The aims of the study were (1) to evaluate quality of life (QoL) and functional outcome in patients following anterior resection (AR) or abdominoperineal resection (APR) for rectal cancer, and (2) ...whether these outcomes were dependent on the level of anastomosis.
Patients who were without recurrent or metastatic disease were identified from the Norwegian Rectal Cancer Registry. QoL was assessed by the EORTC questionnaires QLQ-C30 and QLQ-CR38, and rectal function by a short questionnaire. Of 319 patients studied, 229 had undergone AR and 90 APR. The median age was 73 years, and the median time since surgery was 64 months.
Mean QoL scores for body image and male sexual problems were better following AR than APR (P<0.01), also in patients with a low (≤3cm) anastomosis. Patients who had undergone AR had higher mean scores for constipation (P<0.001) and more often used anti-diarrhoeal medication (P=0.005), than patients who had undergone APR. Patients with a low anastomosis (≤3cm) had more incontinence for gas and solid stools (P<0.05), and had more incontinence (P=0.006) compared with patients with higher anastomosis, but there was no difference in QoL. Subgroup analysis showed that irradiated patients (n=34) had worse rectal function in terms of frequency, urgency, and incontinence (P<0.01).
Although rectal function was impaired in patients with low anastomosis, patients who had undergone AR had better QoL than patients who had undergone APR.
BACKGROUND: The purpose of this study was to analyse the effect of a history of febrile illness on semen quality. METHODS: Twenty‐seven healthy men (median age 24.4 years) were followed with monthly ...semen samples and a daily record of the occurrence of experienced febrile episodes over a 16 month period between March 1998 and June 1999 in Copenhagen, Denmark. Semen samples were analysed for semen volume, sperm concentration, percentage immotile sperm and percentage morphologically normal sperm. RESULTS: Sperm concentration significantly decreased by 32.6% (95% confidence interval –49.9; –9.2) following fever during meiosis and by 35.0% (–50.5; –14.6) following fever during the postmeiotic period of spermatogenesis (spermiogenesis). The percentage of morphologically normal sperm was decreased by 7.4% (–11.6; –3.0) and the percentage of immotile sperm was increased by 20.4% (6.0; 36.8) by fever during spermiogenesis. The number of days the men experienced fever significantly affected their semen parameters. Thus fever during meiosis and spermiogenesis reduced sperm concentration with respectively 7.1% (–12.9; –0.9) and 8.5% (–13.6; –3.0) per day of fever. The percentage of morphologically normal sperm decreased 1.6% (–2.5; –0.6) and the percentage of immotile sperm increased 4.5% (1.7; 7.3) per day of fever during spermiogenesis. There was, however, a large variation in the individual response to fever. CONCLUSIONS: Sperm concentration, morphology and motility in a semen sample are adversely affected by a febrile episode during the postmeiotic period of spermatogenesis (spermiogenesis). Sperm concentration was also adversely affected by fever during the period of meiosis, whereas fever at other time points during spermatogenesis did not seem to significantly affect these sperm parameters. The adverse effect seemed to be dependent upon the number of days with fever.
Summary
Impaired semen quality is frequent in Western countries and is the main reason or contributing reason in up to 50% of cases of couple infertility. Male factor infertility is mainly determined ...by examination of semen samples according to the World Health Organization's 2010 guidelines. AMH has both autocrine and paracrine properties through a direct effect via the AMH type II receptor and is therefore thought to be involved in spermatogenesis. We aimed to study the association between the serum concentration of AMH and semen quality in a cross‐sectional study including 970 young Danish men from the general population. All participants provided a semen sample, had a blood sample drawn, underwent a physical examination, and answered a questionnaire including information on lifestyle and medical history. Serum concentrations of reproductive hormones AMH, luteinizing hormone (LH), follicle‐stimulating hormone (FSH), total testosterone (T), calculated free T, oestradiol (E2) and inhibin B and semen parameters (semen volume, sperm concentration, and percentages of motile and morphologically normal spermatozoa) were determined. We found no association between serum AMH and semen quality, except for a significant (p = 0.011) trend for lower percentage of normal morphology with higher AMH. AMH quartile was positively associated with serum inhibin B (p < 0.001), inhibin B/FSH ratio (p < 0.001) and T/E2 ratio (0.016), and negatively associated with FSH (p = 0.004), LH (p = 0.005) and E2 (p = 0.028). There was no association between AMH quartile and T, calculated free T or total T/LH ratio. In conclusion, serum AMH is not useful as a marker of semen quality, and semen analysis using WHO criteria is still the golden standard in the evaluation of the infertile man.
