferations and very low levels of mRNA expression have so far prevented a thorough description of p13MTCP1-encoding transcripts. Here, we characterize two additional t(X;14) bearing leukemias allowing this analysis. In one case, with a breakpoint located 5′ to the MTCP1 gene, the level of transcription of previously described p13MTCP1-encoding transcripts is enhanced. In the second case, with a breakpoint within the MTCP1 intron I, an alternative transcription initiation site is demonstrated in the tumor cells at 229 bp upstream to exon II. The identification of this internal promoter, together with the similarity between TCL1 and MTCP1 genomic structures, allow us to propose a model in which the duplication of an ancestral gene was followed by the insertion of one copy within the intron of a p8-encoding gene, accounting for the unusual feature of the MTCP1 gene. [ABSTRACT FROM AUTHOR]

Inguinal bladder hernia is a rare clinical condition, with 1-3% of all inguinal hernias involving the bladder. Any portion of the bladder may herniate, from a small portion or a diverticulum to most of the bladder. We present a 55-year-old male with an intermittent right scrotal mass of 6 months' duration. The mass lesion protruded through the right inguinal canal before voiding and reduced after that. Scrotal sonography revealed a hypoechoic lesion in the scrotum that stretched cranially to the intra-abdominal portion of the bladder. Excretory urography showed a duplicated system in the left kidney and deviation of the left orifice to the right side of the trigon. Finally, cystography illustrated herniation of the bladder to the right scrotum. Surgical repair of the hernia was done with mesh. Follow-up cystography one month postoperatively revealed no herniation. [ABSTRACT FROM AUTHOR]

Background and purpose: Development of the male phenotype and the initiation of spermatogenesis are intricately dependent on the cellular events that respond to androgens. The actions of androgens are mediated by the androgen receptor (AR). The aim of this study was to investigate the association of AR 5'UTR and codon 211 genetic variation with the risk of idiopathic male infertility. Materials and methods: Genomic DNA was extracted from 60 men with idiopathic infertility and 70 healthy men. The genetic variation of 5'UTR and codon 211 was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP)- and PCR-single strand conformation polymorphism (SSCP), respectively. Results: No mobility shift was seen in the PCR products of 5'UTR in patient and control groups. We did not identify a single mutation at 5'UTR of AR gene in patients and controls. Genotype frequencies of codon 211 in patient group were GG (67%), GA (23%), AA (10%) and in control group there were GG (77%), GA (21%) and AA (1%). No significant differences were found between the two groups in allelic frequencies (÷2=2.40; P=0.3). Conclusion: Our findings suggest no correlation between these polymorphisms and male infertility in the studied patients. However, further studies of AR polymorphisms with their biological functions are needed to understand the role of these polymorphisms in the development of male infertility. [ABSTRACT FROM AUTHOR]

Efforts were made to predict pesticide concentrations at three different depths in the soil profile, using models developed with Multivariate Adaptive Regression Splines (MARS), a regression analysis model. The models were developed with independently collected data from the Eugene E Whelan Experimental Farm (Agriculture and Agri-Food Canada, Woodslee, Ontario, Canada) from 1992 to 1994. Data from 16 plots, subjected to four different tillage treatments and two different water table management practices, were used. The fate of three herbicides, namely atrazine [2-chloro-4-ethylamino-6-isopropylamino-1,3,5-triazine], metribuzin [4-amino-6-(1, 1-dimethylethyl)-3-(methylthio)-1,2,4-triazin-5(4H)-one], and metolachlor 12-chloro-N-(2-ethyl-6-methylphenyl)-N-(-2-methoxyl-1-methylethyl) acetamide], at three different soil depths were studied. The input variables for the models included Julian day, days after application of pesticide, measured herbicide concentrations, and cumulative figures for rainfall depth, air temperature, soil temperature, and potential evapotranspiration. Considering the limited size of the data set, a 10-fold cross-validation was performed to test and validate the model. Model predictions at the 0-10 cm depth were very close to the measured values, with model efficiencies varying from 83% to 99%. The predictions at the 10-15 cm depth generally varied from 33% to 83%, while the ones at the 15-20 cm depth were within 42% to 95%, with a few exceptions where the model predicted a single value, of the average observed concentrations. These results demonstrate that MARS was able to do a commendable job in simulating pesticide fate and transport in soil with limited data. [ABSTRACT FROM AUTHOR]

