Limited Management Options Research Articles

A Systematic Review and Meta-analysis of the Combination of Vinorelbine and Lapatinib in Patients With Her2-positive Metastatic Breast Cancer.

The development of effective human epidermal growth factor receptor 2 (HER2)-targeted therapies has been heralded as a significant milestone in breast cancer treatment, resulting in improvement of the outcome for those with HER2-positive metastatic breast cancer. Despite these advantages, metastatic breast cancer is still regarded as an incurable disease. In heavily pretreated patients with increasingly limited options for palliative management, ensuring control of disease and maintenance of quality of life is an important goal. Vinorelbine and lapatinib is a combination used in later-line treatment of metastatic HER2-positive breast cancer. The current article presents a systematic review and meta-analysis of prospective series of the vinorelbine/lapatinib doublet for efficacy and toxicity in metastatic HER2-positive breast cancer. Altogether seven prospective trials involving 235 evaluable patients were retrieved for analysis. Pooled estimates of response rate and disease control rate were 24.4% and 63.3% respectively. Furthermore, overall survival was 20.1 months and progression-free survival was 5.44 months. The most common grade 3 and 4 toxicities were seen in fewer than 10% of cases. Vinorelbine/ lapatinib combination regimen may serve as an option for pre-treated patients with metastatic HER2-positive breast cancer.

Vinorelbine plus Capecitabine (Vinocap): a retrospective analysis in heavily pretreated HER2 negative metastatic breast cancer patients.

Metastatic breast cancer is regarded as an incurable entity. In heavily pretreated patients with increasingly limited options for palliative management, ensuring proper quality of life continues is to be an elusive issue. With this in mind, the authors evaluated the efficacy and safety of the Vinorelbine/Capecitabine doublet (VINOCAP). The investigators retrospectively analyzed a cohort of 67 women with HER2 negative MBC treated at a large breast cancer practice and a local cancer center with Vinorelbine 22.5mg/m2 IV on days 1 and 8 combined with Capecitabine 1g PO BID for 14 consecutive days of 21day cycles. Patients had beentreated with anaverage of4 prior lines of chemotherapy. Patient characteristics and outcomes were evaluated. A total of 67 patients received VINOCAP, and an additional 2 underwent repeat exposure yielding a cohort of 69. Clinical benefit rate, defined as complete response (CR), partial response (PR) or stable disease ≥ 6 months (SD), was 55.07%. Complete response was seen in 4.34%, PR in 18.8% and SD ≥ 6 months in 31.9%. Median progression-free survival was 6.2 months and overall survival 35.47 months after VINOCAP exposure. The most common grade 3-4 toxicity was neutropenia in 10% of cases. Dose had to be reduced in 18% of cases due to toxicityof any type. The regimen was well tolerated, and serious side effects were uncommon. Vinorelbine/Capecitabine appears to be an active and well-tolerated regimen in women with MBC. In particular, encouraging was the efficacy of VINOCAP as fourth or greater line of chemotherapy.

Cancer Patients Not Immune to Opioid Crisis

Cancer Patients Not Immune to Opioid Crisis

Chronic migraine: Erenumab, new kid on the block

Migraine is a primary headache disorder and causes substantial pain and disability. Migraine sufferers could suffer from episodic migraine or chronic migraine. While both of these adversely affect the quality of life, the management of chronic migraine patients poses many challenges, as it mainly relies on preventive treatment. Till now, we have very limited options for preventive management of chronic migraine; recently, new drug erenumab has been approved by the Food and Drug Administration. It has shown very promising results in the management of chronic migraine as it acts by novel mechanism as calcitonin gene-related peptide receptor blocker.

Endoscopic Ultrasound-Guided Angiotherapy for Gastric Varices: A Single Center Experience.

There are limited efficacious therapeutic options for management of gastric variceal bleeding. Treatment modalities include transjugular intrahepatic portosystemic shunt, surgical shunts, and endoscopic interventions, including the recent advancement of endoscopic ultrasound (EUS)‐guided coiling. We present a case series of 10 patients with portal hypertension (7 with liver cirrhosis and 3 without cirrhosis), complicated by gastric varices (GV) with bleeding. All cases were treated successfully with EUS‐guided coiling leading to variceal eradication. There were 10 occurrences of minimal self‐limited bleeding at the puncture site during the procedure, and only one occurrence of major bleeding that necessitated cyanoacrylate glue injection for homeostasis. There were no other adverse events within a mean follow‐up time of 9.7 months (range, 1‐28 months). Conclusion: In our series, EUS‐guided angiotherapy was effective for GV eradication with a high safety profile.

