Fnu Deepinder

Adenomas Are Detected More Often in Morning Than in Afternoon Colonoscopy

OBJECTIVES:The effectiveness of colonoscopy in preventing colon cancer depends on adenoma detection and removal. Adequacy of bowel preparation, careful mucosal visualization, and adequate withdrawal time are known to affect adenoma detection rate (ADR). Physician fatigue, which usually increases as the day progresses, might impair ADR. The aim of this study is to assess the effect of timing of colonoscopy, morning vs. afternoon, on ADR.METHODS:Medical records of 9,063 colonoscopies performed in 2006 were reviewed for patient demographics, indications, timing, and findings of colonoscopy. Asymptomatic outpatients who had adequate bowel preparation and complete colonoscopy were included. Morning colonoscopies were defined as those that started before 12 noon and afternoon colonoscopies as those that started after 12 noon. ADR is defined as the detection of at least one adenoma per colonoscopy.RESULTS:A total of 3,619 colonoscopies were included, of which 1,748 (48.3%) were done in the morning and 1,871 (51.7%) were done in the afternoon. ADR was 29.3% in the morning group compared with 25.3% in the afternoon group (P=0.008). There was a trend toward declining ADR for each subsequent hour of the day (P=0.01). In multivariable analysis, colonoscopy in the morning was significantly associated with increased ADR (odds ratio (OR) 1.2 (1.06, 1.4) P=0.006).CONCLUSIONS:Time of performance of colonoscopy seems to be an independent predictor for adenoma detection. ADR was significantly higher in morning colonoscopies than in afternoon colonoscopies. The reasons and implications of this finding should be studied further.

Cell phones and male infertility: dissecting the relationship

There has been a tremendous increase in the use of mobile phones in the past decade and concerns are growing about the possible hazardous effects of radio-frequency electromagnetic waves (EMW) emitted by these devices on human health. Preliminary studies, though with limitations in study design, suggest a possible link between cell phone use and infertility. A recent study found that use of cell phones adversely affects the quality of semen by decreasing the sperm counts, motility, viability and morphology. Evidence of detrimental effect of mobile phones on male fertility is still equivocal as studies have revealed a wide spectrum of possible effects ranging from insignificant effects to variable degrees of testicular damage. Although previous studies suggested a role of cell phone use in male infertility, the mode of action of EMW emitted from cell phones on the male reproductive system is still unclear. EMW can affect the reproductive system via an EMW-specific effect, thermal molecular effect or combination of both. Studies performed on human males are scarce and therefore further studies with a careful design are needed to determine the effect of cell phone use on male-fertilizing potential.

Role of metabolomic analysis of biomarkers in the management of male infertility

Metabolomics is the systematic study of metabolites as small-molecule biomarkers that represent the functional phenotype in a cell, tissue or organism. Detection of crucial disturbances in the concentration of metabolites by metabolomic profiling of key biomarkers can be beneficial in the management of various medical conditions, including male-factor infertility. Recent studies have demonstrated the potential role of this rapid, noninvasive analysis in the investigation of infertile men. Differences in the concentration of oxidative stress biomarkers (–CH, –NH, –OH and ROH) have been found to be uniquely associated with semen plasma of healthy men compared with patients with idiopathic infertility, varicocele and vasectomy reversal. Furthermore, NMR spectra have shown significant differences in citrate, lactate, glycerylphosphorylcholine and glycerylphosphorylethanolamine among semen samples of men with spermatogenesis failure, obstructive azoospermia, oligoasthenoteratozoospermia and healthy donors. Evidence has also shown the value of 31P-magnetic resonance spectroscopy in differentiating patients with testicular failure and ductal obstruction by utilizing phosphomonoester and β-adenosine triphosphate as biomarkers. In addition, metabolomics has shown promise in assisted reproductive techniques. Recent studies involving spectroscopic measurements of follicular fluid and embryo culture media have revealed an association between biomarkers of oxidative stress and pregnancy outcome of oocytes and embryos.