Purpose: Cardiovascular diseases (CVD) are among the leading causes of death worldwide. Recently, non-classical risk factors for cardiovascular disease, such as lower urinary tract symptoms (LUTS), have gained attention. Both CVD and LUTS are prevalent among aging populations and share common vascular risk factors. The purpose of this study was to investigate the potential relationship between Atherosclerotic Cardiovascular Disease risk and functional bladder capacity among men with LUTS., Methods: This study was conducted on 86 men aged 40-79 with complaints of LUTS who were asked for digital rectal examinations, blood tests on serum total cholesterol and high-density lipoprotein (HDL), and mid-stream urine tests for microscopy and culture. For evaluating patients' LUTS, a 24-h voiding diary was asked. The atherosclerotic cardiovascular diseases (ASCVD) score comprises the patient's current age, sex, race, diabetes mellitus status, smoking status, hypertension status, systolic and diastolic blood pressure, total cholesterol, and HDL levels., Results: According to the ASCVD score, 46 and 40 patients were categorized as low and high risks for cardiovascular diseases, respectively. Based on the FBC, 47 patients had decreased FBC and the rest were normal. According to logistic regression, it was determined that age can be considered a predictive variable for decreased FBC and the lower FBC can be considered as a predictive factor in the high-risk group for cardiovascular diseases (p = 0.002)., Conclusion: It seems that decreased FBC is related to a higher predicted cardiovascular event rate in men with LUTS and could be considered a predictor of ASCVD risk., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction and Objective: Stress urinary incontinence (SUI) poses a significant burden on affected individuals, impairing their quality of life and causing embarrassment due to involuntary urine leakage during activities such as sneezing or coughing. While conservative and surgical treatments exist, a subset of patients experiences persistent symptoms despite these interventions. This review provides insights into the potential role of platelet-rich plasma (PRP) as a therapeutic adjunct for patients with SUI that does not respond to conventional non-surgical or surgical treatments., Methods: We conducted a literature review of studies in English to evaluate PRP efficacy in managing SUI., Results: The studies conducted on PRP therapy suggest that it is an effective and safe treatment option for SUI in women. PRP injections, when used alone or in combination with other therapies, have shown significant improvements in SUI symptoms. Moreover, these studies indicate that PRP injections offer a less invasive and low-risk alternative to surgical procedures for managing SUI, which could lead to shorter recovery times., Conclusion: The efficacy of PRP therapy is evidenced by significant reductions in SUI symptoms, as well as improvements in bladder function variables, without significant adverse effects reported. However, further research is necessary to establish the long-term effectiveness and safety of PRP therapy for managing SUI in diverse patient populations. Additionally, ongoing evaluations of PRP therapy in combination with other interventions will be essential for optimizing treatment outcomes and broadening the potential applications of PRP in the management of SUI., Competing Interests: Declarations Conflict of interest The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Clinical education plays an essential role in shaping the nursing identity and is one of the central elements in the education of nursing students. Today, with the advancement of novel technologies, utilizing mobile phone-based technologies in the education of medical sciences is inevitable. Therefore, this study was conducted with the aim of investigating the impact of the urology educational application on nursing students' cognitive-functional criteria and satisfaction during the internship period., Methods: This experimental educational intervention study was conducted during nursing students' urology internship course at Shahid Beheshti School of Nursing and Midwifery in Rasht. The data collection tools included a demographic characteristics questionnaire, cognitive skills scale, functional skills scale, and satisfaction scale (Stokes, 2001). The data were analyzed using SPSS software version 16, and a significance level was set at 0.05., Results: Out of 48 studied students, 28 (58.3%) were males. The mean age of the students was 20.34 (SD = 1.51) years. In the application group, the mean of students' cognitive skills after the intervention significantly increased by 2.33 units (95% CI: 1.73 to 2.9) (t (23)  = 7.97, P < 0.001, d = 1.626). By controlling the scores before the intervention, the adjusted mean score of cognitive skills in the application group was 0.56 units (95% CI: -0.16 to 1.28) higher than the traditional group; however, this difference was not statistically significant (F (1, 45)  = 2.42, P = 0.127, η 2 p  = 0.051). There was no statistically significant difference between the mean score of students' functional skills in traditional and application groups (t (46)  = 0.63, P = 0.532, d = 0.184). The total mean score of satisfaction with education in the application group was 83.0 (SD: 10.7). According to the values ​​of the quartiles, 75% of the students scored higher than 75.9, 50% scored higher than 83.9, and 25% scored higher than 91.1., Conclusion: According to the results of this study, students' scores of functional and cognitive assessment and satisfaction with the application in urology clinical training were reported as favorable. Therefore, it is recommended that mobile phone-based technologies be used in students' clinical education and internships in combination with the traditional method., (© 2024. The Author(s).)

