Relationship between the G protein–coupled oestrogen receptor and spermatogenesis,and its correlation with male infertility

The aim of this study was to investigate the diagnostic value of serum G protein–coupled oestrogen receptor (GPER) levels and their correlation with semen parameters in men with infertility. The participants were divided into two groups as follows: 76 fertile control men (Group 1) and 77 infertile men (Group 2). Semen analysis, hormonal evaluation, serum GPER level and scrotal ultrasound of the participants were evaluated. Follicle-stimulating hormone and total testosterone levels were not significantly different between the groups (p = .413 and p = .535 respectively). The oestradiol level in Group 1 was significantly lower than that in Group 2 (p < .001). The serum GPER level was found to be significantly higher in Group 1 than that of Group 2 (p < .001). GPER levels were positively correlated with the total sperm count, sperm concentration, motility and morphology in Group 2 (r = 0.303, 0.345, 0.260 and 0.322, respectively, p < .001). In this study, GPER levels were positively correlated with sperm parameters, and it was hypothesised that the decrease in GPER expression might be associated with male infertility by adversely affecting spermatogenesis.     

Richard Lower,M.D., Physician and Surgeon (1631–1691)

Richard Lower (1631–1691) was a follower of William Harvey and conducted extensive studies of the physiology of the cardiovascular and respiratory systems. He employed surgery as a key component of his experimental work. He described and employed cardiac massage and maintained arterial oxygenation through positive-pressure respiration. Making good use of these procedures, he established the role of the lungs in the admixture of air to the blood. Lower performed exchange transfusion in dogs and transfused the blood of a sheep into a human. He recognized the role of blood transfusion in replacing blood lost from hemorrhage or other causes. In his work on exchange transfusion, he employed extracorporeal vascular conduits, including arterial heterografts. Through surgical experiments he established that all mesenteric lymph passes through the thoracic duct to the subclavian vein. He performed a variety of procedures through an open thorax, closed the thoracotomy, and observed the animals over a period of days. Lower has not received the recognition he deserves as a pioneer surgical investigator.     

Relationship Between Obesity and Diabetes in a US Adult Population: Findings from the National Health and Nutrition Examination Survey, 1999–2006

Background  

Obesity is one of the most important modifiable risk factors for the prevention of type 2 diabetes. The aim of this study was to examine the prevalence of diabetes with increasing severity of obesity and the distribution of HbA1c levels in diabetics participating in the latest National Health and Nutrition Examination Survey (NHANES).     

Mechanical events and the pressure–volume relationships

Depolarization of cardiac muscle fibres spreads from fibre to fibre throughout the myocardium. In a single fibre, contraction starts just after depolarization and lasts until just after repolarization is complete. The atria contract, completing the filling of the ventricles and thus enhancing their action. In the absence of effective atrial contraction (e.g. atrial fibrillation) cardiac output is decreased on average by 15%. During diastole, when cardiac muscle is relaxed, blood returns to the heart and passes through the atrioventricular (AV) valves into the ventricles. The semilunar valves, between the ventricles and the arteries, are closed as arterial pressure exceeds ventricular pressure. Under normal circumstances, 70% of ventricular filling occurs by late diastole.     

Mechanical events and the pressure–volume relationships

Depolarization of cardiac muscle fibres spreads from fibre to fibre throughout the myocardium. In a single fibre, contraction starts just after depolarization and lasts until just after repolarization is complete. The atria contract, completing the filling of the ventricles and thus enhancing their action. In the absence of effective atrial contraction (e.g. atrial fibrillation), cardiac output is decreased on average by 15%. During diastole, when cardiac muscle is relaxed, blood returns to the heart and passes through the atrioventricular (AV) valves into the ventricles. The semilunar valves, between the ventricles and the arteries, are closed as arterial pressure exceeds ventricular pressure. Under normal circumstances, 70% of ventricular filling occurs by late diastole.     

