Declining testicular function with age. Hormonal and clinical correlates

Testicular endocrine function and androgen-dependent secondary sexual characteristics were assessed in 283 men 18 to 96 years of age. Mean serum total testosterone levels remained unchanged up to age 70 and declined thereafter. In 29 per cent of the men over 70 years of age total testosterone levels were below the lower limit of normal for young adults, In contrast, mean free or unbound testosterone levels declined after age 50 and were below the lower limit of normal for young adults in 40 per cent of the men over 70 years of age. Serum-luteinizing hormone and follicle-stimulating hormone levels showed a slight but steady rise after age 40 which became more abrupt after age 70. Serum gonadotropin levels were elevated in approximately 60 per cent of the men over 70 years of age.Mean testis length and volume were decreased in 78 per cent and 37 per cent, respectively, of the men over 60 years of age. Facial, pubic and axillary hair were also reduced in amount whereas the prostate was enlarged in 73 per cent of the elderly men. There appeared to be an inverse relationship in older men between testicular size and gonadotropin levels, and a direct relationship between testicular and prostatic sizes.It would appear that some degree of Leydig cell hypofunction commonly begins at around 45 to 50 years of age, becoming more pronounced after age 70. The concomitant elevation in serum gonadotropin levels at this time indicates that this is due to a primary decline in testicular function and is not secondary to pituitary hypofunction.     

Educating and Training a Workforce for Nutrition in a Post-2015 World

Nearly all countries in the world today are burdened with malnutrition, manifesting as undernutrition, micronutrient deficiencies, and/or overweight and obesity. Despite some progress, efforts to alleviate malnutrition are hampered by a shortage in number, skills, and geographic coverage, of a workforce for nutrition. Here, we report the findings of the Castel Gandolfo workshop, a convening of experts from diverse fields in March 2014 to consider how to develop the capacity of a global cadre of nutrition professionals for the post-2015 development era. Workshop participants identified several requirements for developing a workforce for nutrition, including an ability to work as part of a multisectoral team; communication, advocacy, and leadership skills to engage decision makers; and a set of technical skills to address future challenges for nutrition. Other opportunities were highlighted that could immediately contribute to capacity development, including the creation of a consortium to link global North and South universities, online training modules for middle managers, and practical, hands-on experiences for frontline nutrition workers. Institutional and organizational support is needed to enable workshop recommendations on education and training to be effectively implemented and sustained. The findings from the Castel Gandolfo workshop can contribute to the delivery of successful nutrition-relevant actions in the face of mounting external pressures and informing and attaining the forthcoming Sustainable Development Goals.     

The role of closed pleural needle biopsy in the diagnosis of malignant mesothelioma of the pleura.

Malignant mesothelioma of the pleura is a disease that requires a biopsy procedure for a definitive diagnosis. In the past, closed pleural needle biopsy (CPNB) has given poor yields due to the small amount of tissue obtained, and the patient has subsequently been subjected to a diagnostic thoracotomy. In recent years, the availability of more accurate histopathologic tests have enabled the pathologist to make a diagnosis more easily on samples obtained at CPNB. In this retrospective study of 20 consecutive cases of malignant mesothelioma of the pleura diagnosed between 1980 and 1990, we found that a blind CPNB was diagnostic in five of seven procedures and CT-guided CPNB was diagnostic in five of six procedures. An open pleural biopsy (OPB) was diagnostic in ten of ten procedures performed. There were no complications associated with any of the CPNB procedures. We conclude that CPNB is a safe and effective manner of diagnosing malignant mesothelioma of the pleura, and should be attempted prior to OPB.