Background: Varicocele is one of the most common treatable causes of male infertility, and its treatment may be beneficial for fertility. This study aimed to evaluate fertility rate and DNA fragmentation index (DFI) following varicocelectomy in primary infertile men with clinical varicocele., Materials and Methods: This prospective longitudinal study was conducted on primary infertility men, in a tertiary center from December 2018 to December 2019 with one-year follow-up. Data of the semen parameters, DFI (%), and fertility rate were gathered before, as well as 4 and 12 months after undergoing varicocelectomy. For data analysis, SPSS software and analytical test were used., Results: Out of 76 patients who were analyzed, 22 (29%) became fertile and 54 (71%) remained infertile. Semen parameters and DFI (%) were improved significantly following varicocelectomy (P<0.001). Smoking history, occupational heated exposure, body mass index (BMI), and infertility duration were determined as predictors associated with fertility status (P<0.05)., Conclusion: Although varicocele repair improved the DFI, the fertility rate was achieved in less than one-third of patients; it seems that the other parameters, such as the history of smoking, occupational heated exposure, overweight, and duration of infertility should be considered as predictors of fertility status, in primary infertile men who are a candidate for varicocelectomy.

Attention-based models trained on protein sequences have demonstrated incredible success at classification and generation tasks relevant for artificial-intelligence-driven protein design. However, we lack a sufficient understanding of how very large-scale models and data play a role in effective protein model development. We introduce a suite of protein language models, named ProGen2, that are scaled up to 6.4B parameters and trained on different sequence datasets drawn from over a billion proteins from genomic, metagenomic, and immune repertoire databases. ProGen2 models show state-of-the-art performance in capturing the distribution of observed evolutionary sequences, generating novel viable sequences, and predicting protein fitness without additional fine-tuning. As large model sizes and raw numbers of protein sequences continue to become more widely accessible, our results suggest that a growing emphasis needs to be placed on the data distribution provided to a protein sequence model. Our models and code are open sourced for widespread adoption in protein engineering. A record of this paper's Transparent Peer Review process is included in the supplemental information., Competing Interests: Declaration of interests J.A.R. and A.M. are employed by Profluent Bio Inc., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Deep-learning language models have shown promise in various biotechnological applications, including protein design and engineering. Here we describe ProGen, a language model that can generate protein sequences with a predictable function across large protein families, akin to generating grammatically and semantically correct natural language sentences on diverse topics. The model was trained on 280 million protein sequences from >19,000 families and is augmented with control tags specifying protein properties. ProGen can be further fine-tuned to curated sequences and tags to improve controllable generation performance of proteins from families with sufficient homologous samples. Artificial proteins fine-tuned to five distinct lysozyme families showed similar catalytic efficiencies as natural lysozymes, with sequence identity to natural proteins as low as 31.4%. ProGen is readily adapted to diverse protein families, as we demonstrate with chorismate mutase and malate dehydrogenase., (© 2023. