Background: This study investigates the effect of letrozole on hormone profiles, semen parameters, body mass index (BMI), degree of oxidative stress and sperm chromatin integrity in men with idiopathic oligo/astheno/ teratozoospermia (iOAT) and T:E 2 ratio ≤ 10. Materials and methods: This study is a longitudinal, prospective, interventional and open-labelled clinical trial. Semen samples were collected from 20 iOAT men with low serum testosterone (T) to estradiol (E 2) ratio (T:E 2 ratio ≤ 10). The participants were treated with 2.5 mg letrozole orally per day for 3 months. Then, sperm parameters, hormone profiles, BMI, chromatin integrity and intracellular reactive oxygen species (ROS) level were assessed pre-and post-treatment. The chromatin integrity was evaluated by assessment of DNA fragmentation (with TUNEL assay) and protamine deficiency (with Chromomycin A3, CMA3). Also, the intracellular ROS levels were investigated by 2′, 7′-dichlorodihydrofluorescein diacetate (DCFH-DA) staining. Finally, the differences between the parameters evaluated before and after letrozole treatment were analyzed with the t-test and the Wilcoxon signed-rank test. Results: Sperm concentration, percentage of sperm motility and its normal morphology increased significantly after letrozole treatment. Moreover, serum testosterone level increased but estradiol level decreased significantly following treatment. The mean of T:E2 ratio improved 1600%. Also, letrozole treatment significantly reduced the percentage of sperm TUNEL positivity and sperm CMA3 positivity. While no significant difference was observed between intracellular ROS levels and BMI before and after treatment. Finally, as a notable result, four spontaneous pregnancies (20%) were achieved after treatment. Conclusions: Letrozole treatment can effectively increase spontaneous pregnancies by improving sperm parameters and sperm chromatin integrity in men with iOAT and T:E2 ratio ≤ 10.

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Papillary serous cystadenocarcinoma of the ovary is a common tumor but occurrence of ovarian type papillary serous cystadenocarcinoma in the testis is very rare. Herein we report such a case in a 49-year-old man presenting with testicular swelling. In this tumor, mesothelioma of tunica vaginalis should be excluded by immunohistochemistry. The best treatment is radial orchiectomy and it is very resistant to chemoradiation. Our case was well after orchiectomy and now after a year he is doing well and completely symptom free.

Background and objectiveWhile obesity prevalence in the United States has increased considerably, its impact on factors such as mortality, comorbidity, and cost have not been extensively analyzed in hospitalized patients. Detailed information on the prevalence of obesity and associated factors among inpatients may help in developing health care policies aimed at reducing mortality, comorbidity, and cost.MethodsIn this study, data for analysis of inpatient discharges from 2005 to 2015 were obtained from the Health Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database. Body Mass Index (BMI) of 30 or greater is defined as obesity. Descriptive analysis includes trends of obesity by sex, race, region, location and payer. To classify magnitude of association between obesity and comorbidities, we classified prevalence ratio (PR) to high risk factor (PR≥1.5), low risk factor (PR= <1.5-1.25), null (<1.25->0.8) and preventive factor (PR<0.8) based on expert epidemiologists opinion. Results During the study period we reviewed 82,618,702 discharges with 6,705,774 obesity for a rate of 8.11%. The percent of obese discharges increased from 4.6% in 2005 to 11.9% in 2015. In all subgroup variables, there was a substantial difference between obesity and non-obesity in hospital patients. Data indicated females had a higher prevalence of hospital discharges with obesity, compared to males. Moreover, Black race had the highest percentage and Asian or Pacific Islander is the lowest in this trend. ConclusionWhile obesity prevalence in the United States population has slowly increased, there has been a more marked increase in obese patients in the hospital.