Thromboembolic Risk in Prostate Cancer Patients Treated with PARP Inhibitors: A Systematic Review and Meta-analysis

BACKGROUND

Poly (ADP-ribose) polymerase inhibitors (PARPi) have been associated with thrombotic events, although the association with thrombosis risk in different cancers remains poorly defined.

METHODS

This meta-analysis included phase II and phase III clinical trials in which patients with metastatic prostate cancer were treated with PARPi either as monotherapy or in combination. The primary endpoints were the rates of thromboembolic events in prostate cancer patients.

RESULTS

A total of 2210 and 1662 patients with prostate cancer were compared in the PARP inhibitor and control groups, respectively. 96 (4.3%) and 37 (2.2%) patients had thrombosis in the PARPi and control groups, respectively. PARPi had a statistically significant increased risk of thrombosis in prostate cancer patients (Odds Ratio (OR)=1.98, 95% CI: 1.06-3.70, P=0.030).

CONCLUSION

The heightened thrombotic risk associated with PARPi treatment in prostate cancer emphasizes the need for comprehensive management protocols to effectively reduce the risk and ensure safer outcomes.

Germline genetic variants in Turkish familial multiple myeloma/monoclonal gammopathy of undetermined significance cases

Multiple myeloma (MM) is a haematological malignancy primarily affecting the elderly, with a striking male predilection and ethnic disparities in incidence. Familial predisposition to MM has long been recognized, but the genetic underpinnings remain elusive. This study aimed to investigate germline variants in Turkish families with recurrent MM cases. A total of 37 MM-affected families, comprising 77 individuals, were included. Targeted next-generation sequencing analysis yielded no previously reported rare variants. Whole exome sequencing analysis in 11 families identified rare disease-causing variants in various genes, some previously linked to familial MM and others not previously associated. Notably, genes involved in ubiquitination, V(D)J recombination and the PI3K/AKT/mTOR pathway were among those identified. Furthermore, a specific variant in BNIP1 (rs28199) was found in 13 patients across nine families, indicating its potential significance in MM pathogenesis. While this study sheds light on genetic variations in familial MM in Turkey, its limitations include sample size and the absence of in vivo investigations. In conclusion, familial MM likely involves a polygenic inheritance pattern with rare, disease-causing variants in various genes, emphasizing the need for international collaborative efforts to unravel the intricate genetic basis of MM and develop targeted therapies.

Clinical evaluation of DIAGNOVIR SARS-CoV-2 ultra-rapid antigen test performance compared to PCR-based testing

Coronavirus Disease-19 (COVID-19) is a highly contagious infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The development of rapid antigen tests has contributed to easing the burden on healthcare and lifting restrictions by detecting infected individuals to help prevent further transmission of the virus. We developed a state-of-art rapid antigen testing system, named DIAGNOVIR, based on immune-fluorescence analysis, which can process and give the results in a minute. In our study, we assessed the performance of the DIAGNOVIR and compared the results with those of the qRT-PCR test. Our results demonstrated that the sensitivity and specificity of the DIAGNOVIR were 94% and 99.2%, respectively, with a 100% sensitivity and 96.97% specificity, among asymptomatic patients. In addition, DIAGNOVIR can detect SARS‑CoV‑2 with 100% sensitivity up to 5 days after symptom onset. We observed that the DIAGNOVIR Rapid Antigen Test's limit of detection (LoD) was not significantly affected by the SARS‑CoV‑2 variants including Wuhan, alpha (B1.1.7), beta (B.1.351), delta (B.1.617.2) and omicron (B.1.1.529) variants, and LoD was calculated as 8 × 102, 6.81 × 101.5, 3.2 × 101.5, 1 × 103, and 1 × 103.5 TCID50/mL, respectively. Our results indicated that DIAGNOVIR can detect all SARS-CoV-2 variants in just seconds with higher sensitivity and specificity lower testing costs and decreased turnover time.