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Purpose: Recently, an association has been observed between metabolic syndrome and erectile dysfunction (ED). This study aimed to evaluate the cardiometabolic index (CMI) in patients with ED., Methods: This cross-sectional study was performed on 144 patients with ED who were referred to a urology clinic in Rasht, Iran, from 2019 to 2021. Metabolic syndrome was evaluated according to National Cholesterol Education Program Expert Panel (NCEP) and Adult Treatment Panel III (ATP III) criteria which are considered three positive criteria from five. Also, the ED severity was classified as weak, moderate, and severe based on the five-item International Index of Erectile Function (IIEF5) questionnaire., Results: The mean age of participants was 53.46 ± 10.58 years. 56.9% had abdominal obesity, 48.6% had hypertriglyceridemia, 34.7% had low HDL-C, 55.6% had hypertension and 56.9% had elevated fasting blood sugar (FBS). 43.8% had diabetes and 13.2% had cardiovascular disease. The mean CMI was 2.51 ± 1.57. The prevalence of metabolic syndrome was 50.7%. Body mass index (BMI) was significantly associated with metabolic syndrome and CMI (P = 0.001). The severity of ED had a significant relationship with high FBS in patients. CMI and components of abdominal obesity, hypertriglyceridemia, and low HDL-C had no statistically significant relationship with ED. However, the incidence of moderate and severe ED increased with increasing the number of metabolic syndrome components., Conclusion: ED is not significantly associated with metabolic syndrome and CMI, however, the severity of this disorder increases with increasing the number of components of metabolic syndrome., Competing Interests: Conflict of InterestThe authors declare no conflict of interest., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Autism spectrum disorder (ASD) is a neurodevelopmental disorder associated with brain development that subsequently affects the physical appearance of the face. Autistic children have different patterns of facial features, which set them distinctively apart from typically developed (TD) children. This study is aimed at helping families and psychiatrists diagnose autism using an easy technique, viz., a deep learning-based web application for detecting autism based on experimentally tested facial features using a convolutional neural network with transfer learning and a flask framework. MobileNet, Xception, and InceptionV3 were the pretrained models used for classification. The facial images were taken from a publicly available dataset on Kaggle, which consists of 3,014 facial images of a heterogeneous group of children, i.e., 1,507 autistic children and 1,507 nonautistic children. Given the accuracy of the classification results for the validation data, MobileNet reached 95% accuracy, Xception achieved 94%, and InceptionV3 attained 0.89%., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Zeyad A. T. Ahmed et al.)

A decade of unprecedented progress in artificial intelligence (AI) has demonstrated the potential for many fields-including medicine-to benefit from the insights that AI techniques can extract from data. Here we survey recent progress in the development of modern computer vision techniques-powered by deep learning-for medical applications, focusing on medical imaging, medical video, and clinical deployment. We start by briefly summarizing a decade of progress in convolutional neural networks, including the vision tasks they enable, in the context of healthcare. Next, we discuss several example medical imaging applications that stand to benefit-including cardiology, pathology, dermatology, ophthalmology-and propose new avenues for continued work. We then expand into general medical video, highlighting ways in which clinical workflows can integrate computer vision to enhance care. Finally, we discuss the challenges and hurdles required for real-world clinical deployment of these technologies.