How Valid is the Quantity and Quality Relationship in CABG Surgery? A Review of the Literature

Numerous analyses have identified an inverse relationship between case volume in coronary artery bypass graft (CABG) surgery and mortality, and have led some to call for the consideration of minimum-volume standards for open-heart surgery programs. These findings, however, have been questioned by studies that demonstrate a weak or absent association, and by the availability of risk-adjusted mortality data. There is also growing evidence that clinical care processes have greater impact on mortality than sheer numbers alone. Policy decisions that may address this issue in the future need to consider the impact of mandating referrals away from low-volume programs, including the negative financial and programmatic effect on hospitals and both the clinical and social ramifications for patients and families, particularly in rural regions of the country.     

Facility Type is Another Factor in the Volume–Outcome Relationship for Complex Hepatopancreatobiliary Procedures

Annals of Surgical Oncology -     

Capillary dynamics and the interstitial fluid–lymphatic system

The capillaries are the ‘business end’ of the circulatory system, where materials exchange between the plasma and tissues. Water-soluble molecules can diffuse through pores in the capillaries, and a Gibbs–Donnan equilibrium exists between the plasma and interstitium. There are several types of capillaries, which vary in their anatomical integrity and permeability. There is also a bulk flow of fluids between the plasma and interstitium, described by the Starling forces. Originally, these forces were thought to cause fluids to leave the capillaries at the arteriolar end and return at the venular end; the role of the lymphatics was to provide an ‘overflow’ mechanism due to protein leakage out of the capillaries. More recent work indicates that this concept needs modification. Lymph flow and interstitial colloidal osmotic pressure are now known to be greater than first thought, and the interstitium has a slightly negative hydrostatic pressure. It is now believed that filtration takes place along most of the capillary, and the lymphatic system plays a more important role in maintaining plasma–interstitium equilibrium and preventing oedema. The system acts as a ‘closed’ one in that the changes in fluid formation (e.g. following haemorrhage or cardiac failure) are self-limiting. However, in some circulations (e.g. those to the kidneys, glands and the gut), net fluid production or absorption is required. This requirement is fulfilled by an independence from the Starling forces, the systems behaving as ‘open’ ones.     

Capillary dynamics and the interstitial fluid–lymphatic system

The capillaries are the ‘business end’ of the circulatory system, where materials exchange between the plasma and tissues. Water-soluble molecules can diffuse through pores in the capillaries, and a Gibbs–Donnan equilibrium exists between the plasma and interstitium. There are several types of capillaries, which vary in their anatomical integrity and permeability. There is also a bulk flow of fluids between the plasma and interstitium, described by the Starling forces. Originally, these forces were thought to cause fluids to leave the capillaries at the arteriolar end and return at the venular end; the role of the lymphatics was to provide an ‘overflow’ mechanism due to protein leakage out of the capillaries. More recent work indicates that this concept needs modification. Lymph flow and interstitial colloidal osmotic pressure are now known to be greater than first thought, and the interstitium has a slightly negative hydrostatic pressure. It is now believed that filtration takes place along most of the capillary, and the lymphatic system plays a more important role in maintaining plasma–interstitium equilibrium and preventing oedema. The system acts as a ‘closed’ one in that the changes in fluid formation (e.g. following haemorrhage or cardiac failure) are self-limiting. However, in some circulations (e.g. those to the kidneys, glands and the gut), net fluid production or absorption is required. This requirement is fulfilled by an independence from the Starling forces, the systems behaving as ‘open’ ones.     

N-Terminal Pro–B-Type Natriuretic Peptide (NT-proBNP) Assessment in the First Year After Renal Transplantation and Its Relationship With Graft Function and Left Ventricular Hypertrophy

Background

NT-proBNP is a natriuretic neurohormone released mainly from ventricular cardiomyocytes in conditions of volumetric or pressure overload; it is suitable for use as a marker of left ventricular hypertrophy (LVH), a common disorder in renal transplant recipients. The study objective here was to assess NT-proBNP levels in the 1st year after renal transplantation (RT) and its relationship with graft function and LVH.

