Success of acupuncture treatment in patients with initially low sperm output is associated with a decrease in scrotal skin temperature

Poor spermatogenesis in patients with inflammation of the genital tract is associated with scrotal hyperthermia. These patients can benefit from acupuncture treatment. We conducted a study to verify whether the influence of acupuncture treatment on sperm output in patients with low sperm density is associated with a decrease in scrotal temperature. The experimental group included 39 men who were referred for acupuncture owing to low sperm output. The control group, which comprised 18 normal fertile men, was used to define a threshold (30.5°C) above which scrotal skin temperature was considered to be high. Accordingly, 34 of the 39 participants in the experimental group initially had high scrotal skin temperature; the other five had normal values. Scrotal skin temperature and sperm concentration were measured before and after acupuncture treatment. The five patients with initially normal scrotal temperatures were not affected by the acupuncture treatment. Following treatment, 17 of the 34 patients with hyperthermia, all of whom had genital tract inflammation, had normal scrotal skin temperature; in 15 of these 17 patients, sperm count was increased. In the remaining 17 men with scrotal hyperthermia, neither scrotal skin temperature nor sperm concentration was affected by the treatment. About 90% of the latter patients suffered from high gonadotropins or mixed etiological factors. Low sperm count in patients with inflammation of the genital tract seems to be associated with scrotal hyperthermia, and, consequently, acupuncture treatment is recommended for these men.     

Changing Methods of Imaging the Common Bile Duct in the Laparoscopic Cholecystectomy Era in Western Australia: Implications for Surgical Practice

OBJECTIVE: To assess changes in the use of endoscopic retrograde cholangiopancreatography (ERCP), intraoperative cholangiography (IOC), and surgical exploration of the common bile duct (CBD) associated with the introduction of laparoscopic cholecystectomy (LC). SUMMARY BACKGROUND DATA: The optimal strategy for dealing with potential stones of the CBD during LC remains controversial. METHODS: The authors conducted a population-based study of all cases of cholecystectomy (20,084) in Western Australia in the periods before, during, and after the introduction of LC (1988-1994). Index admissions were linked to previous or subsequent admissions for ERCP. Factors associated with ERCP were analyzed by multivariate regression models. RESULTS: Between 1988 and 1994, admissions for ERCP almost doubled, whereas the use of IOC decreased from 71% to 51%. Different trends were found for open and laparoscopic procedures. Exploration of the CBD declined because of the infrequent use of this procedure in LC. Preoperative ERCP was significantly more common in older patients and men; the reverse was found for IOC. There was an adjusted 3.5-fold increase in preoperative ERCP both during and after the introduction of LC. The adjusted odds ratios for IOC were 0.48 and 0.52 for these periods. CONCLUSIONS: The introduction of LC was associated with increasing reliance on ERCP to image the CBD and a decrease in the use of IOC. These changes were observed in both LC and open cholecystectomy. They suggest that the use of ERCP before cholecystectomy has partly replaced IOC for visualization of the CBD for suspected stones. Although more than 40% of patients undergoing LC had IOC, surgeons appear to be reluctant to perform surgical exploration of the CBD when stones are present. Savings in terms of both complications and cost can be expected if preoperative ERCPs performed for suspicion of uncomplicated CBD stones are replaced by IOC.     

The kitchen as therapy: qualitative assessment of an integrative cuisine workshop for patients undergoing chemotherapy

Objective

Patients undergoing chemotherapy frequently suffer from gastrointestinal (GI) symptoms and functional difficulties in preparing and eating meals. We conducted a qualitative assessment of an integrative cuisine workshop program designed for patients receiving chemotherapy, examining the effects of the program on patient-reported GI symptoms and nutritional challenges.

Patients and methods

Patients were referred to a complementary/integrative medicine (CIM)-trained physician for consultation, followed by a patient-tailored treatment program. Patients with GI-related symptoms and nutritional concerns were offered a two-session integrative cuisine workshop program. The effects of the workshops were examined using inductive and deductive qualitative research methodologies. Patient narratives, as recorded in the Measure Yourself Concerns and Wellbeing (MYCAW) study tool, and electronic medical files were analyzed.

Results

Of 125 patients referred to the integrative cuisine program, 86 participated in at least one workshop. Participants and non-participants had similar demographic and disease-related characteristics, as well as quality-of-life (QOL)-related concerns. Inductive analysis suggested that participation in the workshops was helpful in developing social relationships, providing emotional support, and enhancing spirituality and nutritional awareness. Implementing the recommended changes at home led to improved QOL-related outcomes. The predominant themes derived from deductive analysis were the implementation of dietary changes and improved gastrointestinal and emotional issues.