For newly diagnosed breast cancer, estrogen receptor status (ERS) is a key molecular marker used for prognosis and treatment decisions. During clinical management, ERS is determined by pathologists from immunohistochemistry (IHC) staining of biopsied tissue for the targeted receptor, which highlights the presence of cellular surface antigens. This is an expensive, time-consuming process which introduces discordance in results due to variability in IHC preparation and pathologist subjectivity. In contrast, hematoxylin and eosin (H&E) staining-which highlights cellular morphology-is quick, less expensive, and less variable in preparation. Here we show that machine learning can determine molecular marker status, as assessed by hormone receptors, directly from cellular morphology. We develop a multiple instance learning-based deep neural network that determines ERS from H&E-stained whole slide images (WSI). Our algorithm-trained strictly with WSI-level annotations-is accurate on a varied, multi-country dataset of 3,474 patients, achieving an area under the curve (AUC) of 0.92 for sensitivity and specificity. Our approach has the potential to augment clinicians' capabilities in cancer prognosis and theragnosis by harnessing biological signals imperceptible to the human eye.

Diagnosis of endoleak following endovascular aortic repair (EVAR) relies on manual review of multi-slice CT angiography (CTA) by physicians which is a tedious and time-consuming process that is susceptible to error. We evaluate the use of a deep neural network for the detection of endoleak on CTA for post-EVAR patients using a novel data efficient training approach. 50 CTAs and 20 CTAs with and without endoleak respectively were identified based on gold standard interpretation by a cardiovascular subspecialty radiologist. The Endoleak Augmentor, a custom designed augmentation method, provided robust training for the machine learning (ML) model. Predicted segmentation maps underwent post-processing to determine the presence of endoleak. The model was tested against 3 blinded general radiologists and 1 blinded subspecialist using a held-out subset (10 positive endoleak CTAs, 10 control CTAs). Model accuracy, precision and recall for endoleak diagnosis were 95%, 90% and 100% relative to reference subspecialist interpretation (AUC = 0.99). Accuracy, precision and recall was 70/70/70% for generalist1, 50/50/90% for generalist2, and 90/83/100% for generalist3. The blinded subspecialist had concordant interpretations for all test cases compared with the reference. In conclusion, our ML-based approach has similar performance for endoleak diagnosis relative to subspecialists and superior performance compared with generalists.

Deep learning and computer vision algorithms can deliver highly accurate and automated interpretation of medical imaging to augment and assist clinicians. However, medical imaging presents uniquely pertinent obstacles such as a lack of accessible data or a high-cost of annotation. To address this, we developed data-efficient deep learning classifiers for prediction tasks in cardiology. Using pipeline supervised models to focus relevant structures, we achieve an accuracy of 94.4% for 15-view still-image echocardiographic view classification and 91.2% accuracy for binary left ventricular hypertrophy classification. We then develop semi-supervised generative adversarial network models that can learn from both labeled and unlabeled data in a generalizable fashion. We achieve greater than 80% accuracy in view classification with only 4% of labeled data used in solely supervised techniques and achieve 92.3% accuracy for left ventricular hypertrophy classification. In exploring trade-offs between model type, resolution, data resources, and performance, we present a comprehensive analysis and improvements of efficient deep learning solutions for medical imaging assessment especially in cardiology., Competing Interests: Competing interestsThe Authors declare no Competing Interests.

Varicocele represents the main cause of male infertility. Right-sided varicocele is rare and can be due to renal malignancy or a venous abnormality. The most common anomaly of the inferior vena cava (IVC) is interruption of IVC with azygos continuation, which is recognized as an uncommon congenital anomaly. The prevalence of the interruption of IVC is less than 0.3% in the healthy population. We describe the case of a 26-year-old man who had right varicocele because of a right-sided IVC with a retro-aortic left renal vein and azygos continuation. The right and left IVCs received the right and left common iliac veins, respectively, and the left renal vein crossed posteriorly to the aorta and joined the right IVC. The right IVC continued cephalad as the azygos vein within the retrocrural space. Isolated right-sided varicoceles are uncommon, but practitioners should be aware of such a condition. In case of a venous anomaly, clinicians should aware of the association with other important clinical presentations.

