Cryptorchidism: A general surgical perspective

Background The treatment of cryptorchidism has changed, with surgery now advocated before the age of two years. Delayed treatment affects fertility, malignant potential and psychological stress. Aims To assess the pattern of referral of cryptorchid patients to a surgical clinic, management and follow-up. Methods A four-year review of 114 cryptorchid patients examined age at presentation, waiting time, timing of surgery and length of follow-up. Results The mean age at presentation to the surgical clinic was 6.7 years (neonatal to 71). The mean age at orchidopexy was 5.6 years. Seventy per cent had a surgical procedure within eight weeks of presentation to a surgeon. Seven per cent were kept under surveillance until a maximum age of three years before orchidopexy was considered. Only 29% proceeded to surgery before the age of two. Seventeen were referred to a paediatric urology unit for further management. Conclusions Orchidopexy seems prudent between one and two years of age. Only one-quarter of patients underwent early orchidopexy. It is vital that it is detected early, by paediatricians at birth or the general practitioners (GPs) at the six-week check up. Prompt referral to a surgeon with a paediatric interest is essential in order to permit surveillance or surgery.     

Hydroxyl porous aromatic frameworks for efficient adsorption of organic micropollutants in water

Environmental pollution is an important issue in sustainable human development. People give great importance to environmental protection, especially with regards to increasingly scarce water resources. Water pollution is becoming more and more serious due to the existence of organic micropollutants. As a platform with good stability, porous aromatic frameworks (PAFs) have been widely studied. Because of their high surface area and thermal stability, they are considered to be a good sewage treatment agent. However, the aromatic nature of PAFs makes their skeletons mostly hydrophobic. This characteristic of PAFs seriously affects their diffusion rate in water as an adsorbent, resulting in a low adsorption rate. In this work, we synthesized a series of hydroxyl functionalized porous aromatic frameworks (PAF-80, PAF-81, and PAF-82) via the Sonogashira–Hagihara cross-coupling reaction, which created polar motifs on the hydrophobic surfaces, and carried out adsorption tests on typical organic micropollutants in water such as bisphenol A (BPA), 2-naphthol (2-NO) and p-chloroxylenol (PCMX). Among the three PAFs, PAF-82 exhibited the highest BET surface area, polar active sites, and a high degree of conjugation, which led to the best adsorption performance compared to that of PAF-80 and PAF-81. The Langmuir adsorption capacity of PAF-82 for BPA, 2-NO, and PCMX is 689 mg g⁻¹, 431 mg g⁻¹, and 480 mg g⁻¹, respectively, which surpasses most previously reported adsorbents. In addition, after 5 cycles of regeneration, it still maintained a high removal rate for pollutants. The obtained results reveal that micropollutant adsorption in water is not controlled by a single factor, but is the result of a synergy of multiple factors, including specific surface area, polar functional groups, pore size distribution, and skeleton conjugation. Our study has revealed the great potential of hydroxyl PAFs for efficient adsorption of organic micropollutants in water.

A series of hydroxyl functionalized PAF materials (PAF-80, PAF-81, and PAF-82) were synthesized, which create polar channels to the hydrophobic surfaces and explored as efficient adsorption of organic micropollutants in water.     

Persistent organ dysfunction after severe sepsis: A systematic review

Objective

Sepsis is a prevalent disease with high mortality. Survivors of sepsis often suffer significant resultant morbidity, including organ dysfunction. However, little is known about persistent or long-term organ dysfunction in this patient population. Our objective was to systematically review original research studies evaluating organ-specific outcomes at 28 days or greater in patients surviving severe sepsis.

Methods

We performed a systematic review of studies reporting organ-specific outcomes at 28 days or greater in survivors of severe sepsis.

Results

We identified 1,173 articles and five met our inclusion criteria. No study reported on organ dysfunction at greater than 30 days. Two studies contributed the majority of patients and had consistent rates of 1 month organ dysfunction for adult respiratory distress syndrome (ARDS) (8%-9%), renal (7%-8%), hepatic (3%-7%), and central nervous system (2%-5%). Another study reported higher rates of dysfunction for pulmonary (non-ARDS and ARDS), hepatic and renal but similar rates for central nervous system and disseminated intravascular coagulation when compared to the first two studies. The most recent study had the highest rates of dysfunction (> 47%) across all organ systems. For organ failure resolution the rates were highly variable.

Conclusions

Our review found variable rates of organ dysfunction at 1 month after severe sepsis. Future studies should attempt to characterize organ dysfunction at greater than 1 month after an acute severe sepsis episode to determine the true prevalence long-term organ dysfunction and treatments for prevention. Additionally, standardized objective measures of organ dysfunction are needed so that future studies can be directly compared.     

Carotid intima media thickness and low high-density lipoprotein (HDL) in South Asian immigrants: could dysfunctional HDL be the missing link?

Introduction

South Asian immigrants (SAIs) in the US exhibit higher prevalence of coronary artery disease (CAD) and its risk factors compared with other ethnic populations. Conventional CAD risk factors do not explain the excess CAD risk; therefore there is a need to identify other markers that can predict future risk of CAD in high-risk SAIs. The objective of the current study is to assess the presence of sub-clinical CAD using common carotid artery intima-media thickness (CCA-IMT), and its association with metabolic syndrome (MS) and pro-inflammatory/dysfunctional HDL (Dys-HDL).

Material and methods

A community-based study was conducted on 130 first generation SAIs aged 35–65 years. Dys-HDL was determined using the HDL inflammatory index. Analysis was completed using logistic regression and Fisher''s exact test.

Results

Sub-clinical CAD using CCA-IMT ≥ 0.8 mm (as a surrogate marker) was seen in 31.46%. Age and gender adjusted CCA-IMT was significantly associated with type 2 diabetes (p = 0.008), hypertension (p = 0.012), high-sensitivity C-reactive protein (p < 0.001) and homocysteine (p = 0.051). Both the presence of MS and Dys-HDL was significantly correlated with CCA-IMT, even after age and gender adjustment. The odds of having Dys-HDL with CCA-IMT were 5 times (95% CI: 1.68, 10.78).

Conclusions

There is a need to explore and understand non-traditional CAD risk factors with a special focus on Dys-HDL, knowing that SAIs have low HDL levels. This information will not only help to stratify high-risk asymptomatic SAI groups, but will also be useful from a disease management point of view.