Glucagon-like peptide-1 receptor agonist treatment of high carbohydrate intake-induced metabolic syndrome provides pleiotropic effects on cardiac dysfunction through alleviations in electrical and intracellular Ca2+ abnormalities and mitochondrial dysfunction

The pleiotropic effects of glucagon-like peptide-1 receptor (GLP-1R) agonists on the heart have been recognised in obese or diabetic patients. However, little is known regarding the molecular mechanisms of these agonists in cardioprotective actions under metabolic disturbances. We evaluated the effects of GLP-1R agonist liraglutide treatment on left ventricular cardiomyocytes from high-carbohydrate induced metabolic syndrome rats (MetS rats), characterised with insulin resistance and cardiac dysfunction with a long-QT. Liraglutide (0.3 mg/kg for 4 weeks) treatment of MetS rats significantly reversed long-QT, through a shortening the prolonged action potential duration and recovering inhibited K⁺ -currents. We also determined a significant recovery in the leaky sarcoplasmic reticulum (SR) and high cytosolic Ca²⁺ -level, which are confirmed with a full recovery in activated Na⁺ /Ca²⁺ -exchanger currents (I_NCX ). Moreover, the liraglutide treatment significantly reversed the depolarised mitochondrial membrane potential (MMP), increased production of oxidant markers, and cellular acidification together with the depressed ATP production. Our light microscopy analysis of isolated cardiomyocytes showed marked recoveries in the liraglutide-treated MetS group such as marked reverses in highly dilated T-tubules and SR-mitochondria junctions. Moreover, we determined a significant increase in depressed GLUT4 protein level in liraglutide-treated MetS group, possibly associated with recovery in casein kinase 2α. Overall, the study demonstrated a molecular mechanism of liraglutide-induced cardioprotection in MetS rats, at most, via its pleiotropic effects, such as alleviation in the electrical abnormalities, Ca²⁺ -homeostasis, and mitochondrial dysfunction in ventricular cardiomyocytes.

Thyroid dysfunctions in adult patients after allogeneic hematopoietic stem cell transplantation

INTRODUCTION

Thyroid dysfunction (TD) is one of the major endocrinopathies shown after allogeneic hematopoietic stem cell transplantation over the long term. The incidence and the risk factors for TD have varied widely.

PATIENTS AND METHODS

Two hundred and fifty-nine patients with pre-transplant normal thyroid function tests who survived at least 1 year after allo-HSCT between 2006-2016 were included in the study.

RESULTS

Sixty-four patients (25%) developed TD at median of 34 months (range, 1-112 months). Hypothyroidism was detected in 32 patients (12%): 5 patients had primary hypothyroidism, and subclinical hypothyroidism occurred in 27 patients. 18 patients (7%) were diagnosed with hyperthyroidism: 2 patients (0.07%) were treated for primary hyperthyroidism, and 16 patients (6%) were followed for subclinical hyperthyroidism. Euthyroid sick syndrome occurred in 14 cases. None of the patients with thyroid dysfunction developed secondary thyroid malignancy. Receiving high-dose TBI (P = .001) was found to be significant risk for hypothyroidism; older age than median (P = .01) and pre-transplant active disease (P < .0001) were related to hyperthyroidism.

CONCLUSIONS

Thyroid dysfunction, mostly hypothyroidism, is a long-term complication after allo-HSCT in 25% of patients. Older age, pre-transplant active disease, and receiving TBI are among the risk factors. Sustained long-term monitoring of thyroid function test should be considered post allo-HSCT.

Alterations in the immunoreactivity of laminin, type IV collagen and α3β1 integrin in diabetic rat ovarian follicles

AIM

In order to determine the possible effects of diabetes, we aimed to investigate the expression of extracellular matrix proteins in the theca and granulosa layers in different follicular stages.

METHODS

Thirty-two adult Wistar albino male rats were divided into 4 groups as control and sampled groups. Four, eight and twelve weeks after inducing diabetes with an intraperitoneal injection of streptozotocin (40 mg/kg), the expressions of laminin, type IV collagen and α3β1 integrin in ovarian tissues were evaluated by immunohistochemical method.

RESULTS

In our study, in the first month of diabetes, a significant increase was observed in laminin, type IV collagen and α3β1 integrin expressions in all follicle types compared to the control group in both the theca and granulosa layers. Laminin and type IV collagen immunoreactivity tended to increase in D2 and D3 groups also. Integrin expression did not change in the newly formed follicles in the D2 and D3 groups, however, it tended to change and increase in the developing follicles.