Should seminal oxidative stress measurement be offered routinely to men presenting for infertility evaluation

OBJECTIVE To determine if seminal oxidative stress measurement should be offered routinely to men presenting for infertility evaluation. METHODS We performed an extensive review of the English-language literature by searching MEDLINE for studies published between 1980 and 2007. RESULTS Research conducted during the last decade has provided growing support for the concept that excessive production of reactive oxygen species (ROS) is related to abnormal semen parameters and sperm damage. Routine semen analysis remains the backbone of clinical evaluation in male infertility, but determining the levels and sources of excessive ROS generation in semen is currently not included in the routine evaluation of subfertile men. However, the diagnostic and prognostic capabilities of seminal oxidative stress measurement exceed the capabilities of conventional sperm quality tests. An oxidative stress test may accurately discriminate between fertile and infertile men and identify those with a clinical diagnosis of male factor infertility who are likely to initiate a pregnancy if they are followed over a period of time. In addition, such a test can help select subgroups of patients with infertility in which oxidative stress is an important factor and those who may benefit from antioxidant supplementation. Although consensus is still required about the type and dosage of antioxidants to be used, rationale and evidence exist supporting their use in infertile men with elevated oxidative stress. CONCLUSION Consensus is growing about the clinical utility of seminal oxidative stress testing in infertility clinics, but standardization of protocols to measure ROS is crucial before introducing these tests into routine clinical practice.

Growth and Development of Male External Genitalia: A Cross-sectional Study of 6200 Males Aged 0 to 19 Years

OBJECTIVE To provide estimates of normal variations in penile measurements and testicular volumes, and to establish reference ranges for clinical use. DESIGN Cross-sectional, population-based study. SETTING Schools, kindergartens, and child care centers in different parts of Bulgaria. PARTICIPANTS A population of 6200 clinically healthy white males aged 0 to 19 years. INTERVENTIONS The study physician chose schools, kindergartens, and child care centers randomly and examined children at random until he reached the required number. Each of the 20 age groups (age range, 0-19 years) had an equal number of males (ie, 310). MAIN OUTCOME MEASURES The mean (SD) values and fifth, 50th, and 95th percentiles of height (Siber Hegner anthropometer), weight (beam balance), testicular volume (Prader orchidometer), penile length (rigid tape), and penile circumference (measuring tape) from birth to 19 years of age. RESULTS Testes did not show any increase in size until the onset of puberty at age 11 years, whereas penile growth was gradual after birth. However, both penile and testicular development demonstrated peak growth from 12 to 16 years of age, which coincided with the maximal male pubertal growth spurt. Data indicate an earlier pubertal development for this study population than that for a similar population several decades ago. Significant differences between urban and rural populations regarding penile length were also noticed. CONCLUSIONS Our study provides the contemporary reference range values for height, weight, testicular volume, and penile length and circumference of males aged 0 to 19 years. Our data show that, even by the end of 20th century, there is still some acceleration of male pubertal development. For the first time are reported somatic differences in genitalia within a population between urban and rural representatives.

Technical and ethical challenges of fertility preservation in young cancer patients

As cancer treatment improves, more young men and women survive, but they suffer from infertility as a major sequel of cancer treatment. Gamete and embryo cryopreservation are the only options available to these patients for preserving their fertility. Although cryopreservation of spermatozoa and embryos are already established, oocyte banking is still experimental. The advent of testicular tissue cryopreservation and spermatogonial stem cell transplantation in men, and ovarian tissue cryopreservation and in-vitro follicular maturation in women, has started a frenzy of experiments worldwide trying to demonstrate their potential use in fertility preservation. Although major improvements have been made in tissue cryobanking in the past decade, there are still many unresolved technical issues related to these procedures. Furthermore, the intersection of cancer and fertility preservation in young patients raises ethical, legal and policy issues for oncologists and cancer survivors. Informed consent of minor patients, legal parentage and medical negligence claims are some of the potential legal challenges faced by society and healthcare providers. This review summarizes the technical and ethical challenges of gamete cryopreservation in young cancer patients.

Approach to Fertility Preservation in Adult and Pre-pubertal Males

Recent advances in medicine have led to ever increasing number of pre-pubertal and adult males surviving cancer treatment. This has increased the need to improve the existing technology for cryopreservation of gametes and search for new fertility preservation options. As of today, only sperm cryopreservation is considered accepted standard clinical practices. Fertility preservation options in pre-pubertal males are still experimental. Cryopreservation of testicular tissue and spermatogonial stem cell transplantation should only be offered within IRB-approved clinical protocol after thorough counseling of patients and their family members as there are still many unresolved issues related to these technologies.