Echocardiography is essential to cardiology. However, the need for human interpretation has limited echocardiography's full potential for precision medicine. Deep learning is an emerging tool for analyzing images but has not yet been widely applied to echocardiograms, partly due to their complex multi-view format. The essential first step toward comprehensive computer-assisted echocardiographic interpretation is determining whether computers can learn to recognize these views. We trained a convolutional neural network to simultaneously classify 15 standard views (12 video, 3 still), based on labeled still images and videos from 267 transthoracic echocardiograms that captured a range of real-world clinical variation. Our model classified among 12 video views with 97.8% overall test accuracy without overfitting. Even on single low-resolution images, accuracy among 15 views was 91.7% vs. 70.2-84.0% for board-certified echocardiographers. Data visualization experiments showed that the model recognizes similarities among related views and classifies using clinically relevant image features. Our results provide a foundation for artificial intelligence-assisted echocardiographic interpretation., Competing Interests: Competing interests: The authors declare no competing financial interests.

Bacterial adhesion to collagen, the most abundant protein in humans, is a critical step in the initiation and persistence of numerous bacterial infections. In this study, we explore the collagen binding mechanism of the multi-modular cell wall anchored collagen adhesin (CNA) in Staphylococcus aureus and examine how applied mechanical forces can modulate adhesion ability. The common structural-functional elements and domain organization of CNA are present across over 50 genera of bacteria. Through the use of molecular dynamics models and normal mode analysis, we shed light on the CNA's structural and conformational dynamics and its interactions with collagen that lead to collagen binding. Our results suggest that the linker region, CNA165-173, acts as a hinge exhibiting bending, extensional, and torsional modes of structural flexibility and its residues are key in the interaction of the CNA-collagen complex. Steered molecular dynamics simulations were conducted with umbrella sampling. During the course of these simulations, the 'locking' latch from the CNA N2 domain was dissociated from its groove in the CNA N1 domain, implying the importance of the latch for effective ligand binding. Finally, we observed that the binding efficiency of the CNA N1-N2 domains to collagen decreases greatly with increasing tensile force application to the collagen peptides. Thus, CNA and similar adhesins might preferentially bind to sites in which collagen fibers are cleaved, such as in wounded, injured, or inflamed tissues, or in which the collagenous tissue is less mature. As alternative techniques for control of bacterial infection are in-demand due to the rise of bacterial antibiotic resistance, results from our computational studies with respect to the mechanoregulation of the collagen binding site may inspire new therapeutics and engineering solutions by mechanically preventing colonization and/or further pathogenesis.

Isolated renal hydatid disease is a rare endemic infestation caused by larval form of Echinococcus granulosus. Hydatiduria is an uncommon presentation of renal hydatid disease. In 2012 a 34-year-old female referred to Razi Hospital, Rasht, Iran with complaints of right flank pain and grape-like material in urine. Diagnosis was made by ultrasonography and CT scan. The patient was treated surgically with nephrectomy in combination with perioperative chemotherapy with albendazol.

Objectives: To evaluate the potential relationship between scrotal ultrasound findings and abnormal semen analysis., Methods: Eighty-seven patients with varicoceles underwent semen analysis and scrotal sonography. On ultrasound, estimated testes volume and the largest pampiniform vein diameters on the affected side at rest and with Valsalva manoeuvre in both the supine and upright positions were examined. In addition, the differences between the largest venous diameters at rest and during the Valsalva manoeuvre in each position (supine and upright) and also the differences between the largest venous diameter in the supine position and the upright position in each condition (at rest and during the Valsalva manoeuvre) were calculated. The relationship between various ultrasound parameters and impaired semen analysis was evaluated using receiver operating characteristic curves., Results: Seventy-one patients had spermatogenesis impairment, and the remaining 16 had normal semen analysis. The difference in the mean spermatic vein diameter at rest between the supine and upright positions (cut-off point, 0.25 mm) had the highest diagnostic accuracy in differentiating the patients with abnormal sperm analysis from those with normal spermatogenesis with an area under the curve of 0.86., Conclusions: Real-time scrotal ultrasound can be helpful in predicting abnormal sperm analysis in patients with varicoceles., Key Points: Scrotal ultrasound is a non-invasive method to evaluate spermatic veins in varicoceles. Ultrasound can evaluate venous dimension change at rest after upright position (ΔD(R) ). ΔD( R)  > 2.5 mm distinguishes patients with abnormal semen analysis. ΔD( R) has the most accuracy in predicting abnormal spermatogenesis. Ultrasound findings improve differentiation between patients with abnormal and normal spermatogeneses.

