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BJU International Nov 2022To demonstrate that surgical sperm retrieval (SSR) and spermatogonial stem cell retrieval (SSCR) in an oncological context are safe and successful.
OBJECTIVES
To demonstrate that surgical sperm retrieval (SSR) and spermatogonial stem cell retrieval (SSCR) in an oncological context are safe and successful.
PATIENTS AND METHODS
This a retrospective study in a tertiary hospital in the UK. Patients requiring fertility preservation from December 2017 to January 2020 were included. Data were analysed with Microsoft Excel 2016 and the Statistical Package for the Social Sciences (version 20).
RESULTS
Among 1264 patients referred to the Reproductive Medical Unit at the University College of London Hospitals for cryopreservation prior to gonadotoxic treatment, 39 chose to go forward with SSR/SSCR because they presented as azoo-/cryptozoospermic or an inability to masturbate/ejaculate. Interventions were testicular sperm extraction (23 patients) or aspiration (one), electroejaculation (one), and testicular wedge biopsy for SSCR (14). The median (range) age was 15.0 (10-65) years and the median testosterone level was 4.4 nmoL/L. Primary diagnoses were sarcoma in 11 patients, leukaemia in nine, lymphoma in eight, testicular tumour in five, other oncological haematological entities in two, other solid cancers in two, while two patients had non-oncological haematological diseases. SSR/SSCR could be offered within 7.5 days on average. Chemotherapy could follow within 2 days from SSR/SSCR, and bone marrow transplant occurred within 19.5 days (all expressed as medians). The success rate for SSR was 68.0% (at least one vial/straw collected). The mean (SD) Johnsen score of testicular biopsies was 5.23 (2.25) with a trend towards positive correlation with SSR success (P = 0.07). However, age, hormonal profile and type of cancer did not predict SSR outcome.
CONCLUSION
We show that SSR and SSCR in an oncological context are valid treatment options with a high success rate for patients in which sperm cryopreservation from semen is impossible. By providing an effective pathway, fertility preservation is possible with minimal delay to oncological treatment.
Topics: Adolescent; Adult; Aged; Humans; Male; Middle Aged; Young Adult; Cryopreservation; Fertility Preservation; Retrospective Studies; Semen; Testicular Neoplasms; Testosterone; Urologists; Child
PubMed: 35535513
DOI: 10.1111/bju.15772 -
Surgical Infections Dec 2016Surgical debridement and broad-spectrum empiric antibiotics are first-line therapy for necrotizing soft tissue infections (NSTI). The objective of this multi-center... (Review)
Review
BACKGROUND
Surgical debridement and broad-spectrum empiric antibiotics are first-line therapy for necrotizing soft tissue infections (NSTI). The objective of this multi-center retrospective review was to evaluate antimicrobial agent initiation and duration and compare outcomes in the treatment of patients with NSTI.
PATIENTS AND METHODS
This review included adults with NSTI, as indicated by International Classification of Diseases, 9th Edition, Clinical Modification codes 728.86, 608.33, or 040.0, who were admitted to three academic institutions between 1/1/09 and 5/15/14. Demographics, antibiotic practices, operative management, and clinical outcomes were compared.
RESULTS
A total of 341 patients were identified at the three centers. Subjects were comparable in age (median 53 years, p = 0.14), gender (67% male, p = 0.57) and body mass index (median 31.9 (p = 0.31) between sites. No significant difference was found in time from admission to start of empiric antibiotic therapy between the three centers (median 1 d for each, p = 0.70), but duration of antibiotic therapy was significantly different (Site A = 16 d, Site B = 12 d, Site C = 9 d, medians, p < 0.001). Although total number of operations differed between sites (median of two at Sites A and B, three at Site C, p = 0.001), sites consistently operated on the day of patient arrival to their facility, and the number of debridements did not differ (median of two for all sites, p = 0.10). Mortality rate (Site A = 22%, Site B = 18%, and Site C = 9%, p = 0.02) and length of stay for survivors (Site A = 29 d, Site B = 16 d, Site C = 19 d, medians, p = 0.001) was significantly different among centers.