Advancing Agricultural Water Security and Resilience Under Nonstationarity and Uncertainty: Evolving Roles of Blue, Green, and Grey Water

Advancing Agricultural Water Security and Resilience Under Nonstationarity and Uncertainty: Evolving Roles of Blue, Green, and Grey Water

Effect of Lanreotide on Kidney Function in Patients With Autosomal Dominant Polycystic Kidney Disease

Autosomal dominant polycystic kidney disease (ADPKD) is characterized by progressive cyst formation in both kidneys and loss of renal function, eventually leading to a need for kidney replacement therapy. There are limited therapeutic management options. To examine the effect of the somatostatin analogue lanreotide on the rate of kidney function loss in patients with later-stage ADPKD. An open-label randomized clinical trial with blinded end point assessment that included 309 patients with ADPKD from July 2012 to March 2015 at 4 nephrology outpatient clinics in the Netherlands. Eligible patients were 18 to 60 years of age and had an estimated glomerular filtration rate (eGFR) of 30 to 60 mL/min/1.73 m2. Follow-up of the 2.5-year trial ended in August 2017. Patients were randomized to receive either lanreotide (120 mg subcutaneously once every 4 weeks) in addition to standard care (n = 153) or standard care only (target blood pressure <140/90 mm Hg; n = 152). Primary outcome was annual change in eGFR assessed as slope through eGFR values during the 2.5-year treatment phase. Secondary outcomes included change in eGFR before vs after treatment, incidence of worsening kidney function (start of dialysis or 30% decrease in eGFR), change in total kidney volume and change in quality of life (range: 1 [not bothered] to 5 [extremely bothered]). Among the 309 patients who were randomized (mean [SD] age, 48.4 [7.3] years; 53.4% women), 261 (85.6%) completed the trial. Annual rate of eGFR decline for the lanreotide vs the control group was -3.53 vs -3.46 mL/min/1.73 m2 per year (difference, -0.08 [95% CI, -0.71 to 0.56]; P = .81). There were no significant differences for incidence of worsening kidney function (hazard ratio, 0.87 [95% CI, 0.49 to 1.52]; P = .87), change in eGFR (-3.58 vs -3.45; difference, -0.13 mL/min/1.73 m2 per year [95% CI, -1.76 to 1.50]; P = .88), and change in quality of life (0.05 vs 0.07; difference, -0.03 units per year [95% CI, -0.13 to 0.08]; P = .67). The rate of growth in total kidney volume was lower in the lanreotide group than the control group (4.15% vs 5.56%; difference, -1.33% per year [95% CI, -2.41% to -0.24%]; P = .02). Adverse events in the lanreotide vs control group included injection site discomfort (32% vs 0.7%), injection site papule (5.9% vs 0%), loose stools (91% vs 6.6%), abdominal discomfort (79% vs 20%), and hepatic cyst infections (5.2% vs 0%). Among patients with later-stage autosomal dominant polycystic kidney disease, treatment with lanreotide compared with standard care did not slow the decline in kidney function over 2.5 years of follow-up. These findings do not support the use of lanreotide for treatment of later-stage autosomal dominant polycystic kidney disease. ClinicalTrials.gov Identifier: NCT01616927.

A comparison of organic fungicides: alternatives for reducing scab on pecan

In the southeastern USA, the most widespread and damaging disease of pecan is scab, caused by Venturia effusa. Although scab can be controlled using conventional chemical methods, organic pecans that attract a premium price mandate the use of organic fungicides. Also, organic production is an environmentally sustainable method. However, where susceptible pecan cultivars are grown, there are limited options for organic management of scab. We conducted experiments to compare organic fungicides to control scab on the susceptible cv. Desirable in 2011, 2012, 2014, 2015, and 2016. The alternatives compared included Bordeaux mixture, compost tea, sodium bicarbonate, Bacillus subtilis, sulfur, cuprous oxide, and extract of the Giant Knotweed (Reynoutria sachalinensis). Rainfall and scab severity differed between seasons. There was consistently low severity on foliage, with little or no difference between treatments. Similarly at the time of the first fruit assessment, the severity was low and the differences in severity small and inconsistent between seasons and treatments. However, by the time of the second fruit assessment, severity of scab had increased and consistent differences among treatments existed (except in the drought year of 2011, when scab severities were very low and similar to the control). In all other years, the control treatment had significantly more severe scab compared to some (2012 and 2014) or all other treatments (2015 and 2016). Extract of the Giant Knotweed as a fungicide was included in 2012, 2014, 2015, and 2016, and fruit on those trees had less severe scab in all years compared to that on fruit of the control trees. In three seasons (2012, 2015, and 2016), applications of Bordeaux mixture resulted in a reduction in scab severity. Compost tea, Sodium bicarbonate, B. subtilis, sulfur, and cuprous oxide significantly reduced scab compared to the control in one or two seasons, but were not consistent among seasons, and were never more efficacious compared to the extract of the Giant Knotweed. Extract of the Giant Knotweed and Bordeaux mixture appear to offer the greatest potential as organic approaches for managing scab in pecan. However, wherever possible, planting of scab resistant cultivars should be considered as a first line of defense.