Methods

Sixty patients (age, 49 ± 16.9 y; male, 58%) were subjected to prospective 1-year follow-up. Basic blood tests and NT-proBNP level measurements were performed twice (in the early period and at 1 year after transplantation). Cardiac echography was performed in 40 patients. LVH was diagnosed when left ventricular mass index was >95 g/m² in women and >115 g/m² in men. Statistical analyses were performed with the use of the R Package.

Results

At 1 year after RT, the NT-proBNP level decreased >2-fold compared with the early period (median 171 pg/mL [interquartile range (IQR), 104.5–283] vs 368 pg/mL[IQR, 170–629]; P = .00008). In the early post-transplantation period, NT-proBNP correlated with the patient's age, body mass index, estimated glomerular filtration rate (eGFR), and left ventricular end-diastolic dimension, and at 1 year after transplantation its correlation with the eGFR range (patients with eGFR ≥60 mL min⁻¹ 1.73 m⁻² had significantly lower NT-proBNP levels than those with eGFR <60 mL min⁻¹ 1.73 m⁻²), with age,and with ejection fraction was found. Patients with LVH had higher NT-proBNP levels than those without LVH in the early period (median 511 pg/mL [IQR, 190–736] vs 380 pg/mL [IQR, 217–511]; P = .09), and at 1 year (median 269 pg/mL [IQR, 155–474] vs 133 pg/mL [IQR, 99–134]; P = .057). At NT-proBNP >480 pg/mL in the early period and >280 pg/mL at 1 year, LVH occurred with a 68% probability (P = .05 and P = .03, respectively).

Conclusions

During the 1st year after RT, NT-proBNP levels decrease ≥2-fold and are primarily related to eGFR. NT-proBNP measurements are useful in identifying patients with LVH.     

Is Physician Quality Reporting System Worth the Cost to Report to Center for Medicare and Medicaid Services?

Background

The Center for Medicare and Medicaid Services (CMS) has proposed a move to payment based on patient-reported outcomes (PROs), and failure to report on PROs will result in a penalty of 2% in 2016. However, the cost to the physician to collect PROs is not known.

Relationship between the expression of hypoxia-inducible factor-1α and chemotherapy response in gastric carcinoma

. Conclusion HIF-1α expression may be a useful indicator to predict the chemotherapy response and clinical outcome in gastric carcinoma.     

Industry and evidence-based medicine: Believable or conflicted? A systematic review of the surgical literature

Background

Over the last few decades medical research and development has come to depend more heavily on the financial support of industry. However, there is concern that financial relations between the medical community and medical industry could unduly influence medical research and therefore patient care. Our objective was to determine whether conflict of interest owing to authors’/investigators’ financial affiliation with industry associated with their academic research has been identified in the surgical literature. In particular, we sought to answer the following questions: What is the extent of such conflict of interest? Does conflict of interest bias the results of academic surgical research in favour of industry? What are the potential causes of this proindustry bias?

Methods

We conducted a systematic review of the literature in May 2008 using the OVID SP search engine of MEDLINE, EMBASE, CINAHL, the Cochrane Database of Systematic Reviews, DARE and Health Technology Assessment. Quantitative studies that included a methods section and reported on conflict of interest as a result of industry funding in surgery-related research specifically were included in our analysis.

Results

The search identified 190 studies that met our criteria. Author/investigator conflict of interest owing to financial affiliation with industry associated with their academic research is well documented in the surgical literature. Six studies demonstrated that authors with such conflicts of interest were significantly more likely to report a positive outcome than authors without industry funding, which demonstrates a proindustry bias. Two studies found that the proindustry bias could not be explained by variations in study quality or sample size.

Conclusion

The conflict of interest that exists when surgical research is sponsored by industry is a genuine concern.