Electroejaculation: A state of the art review

Anejaculation due to neurologic disease is a challenging condition for the treating physician. Electroejaculation is effective at inducing ejaculation in such men and has been a mainstay in treatment protocols for many years. New developments within the past few years have allowed for the refinement of both the electroejaculation technique and the algorithms for treating couples with anejaculatory infertility. This article reviews the recent developments in the use of electroejaculation. The authors were specifically chosen based on their extensive contributions to this field.     

Characteristics of an autologous leukocyte and platelet‐rich fibrin patch intended for the treatment of recalcitrant wounds

We have investigated the physical, biochemical, and cellular properties of an autologous leukocyte and platelet‐rich fibrin patch. This was generated in an automated device from a sample of a patient's blood at the point of care. Using microscopy, cell counting, enzyme‐linked immunosorbent assay, antibody arrays, and cell culture assays, we show that the patch is a three‐layered membrane comprising a fibrin sheet, a layer of platelets, and a layer of leukocytes. Mean recovery of platelets from the donated blood was 98% (±95%CI 0.8%). Mean levels of platelet‐derived growth factor AB, human transforming growth factor beta 1, and vascular endothelial growth factor extracted from the patch were determined as 127 ng (±95% CI 20), 92 ng (±95%CI 17), and 1.35 ng (±95%CI 0.37), respectively. We showed a continued release of PDGF‐AB over several days, the rate of which was increased by the addition of chronic wound fluid. By comparison with traditional platelet‐rich plasma, differences in immune components were found. The relevance of these findings was assessed by showing a mitogenic and migratory effect on cultured human dermal fibroblasts. Further, we showed that fibrocytes, a cell type important for acute wound healing, could be grown from the patch. The relevance of these findings in relation to the use of the patch for treating recalcitrant wounds is discussed.     

Obesity and the diagnostic accuracy for primary aldosteronism

The effects of body mass index on the diagnostic accuracy of primary aldosteronism (PA) are inconsistent and yet important considering the high prevalence and frequent co‐occurrence of obesity and hypertension. The current study included 59 adult patients who underwent a stepwise evaluation for PA, using aldosterone to renin ratio for case detection and plasma aldosterone concentration after saline suppression test and/or 24‐hour urinary aldosterone after oral sodium loading for case confirmation. Body mass index had a quadratic (U‐shaped) correlation with plasma aldosterone concentration, plasma renin activity, aldosterone to renin ratio, and plasma aldosterone concentration after saline suppression test. Among patients with a body mass index ≥30 kg/m², the aldosterone to renin ratio yielded lower case detection accuracy of PA. We conclude that obesity results in a nonlinear correlation with plasma aldosterone concentration, plasma renin activity, and aldosterone to renin ratio, which affects the accuracy of case detection for PA. Patients with a body mass index ≥30 kg/m² are less accurately identified as having PA when saline suppression and/or oral salt loading tests are used for case confirmation.     

Effect of smoking, abstention, and nicotine patch on epidermal healing and collagenase in skin transudate

Delayed wound healing may explain postoperative tissue and wound dehiscence in smokers, but the effects of smoking and smoking cessation on the cellular mechanisms remain unclear. Suction blisters were raised in 48 smokers and 30 never smokers. The fluid was retrieved and the epidermal roof was excised. Transepidermal water loss (TEWL) was measured after 2, 4, and 7 days. Then, the smokers were randomized to continuous smoking or abstinence with a transdermal nicotine patch or a placebo by concealed allocation. The sequence was repeated after 4, 8, and 12 weeks in all smokers and abstainers and in 6 never smokers. Matrix metalloproteinase (MMP)-8 and MMP-1 levels in suction blister fluid were assessed by an enzyme-linked immunosorbent assay. Random-effects models for repeated measurements were applied and p ≤0.05 was considered significant. One week after wounding the TEWL was 17.20 (14.47–19.92) g/cm² hour (mean, 95% CI) in smokers and 13.89 (9.46–18.33) in never smokers ( p <0.01). In abstinent smokers TEWL was 18.95 (15.20–22.70)( p <0.01, when compared with smokers). In smokers, MMP-8 was 36.4 (24.3–48.5) ng/mL (mean, 95% CI) and 15.2 (1.4–30.2) ng/mL in never smokers ( p <0.01). Abstinent smokers' MMP-8 level was 21.2 ng/mL (6.6–43.0) ( p =0.02, when compared with smokers). MMP-1 was unaffected by smoking and abstention. Transdermal nicotine patch did not affect any parameter. We conclude that smoking attenuates epidermal healing and may enhance extracellular matrix degradation. Three months of abstinence from smoking does not restore epidermal healing, whereas 4 weeks of abstinence normalizes suction blister MMP-8 levels. These findings suggest sustained impaired wound healing in smokers and potential reversibility of extracellular matrix degradation.     

Long-term safety and efficacy of eculizumab in generalized myasthenia gravis

Introduction: Eculizumab is effective and well tolerated in patients with antiacetylcholine receptor antibody-positive refractory generalized myasthenia gravis (gMG; REGAIN; NCT01997229). We report an interim analysis of an open-label extension of REGAIN, evaluating eculizumab's long-term safety and efficacy. Methods: Eculizumab (1,200 mg every 2 weeks for 22.7 months [median]) was administered to 117 patients. Results: The safety profile of eculizumab was consistent with REGAIN; no cases of meningococcal infection were reported during the interim analysis period. Myasthenia gravis exacerbation rate was reduced by 75% from the year before REGAIN (P < 0.0001). Improvements with eculizumab in activities of daily living, muscle strength, functional ability, and quality of life in REGAIN were maintained through 3 years; 56% of patients achieved minimal manifestations or pharmacological remission. Patients who had received placebo during REGAIN experienced rapid and sustained improvements during open-label eculizumab (P < 0.0001). Discussion: These findings provide evidence for the long-term safety and sustained efficacy of eculizumab for refractory gMG. Muscle Nerve 2019