Pubertal Maturation of Contemporary Greek Boys: No Evidence of a Secular Trend

Purpose

To examine pubertal status of contemporary Greek boys and compare the data with those of a previous study we performed in the year 1996.

Methods

We performed a cross-sectional study of 932 healthy boys, aged from 8.05 to 16.05 years. Development of the genitalia (G) and pubic hair was assessed by the method of Tanner and testicular volume (TV) was determined with a Prader orchidometer. Genitalia stage 2 (G2) was assessed by probit analysis.

Results

Median (95% confidence interval [CI]) age at G2, defined as TV 4 mL, was 11.3 (10.9–11.6) years, almost the same age as in our study performed in 1996, which was 11.4 (10.7–11.7) years (p = .21). When G2 was defined as change in scrotum texture and TV2 mL, median (95% CI) age at onset of puberty was 10.9 (10.5–11.3) years, again similar to the study performed in 1996 which was 11.0 (10.7–11.4) (p = .32). Median (95% CI) age of pubic hair development was 11.2 (10.8–11.6) years versus 11.5 (11.1–12.0) years in 1996, p = .015.

Conclusions

Our data provide no evidence of a secular trend for gonadarche in Greek boys, although such a trend was evident for pubarche.     

Outcome of TORS to tongue base and epiglottis in patients with OSA intolerant of conventional treatment

Purpose

Transoral robotic surgery (TORS) of the tongue base with or without epiglottoplasty represents a novel treatment for obstructive sleep apnea (OSA). The objective was to evaluate the clinical efficacy of TORS of the tongue base with or without epiglottoplasty in patients who had not tolerated or complied with conventional treatment (continuous positive airway pressure or oral appliance).

Methods

Four-year prospective case series. The primary outcome measure was the apnea-hypopnea index (AHI) in combination with the Epworth Sleepiness Score (ESS). Mean oxygen saturation levels (SaO₂) before and after TORS on respective sleep studies were also recorded. Secondary outcome measures included operative time and complications. Patient reported outcome measures (PROMs) assessed included voice, swallow and quality of life.

Results

Fourteen patients underwent TORS for tongue base reduction with ten having additional wedge epiglottoplasty. A 64 % success rate was achieved with a normal post-operative sleep study in 36 % of cases at 6 months. There was a 51 % reduction in the mean AHI (36.3?±?21.4 to 21.2?±?24.6, p?=?0.02) and a sustained reduction in the mean Epworth Sleepiness Score (p?=?0.002). Mean SaO₂ significantly increased after surgery compared to pre-operative values (92.9?±?1.8 to 94.3?±?2.5, p?=?0.005). Quality of life showed a sustained improvement 3 months following surgery (p?=?0.01). No major complications occurred.

Conclusions

TORS of the tongue base with or without epiglottoplasty represents a promising treatment option with minimal morbidity for selected patients with OSA. Long-term prospective comparative evaluation is necessary to validate the findings of this study.

     

Twenty‐Four–Hour Urine α1‐Microglobulin as a Marker of Hypertension‐Induced Renal Impairment and Its Response on Different Blood Pressure–Lowering Drugs