Conclusions

Chemotherapy-treated patients participating in an integrative cuisine workshop program showed improved QOL outcomes, specifically GI and emotional-related symptoms, and a reduction in nutritional and functional concerns. Increased knowledge and awareness of nutrition and supplement use ultimately resulted in implementation of the CIM recommendations by patients at home.

     

Molecular morphometric analysis shows relative intra-tumoural homogeneity for KRAS mutations in colorectal cancer

KRAS mutation status has a significant role determining anti-epidermal growth factor receptor (anti-EGFR) treatment response in colon carcinoma patients. Malignant transformation is a dynamic process and therefore, it is conceivable that, at a certain point, the tumor cells’ mass might be heterogeneous for particular mutations. Therefore, the fraction of tumor cells carrying a particular mutation may be more relevant for treatment than the simple determination of presence or absence of mutation. The purpose of this study is to assess whether or not KRAS mutation status is heterogeneous and, if so, to what extent in colon carcinoma samples. Deoxyribonucleic acid was extracted from formalin-fixed paraffin-embedded samples of colon carcinoma and analyzed for the presence of KRAS mutation. The relative fraction of mutated versus wild-type KRAS alleles was evaluated by real-time polymerase chain reaction. Additionally, the relative fraction of cancer cells in the tissue sample was evaluated using computer assisted morphometric analysis. Using this data, we calculated the fraction of mutation containing cells in the samples. Colon carcinoma (169 cases) were analyzed, and a KRAS mutation was found in 75 cases (44%), of which 42 were available for morphometric analysis. In 41 (97.6%) of these cases, the fraction of mutation containing tumor cells was 50% or higher, indicating the absence of significant KRAS mutation status heterogeneity. There was a strong positive correlation (R = 0.66, P < 0.0001) between the fraction of mutated KRAS alleles and the fraction of cancer cells in the samples. The strong positive correlation between the fraction of mutated KRAS alleles and the fraction of cancer cells in the samples indicate homogeneity of KRAS mutation status in colorectal carcinoma.     

Acute infantile bilateral striatal necrosis: single-photon emission computed tomography (SPECT) imaging and review

Acute infantile bilateral striatal necrosis is a rarely described acute neurological syndrome associated with radiological findings. Its etiology and pathogenic mechanisms are unknown. Clinically, the syndrome usually follows respiratory illnesses and presents with an array of neurological findings, including axial ataxia, grimacing, mutism, head nodding, and high-pitched cry. This study follows a child with acute infantile bilateral striatal necrosis both clinically and radiologically. In addition, for the first time, the authors describe the serial findings of single-photon emission computed tomography (SPECT) from onset of illness through 20 months. Their findings indicate an initial insult apparent on both magnetic resonance imaging and SPECT localized to the basal ganglia, which, although improved over time, does not fully regress. The residual lesion on SPECT was clinically associated with only mild attention deficit disorder and no motor pathology. The authors review the published literature concerning acute infantile bilateral striatal necrosis and suggest possible mechanisms of this poorly understood and probably underreported condition.     

Growth pattern and final height after cessation of gonadotropin-suppressive therapy in girls with central sexual precocity

OBJECTIVE: The objective of the study was to determine whether height gain after discontinuation of gonadotropin-suppressive (GnRHa) therapy differs in girls with sexual precocity diagnosed at various ages and assess its influence on final height (FHt) outcome. DESIGn: We compared data on post-GnRHa treatment course and FHt of 115 girls [22 diagnosed before chronological age of 6 yr; 38 between ages 6 and 8 yr; and 55 early fast puberty (EFP) between ages 8 and 9 yr] treated with GnRHa from Tanner stage 2-3 to chronological age 11-12 yr and bone age 12-12.5 yr. RESULTS: Despite comparable bone age at cessation of treatment, similar time to resumption of puberty (0.6 +/- 0.7, 0.5 +/- 0.7, and 0.5 +/- 0.7 yr), and age at menarche (12.6 +/- 0.5, 12.6 +/- 0.6, and 12.7 +/- 0.9 yr), height gain from cessation of therapy to FHt was greater and time to epiphyseal fusion was longer in the younger central precocious puberty (CPP) than in the older CPP (P < 0.05) and EFP (P < 0.001) groups. The percentage of residual growth predicted at discontinuation of treatment was achieved only by the younger CPP (6.6 +/- 1.6% vs. 6.7 +/- 1.6%), whereas in older CPP and EFP, it was significantly lower (6.2 +/- 1.6% vs. 4.6 +/- 2.7% and 6.3 +/- 1.5% vs. 3.6 +/- 1.5%, respectively). FHt of these two groups was compromised, compared with FHt predicted at discontinuation of treatment (P < 0.01 and P < 0.001, respectively). CONCLUSIONS: Girls with sexual precocity diagnosed after the age of 6 yr exhibit earlier epiphyseal fusion with diminished posttreatment height gain and compromised FHt. Because recovery of gonadal axis was similar in all girls, differences were probably due to pretreatment intrinsic changes in the growth plate. Prediction of residual growth at discontinuation of treatment is unreliable in these girls.     