CONCLUSIONS
Variation in antibiotic duration between centers with expertise in the care of NSTI illustrates how little is known about best care practices for patients with NSTI. Future studies should emphasize development of evidence-based practices for NSTI management to further improve the outcomes of this complex group of patients.
Topics: Adult; Anti-Bacterial Agents; Fasciitis, Necrotizing; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Retrospective Studies; Soft Tissue Infections; Treatment Outcome
PubMed: 27834617
DOI: 10.1089/sur.2015.238 -
Journal of Athletic Training Feb 2023Significant health care disparities exist in the United States based on socioeconomic status (SES), but the role SES has in secondary school athletes' access to athletic...
CONTEXT
Significant health care disparities exist in the United States based on socioeconomic status (SES), but the role SES has in secondary school athletes' access to athletic training services has not been examined on a national scale.
OBJECTIVE
To identify differences in access to athletic training services in public secondary schools based on school SES.
DESIGN
Cross-sectional study.
SETTING
Database secondary analysis.
PATIENTS OR OTHER PARTICIPANTS
Data for 3482 public high schools.
MAIN OUTCOME MEASURE(S)
Data were gathered from the Athletic Training Locations and Services (ATLAS) database, US Census Bureau, and National Center for Education Statistics. We included schools from 5 states with the highest, middle, and lowest poverty percentages (15 states total) and collected county median household income, percentage of students eligible for free or reduced-price lunch, race and ethnicity demographics, and access to athletic training services (full-time athletic trainer [AT], part-time AT only, no AT) for each school. Data were summarized in means, SDs, medians, interquartile ranges (IQRs), frequencies and proportions, 1-way analyses of variance, and Kruskal-Wallis tests.
RESULTS
Differences were present in school SES between schools with full-time, part-time-only, and no athletic training services. Schools with greater access to athletic training services had fewer students eligible for free or reduced-price lunch (full time: 41.1% ± 22.3%, part time only: 45.8% ± 24.3%, no AT: 52.9% ± 24.9; P < .001). Similarly, county median household income was higher in schools with increased access to athletic training services (full time median [IQR]: $56 026 [$49 085-$64 557], part time only: $52 719 [$45 355-$62 105], and no AT: $49 584 [$41 094-$57 688]; P < .001).
CONCLUSIONS
Disparities in SES were seen in access to athletic training services among a national sample of public secondary schools. Access to ATs positively influences student-athletes' health care across several measures. Pilot programs or government funds have been used previously to fund athletic training services and should be considered to ensure equitable access, regardless of school SES.
Topics: Humans; United States; Cross-Sectional Studies; Sports; Athletes; Schools; Social Class
PubMed: 34623428
DOI: 10.4085/1062-6050-0240.21 -
JACC. Clinical Electrophysiology Oct 2021This study aimed to review the utility of quinidine in patients presenting with recurrent sustained ventricular arrhythmia (VA) and limited antiarrhythmic drug (AAD)... (Review)
Review
OBJECTIVES
This study aimed to review the utility of quinidine in patients presenting with recurrent sustained ventricular arrhythmia (VA) and limited antiarrhythmic drug (AAD) options.
BACKGROUND
Therapeutic options are often limited in patients with structural heart disease and recurrent VAs. Quinidine has an established role in rare arrhythmic syndromes, but its potential use in other difficult VAs has not been assessed in the present era.
METHODS
We performed a retrospective analysis of 37 patients who had in-hospital quinidine initiation after multiple other therapies failed for VA suppression at our tertiary referral center. Clinical data and outcomes were obtained from the medical record.
RESULTS
Of 30 patients with in-hospital quantifiable VA episodes, quinidine reduced acute VA from a median of 3 episodes (interquartile range [IQR]: 2 to 7.5) to 0 (IQR: 0 to 0.5) during medians of 3 days before and 4 days after quinidine initiation (p < 0.001). VA events decreased from a median of 10.5 episodes per day (IQR: 5 to 15) to 0.5 episodes (IQR: 0 to 4) after quinidine initiation in the 12 patients presenting with electrical storm (p = 0.004). Among the 24 patients discharged on quinidine, 13 (54.2%) had VA recurrence during a median of 138 days. Adverse effects in 9 of the 37 patients (24.3%) led to drug discontinuation, most commonly gastrointestinal intolerance.