The purpose of this study was to assess the role of urine α₁‐microglobulin as a marker of hypertension‐induced renal damage compared with estimated glomerular filtration rate, (eGFR), urine albumin, and urine albumin‐to‐creatinine ratio (ACR). Its response on different blood pressure (BP)–lowering drugs was also studied. Sixty never‐treated hypertensive patients (65.0% men, 46.9 years, BP 141.4/94.0 mm Hg) were randomized to an irbesartan (an angiotensin receptor blocker [ARB]) or a diltiazem (a nondihydropyridine calcium channel blocker [CCB])‐based regimen. Patients with diabetes or established cardiovascular, renal, or liver disease were excluded. Blood samples and 24‐hour urine were analyzed at baseline and 6 months after pharmaceutical BP normalization. Serum creatinine was measured and eGFR was calculated. Urine albumin, creatinine, and α₁‐microglobulin were measured and ACR was calculated. Minor changes (P=not significant [NS]) in eGFR were noted during follow‐up in both groups (from 111.0 mL/min/1.73 m² to 108.4 mL/min/1.73 m² in the ARB group and from 111.3 mL/min/1.73 m² to 114.0 mL/min/1.73 m² in the CCB group). Twenty‐four–hour urine indices were all significantly improved (P<.01) in the ARB group (albumin from 19.4 mg/L to 8.2 mg/L, ACR from 21.5 mg/g to 10.0 mg/g, α₁‐microglobulin from 5.06 mg/L to 3.64 mg/L) but not (P=NS) in the CCB group (albumin from 15.6 mg/L to 13.9 mg/L, ACR from 17.6 mg/g to 17.1 mg/g, α₁‐microglobulin from 4.94 mg/L to 4.79 mg/L). These differences between groups remained significant (P<.05) after adjusting for office heart rate and BP. α₁‐Microglobulin was significantly correlated (P<.05) with albumin and ACR both at baseline (r=0.283 and 0.299, respectively) and at the end of follow‐up (r=0.432 and 0.465, respectively) but not (P=NS) with eGFR. It was also significantly related (P<.05) to cardiovascular risk scores (Framingham and HeartScore) both at baseline (r=0.264 and 0.436, respectively) and at the end of follow‐up (r=0.308 and 0.472, respectively). Urine α₁‐microglobulin emerges as a potentially usable marker of hypertension‐induced renal impairment. Its excretion rate and its response to treatment appears similar to that of albumin. Irbesartan but not diltiazem seems to be associated with reduced excretion of α₁‐microglobulin in urine.     

Surgical oncology during the post-COVID-19 era: What is next?

During first outburst of COVID-19, several strategies had been applied for surgical oncology patients to minimize COVID-19 transmission. COVID-19 infection seemed to compromise survival and major complication rates of surgical oncology patients. However, survival, tumor progression and recurrence rates of surgical oncology patients were associated to the consequences of COVID-19 pandemic on their management. In addition, the severity of COVID-19 infections has been downgraded. Therefore, management of surgical oncology patients should be reconsidered.     

A diagnostically‐challenging case of melanoma ex blue nevus with comprehensive molecular analysis,including the 23‐gene expression signature (myPath melanoma)

Melanoma ex blue nevus (MEBN) is a rare, aggressive, and potentially lethal neoplasm. Distinguishing MEBN from an atypical cellular blue nevus can be very challenging. We report a diagnostically difficult case of MEBN with lymph node metastases, in which single nucleotide polymorphism array and fluorescence in situ hybridization were used to arrive at the correct diagnosis. It was also analyzed by the recently‐introduced proprietary 23‐gene expression signature test. To the best of our knowledge, this is the second reported case of MEBN analyzed by the 23‐gene expression signature, which provided a false‐negative result. More studies are needed to assess the sensitivity and specificity of this test in various melanocytic proliferations.     

A case-control study of paternal and maternal age as risk factors in mood disorders

Objective: Advanced parental age might constitute a risk factor for various disorders. We tested whether this concerns also mood disorder patients.

Methods: The study included 314 subjects (42 bipolar-BD patients; 21 manics and 21 depressives, 68 unipolar-UD, and 204 normal controls-NC). Analysis of Covariance (ANCOVA) and the calculation of the Relative Risk (RR) and the Odds Ratio (OR) were used for the analysis.

Results: Paternal age differed between NC and UD patients (29.42?±?6.07 vs. 32.12?±?5.54; p?=?.01) and manics (29.42?±?6.07 vs. 35.00?±?5.75; p?=?.001) and maternal age between NC and manics (25.46?±?4.52 vs. 31.43?±?4.75; p?<?.001) and manic and UD (31.43?±?4.75 vs. 26.75?±?6.03; p?=?.002). The RR and OR values suggested that advanced parental age constitutes a risk factor for the development of mood disorders.

Conclusions: In a non-dose dependent and gender-independent, advanced parental age constitutes a risk factor for the development of BD with index episode of mania (probably manic predominant polarity); only advanced paternal age constitutes a risk factor for the development of UD and BD with index episode of depression (probably depressive predominant polarity). This is the first study suggesting differential effect of advanced parental age depending on predominant polarity of BD.     

Repeat CRS/HIPEC: It Comes Down to Tumor Biology and Ability to Achieve a Complete CRS

Annals of Surgical Oncology -