Government priorities on provincial Nutrient Management Planning (NMP) programs include improving the program effectiveness for environmental quality protection, and promoting more widespread adoption. Understanding the effect of NMP on both crop yield and key water-quality parameters in agricultural watersheds requires a comprehensive evaluation that takes into consideration important NMP attributes and location-specific farming conditions. This study applied the Soil and Water Assessment Tool (SWAT) to investigate the effects of crop and rotation sequence, tillage type, and nutrient N application rate on crop yield and the associated groundwater [Formula: see text] leaching and sediment loss. The SWAT model was applied to the Thomas Brook Watershed, located in the most intensively managed agricultural region of Nova Scotia, Canada. Cropping systems evaluated included seven fertilizer application rates and two tillage systems (i.e., conventional tillage and no-till). The analysis reflected cropping systems commonly managed by farmers in the Annapolis Valley region, including grain corn-based and potato-based cropping systems, and a vegetable-horticulture system. ANOVA models were developed and used to assess the effects of crop management choices on crop yield and two water-quality parameters (i.e., [Formula: see text] leaching and sediment loading). Results suggest that existing recommended N-fertilizer rate can be reduced by 10-25 %, for grain crop production, to significantly lower [Formula: see text] leaching (P > 0.05) while optimizing the crop yield. The analysis identified the nutrient N rates in combination with specific crops and rotation systems that can be used to manage [Formula: see text] leaching while balancing impacts on crop yields within the watershed.

INTRODUCTION.: Phosphodiesterase type 5 inhibitors PDE5Is are less effective in diabetic men with erectile dysfunction (ED); however, the effect of combination therapy with folic acid and PDE5Is in these patients has not been investigated. AIM.: To evaluate the efficacy and safety of combination therapy with folic acid and tadalafil for the management of ED in men with type 2 diabetes mellitus. METHODS.: Eighty-three patients with type 2 diabetes mellitus and ED were included in this randomized double-blind clinical trial. They were randomly divided into two groups. Group A was treated with tadalafil 10 mg every other day plus folic acid 5 mg daily and group B received tadalafil 10 mg every other day plus placebo daily for 3 months. The mean International Index of Erectile Function (IIEF) scores before and after treatment in each groups were recorded. Men with diagnosis of psychological ED, spinal cord injury, or who used folic acid in the past 3 months and patients with any contradiction for use of PDE5Is were excluded. MAIN OUTCOMES MEASURES.: The cross tabulation and independent t-test were used to evaluate the difference between baseline characteristic of the patients in the two groups. Wilcoxon signed-ranks test and Mann-Whitney U-test were used to evaluate the IIEF score and also its changes before and after treatment in the two groups. RESULTS.: The mean IIEF scores before and after treatment were 11.65 ± 2.67 and 16.80 ± 4.03 in group A (P < 0.001) and 12.70 ± 2.31 and 14.37 ± 2.17 in group B (P < 0.001), respectively. The difference of mean IIEF score after treatment between the two groups was significant (16.80 ± 4.03 vs. 14.37 ± 2.17 in groups A and B, respectively) (P = 0.002). Also, the mean IIEF score was significantly increased in group A as compared with group B (5.14 ± 3.84 vs. 1.68 ± 0.99 in groups A and B, respectively) (P < 0.001). Both folic acid and tadalafil were well tolerated by all the patients. CONCLUSION.: Sexual function in diabetic patients with ED treated with the combination of tadalafil and folic acid improved significantly as compared with the placebo group. The use of folic acid and tadalafil is safe., (© 2013 International Society for Sexual Medicine.)