A series of clinical trials
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have examined the effects of angiotensin-converting–enzyme (ACE) inhibitors on survival after acute myocardial infarction. Large studies
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have shown a moderate ...benefit of short-term ACE inhibition started early after infarction in unselected patients. Other studies, in which long-term treatment was started some days after infarction in selected patients with left ventricular dysfunction
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or clinical signs of heart failure,
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have shown a greater benefit. Because of the differences among various studies in relative benefit, timing and duration of treatment, and selection of patients, important questions about the role of ACE inhibition remain unanswered. Another problem . . .
IMPORTANCE: Norepinephrine, the first-line vasopressor for septic shock, is not always effective and has important catecholaminergic adverse effects. Selepressin, a selective vasopressin V1a receptor ...agonist, is a noncatecholaminergic vasopressor that may mitigate sepsis-induced vasodilatation, vascular leakage, and edema, with fewer adverse effects. OBJECTIVE: To test whether selepressin improves outcome in septic shock. DESIGN, SETTING, AND PARTICIPANTS: An adaptive phase 2b/3 randomized clinical trial comprising 2 parts that included adult patients (n = 868) with septic shock requiring more than 5 μg/min of norepinephrine. Part 1 used a Bayesian algorithm to adjust randomization probabilities to alternative selepressin dosing regimens and to trigger transition to part 2, which would compare the best-performing regimen with placebo. The trial was conducted between July 2015 and August 2017 in 63 hospitals in Belgium, Denmark, France, the Netherlands, and the United States, and follow-up was completed by May 2018. INTERVENTIONS: Random assignment to 1 of 3 dosing regimens of selepressin (starting infusion rates of 1.7, 2.5, and 3.5 ng/kg/min; n = 585) or to placebo (n = 283), all administered as continuous infusions titrated according to hemodynamic parameters. MAIN OUTCOMES AND MEASURES: Primary end point was ventilator- and vasopressor-free days within 30 days (deaths assigned zero days) of commencing study drug. Key secondary end points were 90-day mortality, kidney replacement therapy–free days, and ICU-free days. RESULTS: Among 868 randomized patients, 828 received study drug (mean age, 66.3 years; 341 41.2% women) and comprised the primary analysis cohort, of whom 562 received 1 of 3 selepressin regimens, 266 received placebo, and 817 (98.7%) completed the trial. The trial was stopped for futility at the end of part 1. Median study drug duration was 37.8 hours (IQR, 17.8-72.4). There were no significant differences in the primary end point (ventilator- and vasopressor-free days: 15.0 vs 14.5 in the selepressin and placebo groups; difference, 0.6 95% CI, −1.3 to 2.4; P = .30) or key secondary end points (90-day mortality, 40.6% vs 39.4%; difference, 1.1% 95% CI, −6.5% to 8.8%; P = .77; kidney replacement therapy–free days: 18.5 vs 18.2; difference, 0.3 95% CI, −2.1 to 2.6; P = .85; ICU-free days: 12.6 vs 12.2; difference, 0.5 95% CI, −1.2 to 2.2; P = .41). Adverse event rates included cardiac arrhythmias (27.9% vs 25.2% of patients), cardiac ischemia (6.6% vs 5.6%), mesenteric ischemia (3.2% vs 2.6%), and peripheral ischemia (2.3% vs 2.3%). CONCLUSIONS AND RELEVANCE: Among patients with septic shock receiving norepinephrine, administration of selepressin, compared with placebo, did not result in improvement in vasopressor- and ventilator-free days within 30 days. Further research would be needed to evaluate the potential role of selepressin for other patient-centered outcomes in septic shock. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02508649
Testicular germ cell tumours (TGCTs) originate from a common precursor, carcinoma in situ (CIS). Diagnosis at the CIS stage is desirable as it minimizes the necessary treatment. A detailed clinical ...evaluation of an approach to detect CIS cells in the ejaculate using primordial germ cell/gonocyte markers is presented. METHODS: Immunocytological staining for AP-2γ and in some cases, OCT-3/4, NANOG or placental alkaline phosphatase (PLAP) was performed in semen samples from 294 infertile patients and 209 patients with TGCTs or other diseases. RESULTS: Presence of AP-2γ-stained cells was detected in 50% of participants with CIS and in 33.9% of TGCT patients before treatment (non-seminomas: 56.6%, seminomas: 17.4%). OCT-3/4 results were similar to those of AP-2γ, whereas NANOG and PLAP stainings were unsuitable. Sensitivity was 54.5% for participants harbouring pre-invasive CIS but reduced in participants with overt TGCTs, perhaps because of obstruction. Assay specificity was 93.6%, positive predictive value (PPV) 83.3% and negative predictive value (NPV) 60.3%. CONCLUSIONS: Immunocytological semen analysis based on expression of fetal germ cell markers in exfoliated cells has auxiliary diagnostic value, as it detects some patients with CIS/incipient tumour, but a negative result does not exclude TGCT. Further effort is needed to improve this assay, for example, by employing a more sensitive biochemical method of detection.