CONCLUSIONS

The changes in the expression of laminin, type IV collagen and α3β1 integrin, which are the extracellular matrix proteins in the follicle, along with diabetes, show that diabetes plays a role in the regulation of follicular development (Tab. 4, Fig. 36, Ref. 29).

Sweet's syndrome under ipilimumab therapy and a brief comparison of the cases in literature

INTRODUCTION

Ipilimumab is an anti-cytotoxic T lymphocyte antigen 4 (CTLA-4) antibody. Ipilimumab has shown improvement in overall survival in patients with advanced melanoma. Because ipilimumab activates the immune system against the tumor, ipilimumab is associated with adverse events related to immune system activation. Immune-associated side effects are frequently seen in the gastrointestinal system and skin. Sweet's syndrome (SS) is an uncommon inflammatory disorder. Some drugs or malignancy can cause SS. Only a few case reports have been reported of ipilimumab-associated SS.

CASE

A 53-year-old female with metastatic melanoma was treated with ipilimumab. After the fourth cycle, she developed painful lesions on her legs and hands. The pathologic biopsy of the lesions revealed neutrophilic dermatosis consistent with SS.Management and outcome: The patient was treated with 60 mg/day of prednisone for four days, nonsteroidal anti-inflammatory drugs and inhaler bronchodilator and steroid. She had symptomatic relief at the beginning of treatment. The prednisone doses were quickly tapered every three days. When the patient was treated with 10 mg/day of prednisone for three days, the skin nodules recurred. Prednisone 40 mg per day was re-started and then a slower taper by decreasing by 10 mg/day every week was instituted. After one-month treatment the prednisone dose was given as a 5 mg doses for one week and then stopped. No new lesions recurred after slower taper of prednisone.

CONCLUSION

Herein we report a case presented with SS under ipilimumab therapy. Melanoma patients treated with ipilimumab can develop SS. The clinicians should be aware of this condition.

A SGLT2 inhibitor dapagliflozin suppresses prolonged ventricular-repolarization through augmentation of mitochondrial function in insulin-resistant metabolic syndrome rats

BACKGROUND

Metabolic syndrome (MetS) is a prevalent risk factor for cardiac dysfunction. Although SGLT2-inhibitors have important cardioprotective effects in hyperglycemia, their underlying mechanisms are complex and not completely understood. Therefore, we examined mechanisms of a SGLT2-inhibitor dapagliflozin (DAPA)-related cardioprotection in overweight insulin-resistant MetS-rats comparison with insulin (INSU), behind its glucose-lowering effect.

METHODS

A 28-week high-carbohydrate diet-induced MetS-rats received DAPA (5 mg/kg), INSU (0.15 mg/kg) or vehicle for 2 weeks. To validate MetS-induction, we monitored all animals weekly by measuring body weight, blood glucose and HOMO-IR index, electrocardiograms, heart rate, systolic and diastolic pressures.

RESULTS

DAPA-treatment of MetS-rats significantly augmented the increased blood pressure, prolonged Q-R interval, and low heart rate with depressed left ventricular function and relaxation of the aorta. Prolonged-action potentials were preserved with DAPA-treatment, more prominently than INSU-treatment, at most, through the augmentation in depressed voltage-gated K⁺-channel currents. DAPA, more prominently than INSU-treatment, preserved the depolarized mitochondrial membrane potential, and altered mitochondrial protein levels such as Mfn-1, Mfn-2, and Fis-1 as well as provided significant augmentation in cytosolic Ca²⁺-homeostasis. Furthermore, DAPA also induced significant augmentation in voltage-gated Na⁺-currents and intracellular pH, and the cellular levels of increased oxidative stress, protein-thiol oxidation and ADP/ATP ratio in cardiomyocytes from MetS rats. Moreover, DAPA-treatment normalized the increases in the mRNA level of SGLT2 in MetS-rat heart.