Purpose: Benign prostatic hyperplasia (BPH) is the main cause of lower urinary tract symptoms (LUTS) in elderly men. Some patients respond poorly to routine medical therapy and are not well suited for surgery, too. This study was planned to evaluate the effect of Botulinum-A on BPH refractory to current medical therapy in poor surgical candidates., Methods: In this clinical trial, 10 patients with LUTS suggestive of BPH who had responded poorly to medical therapy for at least 6 months and were poor surgical candidates, were received different doses of transurethral Botulinum-A injection based on their prostate volume. The prostate volume, PSA, Qmax, IPSS, PVR and frequency of nocturia were evaluated and compared before and after treatment., Results: The mean IPSS was 24.50 ± 3.8 and 13.40 ± 2.67 before and after the treatment, respectively (P < 0.001). The mean prostate volume was decreased from 41.50 ± 10.85 mL to 30.40 ± 8.05 mL (P < 0.001). The Qmax was increased from 7.87 ± 2.01 mL/s to 16.19 ± 1.76 mL/s (P < 0.001). The mean PSA was 3.12 ± 0.49 ng/mL and 1.71 ± 0.39 ng/mL before and after treatment, respectively (P < 0.001). The mean PVR was 75.6 ± 51.63 mL and 63.50 ± 36.59 mL before and after treatment, respectively (P = 0.096). The mean number of nocturia was decreased from 4.1 ± 0.87 to 2.4 ± 0.84 (P < 0.001). The mean IPSS, Prostate volume, PSA and frequency of nocturia were decreased significantly. Although mean PVR was decreased but it wasn't statistically significant. The mean Qmax was increased significantly., Conclusion: Intraprostatic injection of Botulinum-A may be an effective and safe treatment for symptomatic BPH in selected patients whose medical treatment has faced failure and are poor surgical candidates. Transurethral method could be selected as a preferable technique of injection.

Background: Blood transfusion is an important part of the medical care service. As there has not been a regional study about blood requests for operations, this study was done to assess blood ordering for various types of elective urological surgery., Materials and Methods: In a descriptive, retrospective, cross-sectional study, blood requests for all patients undergoing elective urological surgery in Razi Hospital (Rasht, Iran) during the first 6 months of 2010 were studied. The patients' data (age, sex, weight, type of surgery, haemoglobin level before and after surgery, number of units of blood cross-matched and number of units transfused in the operating theatre and in the 3 days after surgery) were collected from their clinical records. Patients with a history of coagulopathy or anticoagulant drug use were excluded. The cross-match to transfusion ratio (C/T ratio), transfusion index (TI) and transfusion probability (T%) were calculated. The level of statistical significance was set at P =0.05., Results: Of the 435 patients studied, 327 (75.1%) were male and 108 (24.9%) were female. The mean age of patients was 51.74 ± 19.33 years. The mean number of units of blood requested for each operation was 2.8 ± 1.2, whereas the mean number transfused was 0.59 ± 0.24; the difference was statistically significant (P<0.05). The relationships between pre-operative haemoglobin concentration and both blood requested and blood used were also statistically significant (P =0.038 and P <0.001, respectively). Calculated for all the operations, the C/T ratio was 14.16, the TI was 0.11 and the T% was 8.85%. Overall, only 8.5% of the patients (n=37) need blood transfusion in the operating theatre and only 10.8% (n=47) required transfusion within the 72 hours after surgery., Discussion: The amount of blood requested and cross-matched for elective urological surgery is much greater than the real level of consumption. An appropriate, standard blood order guideline would reduce costs and staff workload.