A survey of fertility and sexual health following allogeneic haematopoietic stem cell transplantation in New South Wales,Australia

Four hundred and twenty‐one adult allogeneic haematopoietic stem cell transplant (HSCT) survivors participated in a cross‐sectional study to assess sexual dysfunction and infertility post‐transplant. Survey instruments included the Sydney Post‐Blood and Marrow Transplant (BMT) Survey, Functional Assessment of Cancer Treatment (FACT) – BMT, the Depression, Anxiety, Stress Scales (DASS 21), the Chronic Graft‐versus‐Host Disease (cGVHD) Activity Assessment‐ Patient Self Report (Form B), the Lee cGVHD Symptom Scale and The Post‐Traumatic Growth Inventory. Most HSCT survivors reported sexual difficulties (51% of males; 66% of females). Men reported erectile dysfunction (79%) and decreased libido (61·6%) and women reported loss of libido (83%), painful intercourse (73%) and less enjoyment of sex (68%). Women also commonly reported vaginal dryness (73%), vaginal narrowing (34%) and vaginal irritation (26%). Woman had much higher rates of genital cGvHD than men (22% vs. 5%). Age and cGVHD were significantly associated with sexual dysfunction. Few survivors had children following transplant (3·3%). However, for those of reproductive age at HSCT, 22% reported trying to conceive, with 10·3% reporting success. This study is the largest to date exploring sexual function in survivors of allo‐HSCT. This data provides the basis for health service reform to better meet the needs of HSCT survivors, including evidence to support counselling and education both pre‐ and post‐transplant.     

Implementing change in a long stay hospital using an individual review system

This article describes the process of implementing change to an individual review system in a long-stay hospital. A new review system was devised, piloted, and evaluated. Despite the constraints of the institution (such as large size, and limited resources of staff and time) substantial improvements were made over a two-year period.     

Gut microbiome:a balancing act between degeneration and regeneration

In a symbiotic and mutualistic manner,the gut microbiota strongly influences many vital aspects of host physiology,biology,repair,and regeneration.The role of microbiota in many areas of regenerative medicine is just beginning to emerge,but it is under-recognized because of its complexity.As we remove the barriers that impede our understanding of this complex entity,we will uncover some of the most vital facets of our microbiome that make us who we are,its intrinsic connection with not only our wellbeing,but also with regeneration within.This will subsequently define its utility in regenerative medicine.     

Mixed-methods resistance training increases power and strength of young and older men

PURPOSE: This study examined the effects of mixed-methods resistance training on young and older men to determine whether similar increases in muscle power were elicited. METHODS: Effects of 10 wk of a periodized resistance-training program designed to increase muscle size, strength, and maximal power on isometric squat strength, time course of force development, muscle fiber characteristics, and muscle activation (iEMG), as well as force and power output during squat jumps, were compared in young (YM, 30 +/- 5 yr, N = 8) and older men (OM, 61 +/- 4 yr, N = 10). RESULTS: Isometric squat strength was higher in the YM compared with OM at all testing occasions and increased over the training period by 23 +/- 15% and 40 +/- 42% for the YM and OM, respectively. The early phase of the force-time curve was shifted upward in both groups over the course of the training. During the squat jumps, the YM produced higher force and power at all test occasions and at all loads tested compared with the OM. The YM increased power output by 15 +/- 14%, 33 +/- 16%, and 26 +/- 12%, and the OM by 7 +/- 5%, 36 +/- 23%, and 25 +/- 16% for the 17 kg, and 30% and 60% 1RM loads, respectively. CONCLUSION: Although the results of this study confirm age-related reductions in muscle strength and power, the older men did demonstrate similar capacity to young men for increases in these variables via an appropriate periodized resistance-training program that includes rapid, high-power exercises.     

Endovascular Treatment of Autogenous Radiocephalic Fistulas with the “Eighth Note” Deformity for Hemodialysis

The purpose of this paper is to describe a unique “eighth note” deformity of the autogenous radiocephalic fistula for hemodialysis and to retrospectively evaluate the efficacy and safety of its endovascular treatment. Over 3 years, a total of 808 patients and 558 autogenous radiocephalic fistulas were treated for vascular access dysfunction or thrombosis. These included 14 fistulas in 14 patients (9 men, 5 women; mean age, 58.2 ± 2.8 years; range 27–79 years) whose fistulograms before treatment resembled a musical note, the eighth note. Endovascular treatment sought to remodel the deformed vascular access to a classic radiocephalic fistula and increase the number of cannulation sites available for hemodialysis. The technical and clinical success rates were each 92.8% (13/14). Fistula remodeling was successful in 13 patients. The postintervention primary patency was 100% at 90 days, 91.7 ± 0.8% at 120 days, 78.6 ± 13.9% at 180 days, 62.9 ± 17.9% at 360 days, 31.4 ± 24.0% at 540 days, and 0% at 720 days. The postintervention secondary patency was 100% at 90 days, 100% at 120 days, 100% at 180 days, 85.7 ± 13.2% at 360 days, and 85.7 ± 13.2% at 720 days. No major complications were noted. Minor complications were found in 71.4% of patients, all of which resolved spontaneously. In conclusion, endovascular treatment of fistulas with the eighth note deformity can effectively increase the number of available cannulation sites, facilitate fistula maturation, and facilitate thromboaspiration after fistula thrombosis.     

Effect of Freezing Rate and Dendritic Ice Formation on Concentration Profiles of Proteins Frozen in Cylindrical Vessels

The process of freezing protein solutions can perturb the conformation of the protein and potentially lead to aggregate formation during long-term storage in the frozen state. Radial macroscopic freeze concentration and temperature profiles for bovine serum albumin (BSA) solutions in small cylindrical stainless steel vessels were determined for various freezing rates. The measured concentrations of both BSA and immunoglobulin G2, as well as trehalose in sampled ice sections, increased by up to twofold to threefold toward the bottom and radial center for slow freezing rates produced in stagnant air freezers. The concentration and temperature profiles result in density gradients that transport solutes by convective flow. For faster external cooling by either forced convection of air or a liquid coolant, the increased freezing rate raised the ice front velocity resulting in enhanced dendritic ice growth. The ice trapped the solutes more effectively before they were removed from the ice front by diffusion and convection, resulting in more uniform solute concentration profiles. The dynamic temperature profiles from multiple radial thermocouples were consistent with the independently measured freeze concentration profiles. The ability to control the protein concentration profile in the frozen state offers the potential to improve stability of protein in long-term frozen storage.     

Exploring the relationships between housing,neighbourhoods and mental wellbeing for residents of deprived areas

Background  

Housing-led regeneration has been shown to have limited effects on mental health. Considering housing and neighbourhoods as a psychosocial environment, regeneration may have greater impact on positive mental wellbeing than mental ill-health. This study examined the relationship between the positive mental wellbeing of residents living in deprived areas and their perceptions of their housing and neighbourhoods.