Urologii︠a︡ (Moscow, Russia : 1999)
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Randomized Controlled Trial
[Adjuvant antioxidant therapy in varicocele infertility].
Infertility affects an estimated 15% of couples globally. Male factor infertility accounts for about a half of infertility cases. About 40% of infertile men have varicocele. The aim of this study was to investigate the efficacy and safety of a complex of acetyl-L-carnitine, L-carnitine fumarate and alpha-lipoic acid (SpermActin-forte) (SA) for adjuvant antioxidant therapy after microsurgical varicocelectomy (MVE) in men with varicocele and assess its impact on the level of DNA fragmentation in sperm cells. ⋯ Using nutraceuticals (SA) after MVE is an effective and safe adjuvant antioxidant therapy of male infertility in patients with varicocele which leads to an improvement in the basic sperm parameters (sperm concentration and motility) and a decrease in the level of sperm DNA fragmentation in the short term. Adjuvant antioxidant therapy of varicocele infertility potentiates the effects of monotherapy (both medical and surgical), leads to an increase in its effectiveness and shortens the time to pregnancy. Further studies in this field are needed to assess long-term outcomes of the treatment.
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Since the first use of robotic surgical system in 2000, the robot-assisted technology has gained wide popularity throughout the world. Robot-assisted surgical training is a complex issue that requires significant efforts from students and teacher. During the last two decades, simulation-based training had received active development due to wide-spread occurrence and popularization of laparoscopic and robot-assisted surgical techniques. ⋯ It was established that simulation-based training is the most promising teaching tool that can be used in the training of the next generation robotic surgeons. Today the use of simulators to train surgeons is validated. Price of devices is an obvious barrier for inclusion in the program for training of robotic surgeons, but the lack of this tool will result in a sharp increase in the duration of specialists training.
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Nocebo effect is the onset or exacerbation of unwanted symptoms (adverse reaction) as a reaction to medical treatment. The nocebo effect is very common both in clinical practice and in clinical trials. Medical practitioner's knowledge of the patient's predisposition to nocebo effects can affect the management strategy and building doctor-patient relationship. ⋯ Solving this contradiction and minimizing the risk of nocebo effect allows choosing the proper strategy of doctor-patient communication. It is important not to ignore the various psychological, medical and organizational measures aimed at improving the patient comfort in the course of treatment. This prevents the accumulation of negative treatment experiences and is the key to successful treatment and prevention of nocebo effect.