CONCLUSIONS

Overall, our data provided a new insight into DAPA-associated cardioprotection in MetS rats, including suppression of prolonged ventricular-repolarization through augmentation of mitochondrial function and oxidative stress followed by improvement of fusion-fission proteins, out of its glucose-lowering effect.

Incision and venous patch graft in the surgical treatment of penile curvature in Peyronie's disease

OBJECTIVES

To assess the efficacy of incision and venous patch grafting method in the surgical treatment of the curvature in Peyronie's disease.

METHODS

Fifty-eight patients with Peyronie's disease underwent incision of the tunica albuginea with Peyronie's plaque(s) and venous patch grafting between 1994 and 1999. Segment(s) of lower saphenous vein in 48, deep dorsal vein in 7, and upper saphenous veins were used in 3 cases as venous patch(es). Assessment of the potency status, curvature, and vascular structure were performed pre-operatively with detailed history, counselling, autophotography, and color Doppler ultrasonography. Realistic expectations from the surgery was discussed with the patients in advance. Postoperative evaluation was performed at least twice, in the 6th week and the 3rd month. The third evaluation was done in 12-36 months by telephone.

RESULTS

Fifty of the patients (86%) achieved straight erections after the surgery. Five patients (9%) had improvement in their penile curvature that enabled them to perform sexual intercourse easily. In 3 of our patient (5%) recurrence of the curvature was observed. Penile shortening of 0.5-1.5 cm was observed in 13 of the cases (22.4%). Fifty-four cases (93%) reported no change in their quality of erections.

CONCLUSION

Incision of the tunica albuginea and venous patch grafting technique is a very satisfactory surgical method in the treatment of the curvature in Peyronie's disease.

Effect of testosterone on the number of NADPH diaphorase-stained nerve fibers in the rat corpus cavernosum and dorsal nerve

OBJECTIVES

To elucidate the effect of testosterone on penile nerve supply.

METHODS

Three groups of 10 rats each were assessed; two groups were castrated and the third underwent a sham operation (control). After castration, one group received subcutaneous injection of testosterone while the others received sesame oil. At 8 weeks, the rats underwent a functional analysis. The evaluation included a subcutaneous injection with apomorphine to study centrally mediated erection, and cavernous nerve electrostimulation and papaverine injection to study peripherally mediated erection. At death, a penile midshaft specimen was taken for nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase staining.

RESULTS

In the apomorphine study, castrated rats had no erections, but the erectile function of those receiving testosterone was restored to the level of the controls. The mean numbers of NADPH-diaphorase-stained nerve fibers in the copora cavernosa and both dorsal nerves of castrated rats, at 165.8 +/- 20.0 and 271.3 +/- 21.1, respectively, were significantly lower than those of the controls, at 271.7 +/- 14.6 and 471.2 +/- 27.6, respectively. Those of the testosterone replacement group, at 290.7 +/- 10.1 and 500.7 +/- 23.9, respectively, recovered to the control level. The intracavernosal pressure decreased significantly in the absence of testosterone, both after electrostimulation and intracavernosal papaverine injection, and recovered to the control level after testosterone replacement.

CONCLUSIONS

Our results indicate that testosterone acts on the nervous system to mediate erection. When it is absent, there may be downregulation of both the production and activity of nitric oxide (NO), thereby decreasing the response to peripheral stimulation via the NO pathway. Testosterone replacement may upregulate NO activity to the control level.

Apoptosis in the erectile tissues of diabetic and healthy rats

OBJECTIVE

To compare the frequency of apoptosis in the erectile tissue of chronic diabetic and healthy rats.

MATERIALS AND METHODS

Fourteen chronic diabetic and 10 healthy Sprague-Dawley rats were killed, their penises harvested and stored at -70 degrees C until staining and flow cytometric analysis for apoptosis. A cell suspension was obtained from the penile tissue by scraping the inside of the cavernosum with a scalpel and filtering through a mesh. Samples of the cell suspension (0.5 x 106 cells) were stained with Annexin V (an indicator of apoptosis) and propidium iodide (PI, which stains dead cells), incubated for 15 min at room temperature and analysed by flow cytometry. The DNA content was also analysed in each sample.