Spatio-temporal controls of dissolved organic carbon stream water concentrations

Elevated concentration and high variance of dissolved organic carbon (DOC) in surface waters are a challenge for the production of drinking water. Past studies have indicated a dominant role of wetlands in DOC mobilization, but have mainly been focused on boreal and oceanic catchments. Here we analyze the observational DOC time series from 89 temperate humid catchments which drain into German drinking water reservoirs. We characterize the DOC concentration median and variability and utilize partial least squares regression in order to quantify the relation to catchment characteristics such as land use, climate, and topography. We found that the long-term median DOC concentration in the catchment is well predicted by the 90th percentile of the distribution of the topographic wetness index (0.9P TWI) over the entire catchment area. The 0.9P TWI can be directly connected to the abundance of riparian wetlands in the catchments. DOC concentration variability (represented as the ratio of the interquartile range and the median concentrations) was also found to be well predictable. Concentration variability was highest in cold and wet catchments with a high 0.9P TWI. Here we also found stronger correlations between DOC concentrations and discharge, with positive concentration-discharge patterns. Catchments with elevated DOC-concentration variance also exhibited the most severe long-term increases in concentrations. Our results thus indicate that, in temperate climates, riparian wetlands can be the dominant source zones of DOC and control the hydrological mobilization and potentially also the spatial difference in long-term concentration trends observed in surface waters. We conclude that the dominance of topography and climatic conditions in controlling spatio-temporal patterns in DOC concentrations leads to very limited management options.

Recent advances on the characterization and control of sunflower soilborne pathogens under climate change conditions

The control of soilborne crop pathogens is conditioned by the limited management options due to difficult access to active infection courts and to restrictions in the use of synthetic pesticides in Europe. For most soilborne sunflower pathogens, an effective management relies on genetic resistance which is, however, hindered by new pathogen populations (new races). Special emphasis is thus put on updated monitoring and characterization of pathogens and on the enlargement of the set of tools for disease management. Concerning characterization, advances on the population structure of Verticillium dahliae affecting sunflower by means of genetic, molecular and pathogenic approaches are presented. Also in relation to increases of sunflower wilt diseases recently observed, the fungus Cadophora malorum has been identified in Russia and reported as a new pathogen of this crop. Third, new races of Plasmopara halstedii (sunflower downy mildew), have been identified in Spain and Portugal. Most of them have a high virulence, since they overcome several genes for resistance. With regard to alternatives for disease control, entomopathogenic fungi (EF) constitute a novel tool. Used for years in Integrated Pest Management strategies due to their efficacy in controlling insect pests affecting crops, new ecological roles of these fungi have recently been reported. The EF species Beauveria bassiana and Metarhizium brunneum have been assessed by their in vitro effect against V. dahliae and C. malorum by our research group. Our results suggest that antibiosis and/or competition for ecological niche are operating in some EF-pathogen interactions. In summary, pathogen characterization is essential for genetic resistance for worldwide environments of sunflower production. Moreover, the security of sunflower yield and profitability is dependent not only on effective genetic resistance, but also on additional new control options that can be included in successful strategies of sunflower disease management.

