Disclaimer and position: This pamphlet is a manuscript written under the auspices of the Iranian Urology Association undertaken by the Research Committee and Guild Affairs Committee. This is neither obligatory nor a forensic reference although supported and confirmed scientifically by authors and recommended to be trusted. We know that the situation of the Covid-19 outbreak is hyperkinetic and any new scientific work or factual event may impose a drastic change in previous analyses and predictions. The urologist is the responsible and authorized party and this recommendation pamphlet is not a document to replace academic documentaries, medical evidence, health governmental organizations protocols, and decrees or patient’ s autonomy. Nevertheless, this may be a paragon of similar recommendation manuscripts in similar outbreaks. The scientific community is convinced to be more improvising and anticipatory for such imminent situations that may happen again and again....

BACKGROUND: There are many patients awaiting liver transplantation withonly few donors providing the organ. The Child-Turcotte-Pugh score (CTP) and the Model for End stage Liver Disease (MELD) are the most common scores for prioritizingpatients on waiting lists. In this study, we compared the ability of these scores to predict mortalityor removal from the waiting list due to poor medical conditions.METHODS: A total of257 patients were included in our study and we observed their status in the waiting list overa 9-month period. MELD and CTP of the patients at the time of listing were calculated. We used both ROC-curve and Area Under the Curve (AUC) to calculate the predictive ability of these scores.RESULTS: During follow up, 22 patients died and 9 patients were removed from the waiting list due to poor medical conditions. Comparing the predictive ability of CTP and MELD, the AUC for CTP was larger than that of MELD (0.75 versus 0.69; P-value=0.065). The best cutoff point for discriminating mortality or removal from the waiting list due to severe deterioration is 8 for CTP and 13.67 for MELD. The sensitivity and specificity was 0.74 and 0.67, respectively for CTP and 0.74 and 0.58, respectively for MELD.CONCLUSION: The CTP score can predict mortality or removal from the liver transplantation waiting list better than the MELD overa 9-month period. However, better improved models need to be developed for prioritization of patients in the waiting list.

Background: HBV-specific cytotoxic T lymphocyte (CTL) activity is believed to play a critical role in controlling HBV infection. The phosphatidylinositol 3-kinase (PI3K) /Akt signaling pathway manipulates cell fate decisions in many different cell types by regulating the activity of downstream effectors. We have previously testified that the fusion protein of CTP-HBcAg18-27--Tapasin could enter the cytoplasm of dendritic cells and efficiently induce robust specific CTL response in vitro.Objectives: In the present study, we evaluated specific CTL response and the level of apoptosis of CD8+T cells induced by CTP-HBcAg18-27-Tapasin in HLA-A2 transgenic mice (H-2Kb). Meanwhile, we preliminary investigated PI3K, phosphorylation level of Akt, and mammalian target of rapamycin (mTOR) as positive regulator of the magnitude and effector function of the hepatitis B virus-specific cytotoxic T lymphocytes in HLA-A2 transgenic mice.Materials and Methods: HLA-A2 transgenic mice were immunized by intramuscular injection in the hind legs three times at one-week intervals with PBS, CTP-HBcAg18-27-Tapasin (50 mg), CTP-HBcAg18-27 (50 mg), HBcAg18-27-Tapasin (50 mg), and HBcAg18-27 (50 mg). One week after the last immunization, mice were sacrificed and splenocytes were harvested in strile condition. The specific CTL response was analyzed by flow cytometry and enzyme linked immunosorbent assay (ELISA), the expression of (PI3K) /Akt signaling was detected by RT-PCR and western blot.Results: The results showed that CTP-HBcAg18-27-Tapasin significantly increased the percentages of IFN-g+CD8a+T cells, the numbers of these polyfunctional triple-cytokine-producing (IFN-g, TNF-a, and IL-2) CD8+T cells, the secretion of cytokine IFN-g, IL-2, and TNF-a, while in comparison to control group, it significantly decreased the percentage of apoptotic CD8+T cells in HLA-A2 transgenic mice. Moreover, the expression of PI3K, P-Akt, and P-mTOR was significantly upregulated in CTP-HBcAg18-27-Tapasin group compared with control groups.Conclusions: In conclusion, CTP-HBcAg18-27-Tapasin could reduce apoptosis of CD8+T cells, increase the percentages of IFN-g+CD8a+T cells, and elicit cell-mediated immunity in HLA-A2 transgenic mice, these processes were associated with activation of the PI3K/Akt signaling pathway.

Background: Liver cirrhosis is one of the most significant causes of death in many regions worldwide. This study aimed to assess the correlation of hemostatic and endocrine parameters with Child-Turcotte-Pugh (CTP) scoring in patients with non-alcoholic liver cirrhosis. Materials and Methods: This study included 59 patients monitored for non-alcoholic liver cirrhosis in a gastroenterology clinic from January 2018 to February 2019. The subjects were grouped according to the CTP scores, and their adrenocorticotropic hormone (ACTH), cortisol, dehydroepiandrosterone sulfate (DHEA-SO4), progesterone, growth hormone (GH), insulin-like growth factor-1 (IGF-1), GH/IGF-1 ratio, fibrinogen, D-dimer, and D-dimer/fibrinogen ratio were measured. Results: According to CTP scoring, 20. 3% of patients were CTP-A (n=12), 35. 6% were CTP-B (n=21), and 44. 1% were CTP-C (n=26). There were statistically significant differences for IGF-1, DHEA-SO4, and GH/IGF-1 ratios between CTP-A and CTP-B groups (P = 0. 002, P = 0. 043, P = 0. 038, respectively). Additionally, there were statistically significant differences between the CTP-B and CTP-C groups for D-dimer and GH values (P = 0. 024, P = 0. 006, respectively). There were statistically significant differences for D-dimer, GH, IGF-1, and D-dimer/fibrinogen ratio between the CTP-A and CTP-C groups (P < 0. 001, P = 0. 016, P = 0. 002, P = 0. 031, respectively). Conclusion: Severe hemostatic and endocrine complications develop in patients with liver cirrhosis due to non-alcoholic causes. Additionally, it seems that using D-dimer and D-dimer/fibrinogen ratio, along with fibrinogen level, can be beneficial in showing liver damage in these patients.

Background: Conventional Tissue Processing (CTP) is the gold standard method for tissue processing; however, the method is relatively time-consuming. Microwave Tissue Processing (MTP) reduces the turnaround time and gives comparable histomorphology to CTP. The objective was to compare the Laboratory-grade Microwave Processing (LMP) and Domestic Microwave tissue Processing (DMP) with CTP in terms of histomorphology and immunohistochemistry (IHC) staining. Methods: Three tissue bits from 89 formalin-fixed resection specimens received in the histopathology laboratory were processed by CTP, LMP, and DMP processing methods. The specimens were fixed in 10% neutral buffered formalin for 24 hours. The sections were stained with Hematoxylin and Eosin (H and E) stain. In subgroup analysis, IHC was done on 17 relevant cases using two antibodies, Ki67 (Nuclear) and Pancytokeratin (Membranous and cytoplasmic). Parameters such as the clarity of section, cytoplasmic details, nuclear details, color intensity, and interface of epithelium and connective tissue were studied. Parameters like color intensity, localization of antigen, background staining, and crispness of staining were studied on IHC. The results were analyzed using Kappa statistics. Results: There was a fair to moderate agreement between CTP and LMP. There was a slight to fair agreement between CTP to DMP and LMP to DMP. Conclusion: Microwave tissue processing reduced the turnaround time. The overall quality of LMP tissue was better than DMP and was equally good as that of CTP.