Clinical spectrum and medical treatment of children with electrical status epilepticus in sleep (ESES)

Purposes:   To describe the clinical spectrum and to evaluate the efficacy of different therapeutic agents in children with electrical status epilepticus in sleep (ESES).
Methods:   Clinical data of all patients with ESES (not including patients with Landau-Kleffner syndrome) in four pediatric neurology outpatient clinics were analyzed. Thirty patients with ESES had been treated between 1994 and 2007.
Results:   Eleven (37%) children had benign partial epilepsies of childhood, five (17%) had cerebral palsy, five (17%) had hydrocephalus, one (3%) had schizencephaly, one (3%) had prenatal parenchymal bleeding, and the etiology was unclear in seven (23%). The duration of ESES ranged between 2 and 60 months. The antiepileptic drugs that were found to be efficacious were: levetiracetam (41%), clobazam (31%), and sulthiame (17%). Valproic acid, lamotrigine, topiramate, and ethosuximide showed no efficacy. Steroids were efficacious in 65%; immunoglobulins were efficacious in 33%. High-dose diazepam was efficacious in 37%, but all the children had temporary response. Seventeen patients (57%) had cognitive deterioration, whereas the rest presented with regression in attention, speech, communication, and behavior. Fourteen children had permanent cognitive deficit. There was a significant correlation (p = 0.029) between the duration of ESES and residual intellectual deficit at follow-up.
Conclusions:   ESES reflects an evolution of benign partial epilepsy of childhood in more than one-third of the patients, whereas there is an underlying structural brain anomaly in another one-third. The most efficacious antiepileptic drugs (AEDs) are levetiracetam and clobazam. The duration of ESES correlated significantly with residual intellectual deficit at follow-up.     

Blunted heart rate dip during sleep and all-cause mortality

BACKGROUND: Although it has been somewhat overlooked, resting heart rate is an established predictor of cardiovascular and noncardiovascular outcome. We assessed the determinants and mortality associations of heart rate measured during ambulatory blood pressure monitoring (ABPM) to evaluate its informativeness during activity and sleep. METHODS: We studied a cohort of 3957 patients aged 55 +/- 16 (mean +/- SD) years (58% treated for hypertension) who were referred for ABPM during 1991 to 2005. Heart rate nondipping was defined as follows: (awake value - sleep value)/awake value < 0.1. Linear and logistic regression models assessed covariate associations with ambulatory heart rate indices. All-cause mortality was analyzed by Cox proportional hazards modeling. RESULTS: Female sex, body mass index (calculated as weight in kilograms divided by height in meters squared), and treated diabetes were positively related to awake and sleep heart rate, whereas age and treated hypertension were inversely associated. All these variables were associated with lower sleep-related heart rate dipping magnitude. Multivariate-adjusted odds ratios (95% confidence intervals) for heart rate nondipping were 1.02 (1.02-1.03) per year of age; 1.05 (1.03-1.06) for body mass index; 1.39 (1.20-1.60) for women; 1.30 (1.12-1.51) for nappers; 2.19 (1.87-2.57) for treated hypertensive patients; and 1.38 (1.09-1.76) for treated diabetic patients. Mortality analysis according to deciles of the different heart rate variables showed a robust linear relationship only for heart rate dip and a hazard ratio of 2.67 (1.31-5.47) for the lowest vs the highest decile. CONCLUSIONS: In clinical practice, ambulatory heart rate adds prognostic information beyond that of other ABPM predictors. Heart rate measures during sleep, and in particular the absence of dipping of heart rate to sleep levels, were independently associated with all-cause mortality.