Remote delivery of weight management for adults with intellectual and developmental disabilities: Rationale and design for a 24 month randomized trial

Adults with intellectual and developmental disabilities (IDD) represent an underserved segment of the US population with a high prevalence of obesity and limited options for weight management. Previous research has demonstrated clinically meaningful weight loss of 7% of total body weight in in adults with IDD using an enhanced Stop Light Diet (eSLD) in combination with monthly at-home face-to-face (FTF) behavioral sessions, and a recommendation for increased physical activity. However, the time and cost associated with FTF delivery (travel + sessions) limits the potential for scaling and implementation and suggests the need for the evaluation of less costly and burdensome strategies for intervention delivery. Therefore, we will conduct a 24-mo. randomized trial to compare a weight management intervention (6 mos. weight loss, 12 mos. maintenance, 6 mos. no-contact follow-up) delivered to 120 overweight/obese adults with IDD in their home, either remotely (RD) using video conferencing on a tablet computer, or during FTF visits. Our primary aim is whether RD is non-inferior to FTF for weight loss (0–6 mos.). Secondarily, we will compare the RD and FTF groups on mean weight loss, the proportion of participants who achieve clinically meaningful weight loss, and changes in quality of life across 24 months. We will also conduct cost analysis, cost-effectiveness, and contingent valuation analyses to compare the RD and FTF groups.

Visualisation of the insertion of a membrane for the treatment of preterm rupture of fetal membranes using a synthetic model of a pregnant uterus.

Preterm premature rupture of fetal membranes is a leading cause of preterm delivery. Preterm labour can compromise fetal survival, and even if a pregnancy affected by preterm premature rupture of fetal membrane continues, major complications associated with leakage of amniotic fluid and risk of infection can affect the normal development and survival of the baby. There are limited management options for preterm premature rupture of fetal membrane other than delivery of the baby if ascending infection (chorioamnionitis) is suspected. We have previously reported the development and characterisation of an implantable membrane with the aim of using it to occlude the internal os of the cervix, in order to prevent amniotic fluid loss, allow fluid reaccumulation and reduce the risk of chorioamnionitis. For this, an electrospun biocompatible and distensible bilayer membrane was designed with mechanical properties similar to the human amniotic membrane. In this study, we consider the effects of sterilization on the membrane, how to insert the membrane and visualise it using routine clinical methods. To do this, we used e-beam sterilisation and examined the ability of the membrane to adhere to ex vivo human cervical tissues. We also studied its insertion into a custom-synthesised model of a 20-week pregnant uterus and imaged the membrane using ultrasound. Sterilisation produced minor effects on physical and mechanical properties, but these did not affect the capacity of the membrane to be sutured or to provide a fluid barrier. We demonstrated that fibrin glue can successfully adhere the bilayer membrane to cervical tissues. Finally, we demonstrated that the membrane can be inserted through the cervix as well as visualized in place using ultrasound imaging and an endoscope. In summary, we suggest this membrane is a candidate for further development in an appropriate animal model, supported by appropriate imaging, to precede possible future human studies if judged to demonstrate satisfactory safety and efficacy profiles.

Amantadine extended-release capsules for levodopa-induced dyskinesia in patients with Parkinson's disease.

Levodopa-induced dyskinesia (LID) is a common motor complication in patients with Parkinson’s disease on chronic levodopa therapy. The management of LID is important as dyskinesia can be disabling and impair quality of life. Currently, there are limited treatment options for the medical management of LID. Amantadine extended-release capsules (Gocovri™) is the first medication that received US Food and Drug Administration approval for the treatment of LID. The following is a review of the pharmacodynamics, efficacy and safety profile, and current state of treatment of amantadine for LID.

Impacts of Wild Horses, Cattle, and Wildlife on Riparian Areas in Idaho

On the Ground • Our study confirms that grazing by cattle and horses can negatively impact riparian ecosystems if not properly managed. • Population levels and grazing patterns of wild free-roaming horses limit management options, potentially leading to rangeland and riparian degradation. • Grazing by wild free-roaming horses and cattle in riparian areas caused streambank disturbance and reductions in stubble height and herbaceous biomass. • Both wild free-roaming horses and cattle affected riparian attributes while wildlife had little effect. • Horses had a greater negative impact than did cattle when examined on an individual animal basis. • Managers and ranchers in areas with wild free-roaming horses will need to consider potential impacts of unmanaged wild free-roaming horses in combination with livestock to mitigate the cumulative effects of multiple species of grazers on riparian condition.