RESULTS

In normal erectile tissue, a mean of 6.2% of cells were stained with Annexin V, while only 2.7% were stained with PI; DNA content analyses showed 7.5% were hypodiploid cells. In diabetic rats 19.5% of cells were stained with Annexin V and 5.2% with PI; 22.9% of cells were hypodiploid.

CONCLUSION

The ratio of apoptotic cells in the erectile tissues of diabetic rats was significantly greater than in normal rats. The high rate of apoptosis in diabetic rats may play a role in the pathophysiology of erectile dysfunction.

Structural alterations in the tunica albuginea of the penis: impact of Peyronie's disease, ageing and impotence

OBJECTIVE

To investigate whether changes in the structure of the tunica albuginea influence the development of erectile dysfunction.

PATIENTS AND METHODS

Biopsy specimens taken from the tunica of 64 patients (both potent and impotent) with and without Peyronie's disease were evaluated. Tissue samples were stained and examined under light and electron microscopy, and the concentration of elastic fibres present in each was measured using computerized image analysis.

RESULTS

The concentration of elastic fibres was lower in impotent than in potent patients (P = 0.0365) and was also significantly less in patients with Peyronie's disease. Furthermore, the concentration of elastic fibres decreased with age. Electron and light microscopy revealed the presence of distinct alterations in the tunica albuginea in impotent patients and patients with Peyronie's disease that might interfere with function.

CONCLUSION

The decrease in elastic fibre concentration and changes in microscopic features may contribute to erectile dysfunction by impairing the veno-occlusive function of the tunica albuginea.

Duplex ultrasonography after prostaglandin E1 injection of the clitoris in a case of hyperreactio luteinalis

We report an unusual case of persistent postpartum clitorimegaly due to ovarian hyperreactio luteinalis. Duplex ultrasonography of the clitoris after intracorporeal injection of prostaglandin E1 revealed marked clitoral erection and increased arterial flow, as in the penis.

Our experience with pharmacological erection treatment of erectile dysfunction

Administration of vasoactive drugs intracavernously is a well-known easily used and inexpensive alternative in treatment of a certain group of patients with erectile dysfunction. There are a few drugs used for this purpose, but we prefer papaverine as the first choice because it is easily available and inexpensive in our country. We used alprostadil only in nonresponders to papaverine or if there was any complication with papaverine. We present a series of 69 patients, 24 with psychogenic (34.8%), 27 with organic (39.1%), and 18 (26.1) with mixed etiology of erectile dysfunction, treated with intracavernous self-injection therapy. Mean follow-up of the patients was 13.6 months (7-30 months). In this study, 3,430 papaverine and 780 alprostadil injections were performed in 56 and 13 patients, respectively. In 75% of the papaverine injections and in 83% of the alprostadil injections, erections were achieved sufficient for sexual intercourse. During the follow-up, there were not any abnormal alterations in liver function tests. The main complaint of the patients who used papaverine was a burning sensation (98%) during administration of the drug, which did not last more than 1 minute. Of 13 patients in the alprostadil group, 56.9% of the patients complained mainly of discomfort during erection. We concluded that intracavernous therapy is a good and inexpensive option in the management of erectile dysfunction in carefully selected patients.

Is colchicine effective in Peyronie's disease? A pilot study

OBJECTIVES

The treatment of Peyronie's disease with oral or topical agents has not been entirely satisfactory. In this pilot study, we hypothesized that colchicine, known to induce collagenase activity and decrease collagen synthesis, might be an ideal agent in the treatment of Peyronie's disease.

METHODS

Colchicine was administered orally for 3 to 5 months to a group of 24 previously untreated patients with Peyronie's disease.

RESULTS

Peyronie's plaque decreased or disappeared in 12 of the 24 patients, 7 of 9 patients with painful erections reported significant relief, and penile curvature was improved in 7 of 19 cases. Erectile status, narrowing of the penis, and accompanying Dupuytren's contracture did not change in any of the cases.

CONCLUSIONS

Although this pilot study shows some promising results of the use of colchicine in the treatment of Peyronie's disease, the ultimate usefulness of this agent will be determined only by a prospective double-blind clinical study.