CONCLUSIONS
In patients with recurrent VAs and structural heart disease who have limited treatment options, quinidine can be useful, particularly as a short-term therapy.
Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Humans; Quinidine; Retrospective Studies; Ventricular Fibrillation
PubMed: 34217656
DOI: 10.1016/j.jacep.2021.03.024 -
Journal of Orthopaedics 2020Surgical management of high-grade spondylolisthesis is not only challenging but also controversial, from in situ fusion to complete reduction. We report our results of a... (Review)
Review
BACKGROUND
Surgical management of high-grade spondylolisthesis is not only challenging but also controversial, from in situ fusion to complete reduction. We report our results of a safe three-stage spinal procedure in a single surgical session with seven patients diagnosed high-grade spondylolisthesis.
HYPOTHESIS
Posterior fixation combined with interbody fusion is effective on reduction, ossification and clinical outcomes in high-grade spondylolisthesis.
PATIENTS AND METHODS
This study is a retrospective review of patients who underwent surgery between 2016 and 2018. The surgical method involved specific installation for deformity reduction, pedicle screw fixation, correction of lumbosacral kyphosis with a specific distraction maneuver, wide decompression, gradual reduction of the deformity, and sometimes maintenance of the reduction with interbody fusion. Patients were checked out at 2, 6 and 12 months and yearly after the procedure. Clinical, radiological, Visual Analogic Scale (VAS) and Oswestry Disability Index (ODI) outcomes measures were collected.
RESULTS
Seven patients with high-grade spondylolisthesis at L5-S1 (2 patients grade II, 4 patients grade IV and 1 patient grade V), with a median age of 37 years [17; 72] were included. Median follow-up was 24 months [12; 25 months]. All patients have a fused joint at 6 months except one. Median lumbosacral angle (LSA) improved from 76°[59; 85] to 94°[76; 104]. grade of 2 cases was stable after surgery, 3 cases with loss of two ranks and 2 cases with loss of one rank. The radiological parameters showed statistically significant difference (p = 0.036) postoperatively. There was not deep infection. Medians VAS and ODI showed improved pain and disability scores.
CONCLUSION
This procedure allows correct reduction rate of high-grade spondylolisthesis with good clinic-radiologic outcomes. Though surgically demanding, it was safe and reproducible.
LEVEL OF EVIDENCE
IV, retrospective.
PubMed: 32952331
DOI: 10.1016/j.jor.2020.08.015 -
Annals of Work Exposures and Health Oct 2019Occupational exposures in population-based case-control studies are increasingly being assessed using decision rules that link participants' responses to occupational... (Review)
Review
OBJECTIVES
Occupational exposures in population-based case-control studies are increasingly being assessed using decision rules that link participants' responses to occupational questionnaires to exposure estimates. We used a hierarchical process that incorporated decision rules and job-by-job expert review to assign occupational benzene exposure estimates in a US population-based case-control study of non-Hodgkin lymphoma.
METHODS
We conducted a literature review to identify scenarios in which occupational benzene exposure has occurred, which we grouped into 12 categories of benzene exposure sources. For each source category, we then developed decision rules for assessing probability (ordinal scale based on the likelihood of exposure > 0.02 ppm), frequency (proportion of work time exposed), and intensity of exposure (in ppm). The rules used the participants' occupational history responses and, for a subset of jobs, responses to job- and industry-specific modules. For probability and frequency, we used a hierarchical assignment procedure that prioritized subject-specific module information when available. Next, we derived job-group medians from the module responses to assign estimates to jobs with only occupational history responses. Last, we used job-by-job expert review to assign estimates when job-group medians were not available or when the decision rules identified possible heterogeneous or rare exposure scenarios. For intensity, we developed separate estimates for each benzene source category that were based on published measurement data whenever possible. Frequency and intensity annual source-specific estimates were assigned only for those jobs assigned ≥75% probability of exposure. Annual source-specific concentrations (intensity × frequency) were summed to obtain a total annual benzene concentration for each job.