Outcomes and patterns of relapse after definitive radiation therapy for oligometastatic cervical cancer

PurposeSurvival rates for women with metastatic cervical cancer are low, with limited management options. Definitive radiation therapy (RT) for oligometastatic disease has led to prolonged survival in other malignancies, but this approach has yet to be systematically studied for cervical cancer. Methods and materialsWe evaluated 38 patients who received definitive RT to oligometastatic sites of cervical cancer at a single institution from 2002 to 2015. Patients presented with synchronous (n=9) or metachronous (n=15) oligometastatic disease to supraclavicular (SCV) nodes, or with recurrent disease in mediastinum (n=10) or lung (n=7). Three patients were treated for both SCV and mediastinal sites, and six patients were treated for para-aortic or pelvic recurrences along with oligometastatic sites. Most received chemotherapy: induction (n=5), concurrent (n=24), or adjuvant (n=5). Outcomes were evaluated via Kaplan-Meier, and associations were examined via Cox proportional hazards modeling. ResultsMedian follow-up was 35.2months (range 3.1–94.7). Median overall survival (OS) was 50.7months from end of RT, with 2-year and 3-year OS rates of 74% and 65%. Median progression-free survival (PFS) was 21.7months, with 1-year and 2-year PFS rates of 63% and 48%. Of the 38 patients, 21 (55%) experienced progression, at a median time of 24.8months. There was one in-field failure. Other relapses occurred regionally (n=10) and distally (n=12), with two patients experiencing both. The most common site of recurrence following treatment of SCV disease was mediastinum (n=7). The incidence of grade≥3 toxicity from treatment of oligometastatic sites was <3%. ConclusionsDefinitive RT to sites of oligometastatic cervical cancer can result in excellent local control, favorable outcomes, and even achieve long-term survival for carefully selected patients, with minimal RT-associated toxicity.

The Future of Giant Clam-Dominated Lagoon Ecosystems Facing Climate Change

Several small isolated Pacific Ocean atoll lagoons were characterized by their unique abundances of giant clams for at least 35 years, but they were recently affected by massive mortalities. We review evidences that confirm collapses in the past 10 years, discuss the likely causal factors based on current knowledge, and assess the consequences for management. Recent in situ and modeling research have focused on how management, natural processes, and climate change can influence the population trajectories. Projections suggest increasing risks with limited management options to reverse the trend. The various documented cases support the hypothesis that mass mortalities of giant clams are triggered by climate variability, enhanced by the geomorphological specificities of these atolls. The exact mechanisms leading to mortalities and consequences for the whole ecosystem remain unknown and are probably case-dependent. These collapsing ecosystems represent well the fast impact that climate change can have on reef ecosystems.

Weed Control with and Strawberry Tolerance to Herbicides Applied through Drip Irrigation

Broadleaves, grasses, and nutsedge species are persistent problems with limited management options for strawberry growers in Florida. Field experiments were conducted in 2015-2016 (year 1) and 2016-2017 (year 2) at the Gulf Coast Research and Education Center in Balm, FL, to evaluate weed control and strawberry tolerance to herbicides applied through the drip irrigation. 2940 g ai ha-1EPTC, 105 g ai ha-1flumioxazin, 570 g ai ha-1fomesafen, 52 g ai ha-1halosulfuron, 3585 g ai ha-1napropamide, oxyfluorfen 560 g ai ha-1, and 1070 g ai ha-1S-metolachlor were applied through a single drip tape at 7 or 14 d prior to transplanting. Halosulfuron was the most injurious herbicide, causing 18 and 46% injury at 35 d after transplanting (DATP) in year 1 when the herbicide was applied 7 and 14 d prior to transplanting, respectively. However, strawberry plants recovered from the initial injury and there was no reduction in total berry yield. None of the other herbicides evaluated elicited significant crop injury nor reduced berry yield. Averaged over application timings, EPTC, fomesafen, and napropamide suppressed yellow nutsedge emergence to 49, 64, and 41% of the nontreated control, respectively. Flumioxazin, fomesafen, and halosulfuron suppressed black medic emergence to 55, 52, and 55% of the nontreated control, respectively. None of the herbicides evaluated adequately suppressed Carolina geranium. Overall, results suggest that the evaluated herbicides with the exception of halosulfuron are safe for use on strawberry and would give growers an alternative management option. Drip-applied herbicides permit application closer to the transplant date and would be helpful as part of a weed control program for weed suppression.