BACKGROUND: It has been suggested that finger length may correlate with function or disorders of the male reproductive system. This is based on the HOXA and HOXD genes’ common embryological control ...of finger development and differentiation of the genital bud. The objective of this study was to explore the association between the ratio of 2nd to 4th finger length (2D:4D ratio) and testis function in a sample of young Danish men from the general population. METHODS: Semen samples and finger measurements were obtained from a total of 360 young Danish men in addition to blood samples for sex hormone analysis to describe the possible association between 2D:4D and semen and sex-hormone parameters. RESULTS: A statistically significant inverse association with the 2D:4D was found only in relation to hormone levels of FSH in the group of young men with a 2D:4D >1 (P = 0.036) and a direct association with the total sperm count in the group of young men with a 2D:4D #1 (P = 0.045). CONCLUSION: The statistically significant results may be ‘false positives’ (type I error) rather than representing true associations. This relatively large study of young, normal Danish men shows no reliable association between 2D:4D finger ratio and testicular function. Measurements of finger lengths do not have the power to predict the testicular function of adult men.
To estimate the risk of bowel obstruction (BO) after hysterectomy for benign indications depending on the surgical method (abdominal, vaginal, or laparoscopic) and identify risk factors for adhesive ...BO.
A national registry-based cohort.
Danish hospitals during the period 1984–2013.
Danish women who underwent hysterectomy for benign indications (N = 125 568).
Abdominal hysterectomies were compared with vaginal hysterectomies, laparoscopic hysterectomies, and minimally invasive (vaginal and laparoscopic) hysterectomies.
The incidence of BO according to the surgical method was compared using Cox proportional hazard regression. The covariates included were the time period, age, concomitant operations, previous abdominal surgery or disease, and socioeconomic factors. In a subanalysis (n = 35 712 women) of the period 2004–2013, detailed information from the Danish Hysterectomy Database enabled the inclusion of patient-, surgery-, and complication-related covariates. The overall crude incidence of BO was 17.4 of 1000 hysterectomies (2196 incident cases). The 10-year cumulative incidence of BO differed among the surgical routes (abdominal, 1.7%; laparoscopic, 1.4%; and vaginal, 0.9%). In multiple-adjusted analyses, the risk of BO was higher after abdominal hysterectomy than after vaginal (hazard ratio 1.64 95% confidence interval, 1.39–1.93) and minimally invasive (vaginal or laparoscopic) hysterectomy (hazard ratio 1.54 1.33–1.79). Additional pre-existing risk factors for BO at the time of hysterectomy were increased age, low education, low income, smoking, high American Society of Anesthesiologists comorbidity score, history of infertility, abdominal infection, and previous abdominal surgery (apart from cesarean section), penetrating lesions in abdominal organs, or operative adhesiolysis. Perioperative risk factors at the time of hysterectomy included concomitant removal of the ovaries, adhesiolysis, blood transfusion, readmission, and overall presence of perioperative complications.
Abdominal hysterectomy is associated with a 54% higher risk of BO than minimally invasive (laparoscopic or vaginal) hysterectomy.
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