RESULTS
Of the 8827 jobs reported by participants, 8% required expert review for one or more source categories. Overall, 287 (3.3%) jobs were assigned ≥75% probability of exposure from any benzene source category. The source categories most commonly assigned ≥75% probability of exposure were gasoline and degreasing. The median total annual benzene concentration among jobs assigned ≥75% probability was 0.11 ppm (interquartile range: 0.06-0.55). The highest source-specific median annual concentrations were observed for ink and printing (2.3 and 1.2 ppm, respectively).
CONCLUSIONS
The applied framework captures some subject-specific variability in work tasks, provides transparency to the exposure decision process, and facilitates future sensitivity analyses. The developed decision rules can be used as a starting point by other researchers to assess occupational benzene exposure in future population-based studies.
Topics: Benzene; Case-Control Studies; Decision Support Techniques; Humans; Lymphoma, Non-Hodgkin; Occupational Exposure; Occupations; Retrospective Studies; Risk Assessment; Surveys and Questionnaires
PubMed: 31504127
DOI: 10.1093/annweh/wxz063 -
PloS One 2018Patient-reported experience is an important component of a holistic approach to quality of care. Patients' expectations of treatments and global disease management may...
BACKGROUND
Patient-reported experience is an important component of a holistic approach to quality of care. Patients' expectations of treatments and global disease management may indicate their illness representations and their satisfaction and hopes regarding quality of care.
OBJECTIVE
To study expectations of patients with inflammatory bowel disease.
METHODS
Two focus groups were conducted with 14 patients to explore their expectations about treatments and disease management. From qualitative content analyses of focus group discussions, we built a 22-item expectations questionnaire that was sent to 1756 patients of the Swiss IBD cohort. Answers were collected on a visual analog scale from 0 to 100, and medians (interquartile range [IQR]) calculated. Factor analysis identified main expectation dimensions, and multivariate analyses were performed to describe associations with patient characteristics.
RESULTS
Of 1094 patients (62%) included in the study, 54% were female, 54% had Crohn's disease, 35% had tertiary education, and 72% were employed. Expectation dimensions comprised realistic, predictive, and ideal expectations and were linked to information, communication, daily care, and disease recognition. Half (11 of 22) of the expectations were ranked as very high (median score > 70), the 2 most important being good coordination between general practitioners and specialists (median score: 89, IQR: 71-96) and information on treatment adverse events (89, IQR: 71-96). Women had overall higher levels of expectations than did men. Expectations were not associated with psychosocial measures, except those related to disease recognition, and most of them were highly associated with increased concerns on disease constraints and uncertainty.
CONCLUSIONS
Patients have high expectations for information and communication among caregivers, the levels varying by gender and region. Patients also appear to request more active participation in their disease management.
Topics: Adult; Anticipation, Psychological; Cohort Studies; Cross-Sectional Studies; Female; Focus Groups; Health Communication; Humans; Inflammatory Bowel Diseases; Male; Patient Participation; Qualitative Research; Surveys and Questionnaires
PubMed: 29772017
DOI: 10.1371/journal.pone.0197351 -
Ecology and Evolution Jul 2017The underground part of a tree is an important carbon sink in forest ecosystems. Understanding biomass allocation between the below- and aboveground parts () is... (Review)
Review
The underground part of a tree is an important carbon sink in forest ecosystems. Understanding biomass allocation between the below- and aboveground parts () is necessary for estimation of the underground biomass and carbon pool. Nevertheless, large-scale biomass allocation patterns and their control mechanisms are not well identified. In this study, a large database of global forests at the community level was compiled to investigate the and their responses to environmental factors. The results indicated that both the aboveground biomass () and belowground biomass () of the forests in China (medians 73.0 Mg/ha and 17.0 Mg/ha, respectively) were lower than those worldwide (medians 120.3 Mg/ha and 27.7 Mg/ha, respectively). The of the forests in China (median = 0.23), however, were not significantly different from other forests worldwide (median = 0.24). In general, the allocation of biomass between the belowground and aboveground parts was determined mainly by the inherent allometry of the plant but also by environmental factors. In this study, most correlations between and environmental factors (development parameter, climate, altitude, and soil) were weak but significant (<.01). The allometric model agreed with the trends observed in this study and effectively estimated based on across the entire database.