Double‐blind placebo‐controlled randomized clinical trial evaluating doxycycline effects on chemotherapy‐induced oral mucositis

Chemotherapy (CT)-associated oral mucositis (OM) is one of the most debilitating and painful side effects in oncology patients, with limited effective management options. During CT, matrix metalloproteinases (MMPs) are upregulated, causing damage in mucosal and submucosal tissues, and playing a key role in OM; therefore, the use of subantimicrobial doxycycline as a MMP inhibitor may represent a potential approach for OM management. The aim of this clinical trial was to evaluate the efficacy and safety of low doses of doxycycline in OM development in individuals with acute leukaemia (AL) during CT. Randomized controlled clinical trial (Registration No. NCT01087476) performed in adult AL patients scheduled to receive CT (September 2010-October 2014). Individuals were stratified by leukaemia type and assigned randomly to receive doxycycline hyclate (50mg/d) (doxycycline group: DG) or placebo (placebo group: PG) before and during CT. Included subjects had a baseline oral examination and thereafter 3 times a week during 21days. The primary outcome was OM development. One hundred and forty-seven AL subjects were enrolled: 74 in DG and 73 in PG; baseline characteristics between groups were comparable. During follow-up, 15 (10.2%) individuals developed OM; no differences between treatment groups were found (DG:8.1%, PG:12.3%; P=.59). The mean OM Assessment Scale score was 2.51, without differences between groups (DG:2.7, PG:2.4; P=.65). Low baseline blood albumin levels in the OM-affected individuals were identified, revealing the effect of systemic deterioration as a predisposing factor for OM development. No adverse effects were observed. Subantimicrobial doses of doxycycline did not reduce the incidence, onset, duration or severity of OM.

Bioengineered dermal substitutes for the management of traumatic periocular tissue loss

ABSTRACTPurpose: Traumatic periocular injuries occasionally result in significant soft tissue loss, for which there are limited management options that provide satisfactory cosmetic and functional outcomes. The authors describe the use of a bioengineered dermal substitute (Integra® Dermal Regeneration Template [DRT], Integra LifeSciences, Plainsboro, NJ) as an alternative to immediate flap reconstruction or skin grafting.Methods: Retrospective interventional case series of patients who underwent DRT placement for periocular tissue loss at the time of trauma. In each case, primary closure or immediate flap reconstruction was deemed impractical or undesirable due to the size and location of the primary and associated secondary defects. One to four weeks later, the outer silicone layer was removed and healing assessed. Additional reconstructive techniques were performed as needed.Results: Three patients were treated at Bascom Palmer Eye Institute and one at Byers Eye Institute at Stanford. The defects healed completely in two patients, and by 79.2% in a third, with no need for additional reconstructive surgery. In the remaining patient, the defect was significantly downsized by 56.1%, allowing for a simpler flap reconstruction.Conclusions: Bioengineered dermal substitutes should be considered as a viable alternative to traditional reconstructive techniques for large periocular defects resulting from trauma. The outer silicone layer prevents desiccation and serves as a protective barrier, while the inner collagen matrix organizes the growth of neo-dermis and minimizes wound contraction. The dimensions of cutaneous defects can therefore be reduced dramatically, potentially eliminating the need for skin grafting and/or reducing the ultimate complexity of flap reconstruction.

Effect of Sappan Wood Ethanol Extracts (Caesalpinia sappan. L) to the Sperm Motility, Viability, and Concentration of Male Wistar Rats

Background: Idiopathic male infertility becomes an issue because of the limited management options and increasing number of infertile couples. Sappan wood ( Caesalpinia sappan. L ) is an herbal plant predicted to have fertility and spermatogenesis enhancing effects through antioxidant properties. This study aimed to observe the effects of sappan wood ethanol extract in improving sperm quality of male wistar rat based on sperm motility, viability, and concentration. Methods: This was an experimental laboratory study by using sappan wood ethanol extracts as material and male wistar rat as the experimental animal. Twenty-four adult male wistar rats were divided into 4 groups including rats which were treated with aquades, 30, 60, and 120 mg/kg/day/orally of ethanol extract of sappan wood, respectively, during 35 days. After this period, the animals were sacrificed. Then the epididymis were taken for samples to calculate sperm motility percentage, sperm viability percentage and sperm concentration. Comparison between control group and the treated group was analyzed by one-way Annova. Results: There were significant differences between the control group and the group with 120 mg/kg of sappan wood ethanol extracts in the percentage of motility (36.39% and 51.75%; p-value 0.001), viability percentage (55.36% and 66.63%, p-value 0.031), and sperm concentration (54.47 million/ml and 47.79 million/ml; p-value 0.001). Conclusions: The ethanol extract of sappan wood with a dose of 120 mg/kg for 35 days is able to improve sperm motility percentage, sperm viability percentage, and sperm concentration of male wistar rat. DOI: 10.15850/amj.v4n2.1078