PubMed: 28770085
DOI: 10.1002/ece3.3089 -
Jornal de Pediatria 2019To estimate the mean age at menarche and its association with nutritional status in Brazilian adolescents.
OBJECTIVE
To estimate the mean age at menarche and its association with nutritional status in Brazilian adolescents.
METHODS
The study sample included female adolescents aged 12-17 who participated in a multicenter, school-based, country-wide, cross-sectional study entitled The Study of Cardiovascular Risk in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes [ERICA]). Mean and median ages at menarche in Brazil were estimated. The association of age at menarche with sociodemographic data and nutritional status were described as means and their respective 95% confidence intervals. Survival analysis was used to assess the age at menarche according to nutritional status categories and the log-rank test was used to compare the medians. Bivariate and multivariate analyses were performed using Cox regression to verify the association between menarche and other variables.
RESULTS
A total of 73,624 students were evaluated, comprising 40,803 girls, of whom 37,390 reported menarche at a mean age of 11.71 years and a median of 12.41 years. Median age at menarche was lower in overweight and obese girls (p<0.001). The multivariate analysis showed that excess weight (HR=1.28; 95% CI 1.21-1.36; p<0.001) and studying in a private school (HR=1.06; 95% CI 1.02-1.10; p=0.003) were associated with menarche.
CONCLUSIONS
This is a pioneering study in Brazil with national and regional representativeness to estimate the mean and the median age of occurrence of menarche. Adolescents with excess weight had an earlier menarche than their peers, even after adjustment for confounding factors.
Topics: Adolescent; Age Factors; Child; Cross-Sectional Studies; Ethnicity; Female; Humans; Menarche; Nutritional Status
PubMed: 29352861
DOI: 10.1016/j.jped.2017.12.004 -
Archives of Razi Institute Feb 2022In prediabetes, blood glucose levels are higher than normal; however, they remain below the diabetes threshold. Studies conducted on biomarkers for this disease result...
In prediabetes, blood glucose levels are higher than normal; however, they remain below the diabetes threshold. Studies conducted on biomarkers for this disease result in controlling diabetes mellitus (DM) or reducing the risk of developing complications. Lipid profile parameters are considered important predictors of DM. Therefore, this study was conducted on three groups of normoglycemic (n=30), pre-diabetics (n=125), and diabetics (n=30) to recognize the predictive role of lipid parameters in the transition from pre-diabetes to diabetes. In this experiment, in addition to total cholesterol and triglycerides, very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride/HDL ratio, and fasting triglyceride-fasting blood glucose (FBG) index were measured. Based on the results, medians for total cholesterol, LDL, HDL, LDL/HDL ratio, cholesterol/HDL ratio, and LDL/HDL ratio did not differ significantly across the groups of normoglycemia, prediabetes, and diabetes. For triglyceride, the medians were significantly higher in pre-diabetes and also diabetes, compared to normoglycemia (i.e., 127.9 and 129.1 vs. 94.5 mg/dL, respectively [<0.001]). Moreover, the same results were observed in the case of VLDL (i.e., 25.6 and 30.9 vs. 18.9 mg/dL, respectively). The triglyceride/HDL ratio significantly increased pre-diabetics and diabetics, compared to normoglycemic (2.72 and 2.67 vs. 2.18, respectively). Moreover, the median of the triglyceride-FBG index significantly had an increase in pre-diabetics and diabetics, compared to normoglycemic (8.89 and 9.38 vs. 8.22, respectively). The importance of triglyceride, VLDL, triglyceride/HDL ratio, and triglyceride-FBG index in distinguishing between pre-diabetes and normoglycemia was verified by a receiver operating characteristic curve analysis of the results. Logistic regression analysis confirmed the risk effects of the four parameters on pre-diabetes and diabetes. Therefore, triglyceride, VLDL, triglyceride-FBG index, and triglyceride/HDL ratio are considered promising biomarkers used to predict pre-diabetes and DM in the general population.
Topics: Biomarkers; Blood Glucose; Cholesterol; Cholesterol, LDL; Diabetes Mellitus; Prediabetic State; Triglycerides; Humans
PubMed: 35891716
DOI: 10.22092/ARI.2021.356465.1846