J.C. Trussell

BioGlue and Dermabond save time, leak less, and are not mechanically inferior to two-layer and modified one-layer vasovasostomy

OBJECTIVE To compare operative time, patency, and integrity of glue-assisted versus suture-only vasovasostomies. DESIGN A Medline search revealed no vasovasostomy studies testing tissue adhesives other than fibrin. We compare glue-reinforced to suture-only vasovasostomies. SETTING An academic medical center. PATIENT(S) None. INTERVENTION(S) Using bull vas deferens, we performed: [1] two-layer anastomoses, [2] modified one-layer anatomoses, and [3] Bioglue, Dermabond, or CoSeal-reinforced anastomoses supported by three transmural sutures. MAIN OUTCOME MEASURE(S) Operative times were recorded, patency verified, and microscopic dissection performed to rule out luminal glue intravasation. Destructive mechanical testing was then completed with statistical comparison of load to failure, displacement to failure, and linear stiffness. RESULT(S) Operative time was greatest for two-layer anastomoses and significantly reduced for all three glue-reinforced three-suture anastomoses. All techniques were patent and free of glue intravasation. BioGlue and Dermabond demonstrated greater integrity than all other techniques. Mechanically, BioGlue and Dermabond were superior to both the unreinforced three stitch and CoSeal groups and were capable of resisting higher loads before failure. CONCLUSION(S) Glue-reinforced anastomoses are significantly less time consuming than traditional techniques. BioGlue and Dermabond have greater mechanical integrity and may be superior to both CoSeal and the sutured techniques.

Racial and ethnic differences in the polycystic ovary syndrome metabolic phenotype

BACKGROUND: Women with polycystic ovarian syndrome have a high prevalence of metabolic syndrome and type 2 diabetes mellitus. Blacks and Hispanics have a high morbidity and mortality due to cardiovascular disease and diabetes mellitus in the general population. Since metabolic syndrome is a risk factor for development of type 2 diabetes and cardiovascular disease, understanding any racial and ethnic differences in metabolic syndrome among women with polycystic ovarian syndrome is important for prevention strategies. However, data regarding racial/ethnic differences in metabolic phenotype among women with polycystic ovary syndrome are inconsistent. OBJECTIVE: We sought to determine if there are racial/ethnic differences in insulin resistance, metabolic syndrome, and hyperandrogenemia in women with polycystic ovarian syndrome. STUDY DESIGN: We conducted secondary data analysis of a prospective multicenter, double‐blind controlled clinical trial, the Pregnancy in Polycystic Ovary Syndrome II study, conducted in 11 academic health centers. Data on 702 women with polycystic ovarian syndrome aged 18‐40 years who met modified Rotterdam criteria for the syndrome and wished to conceive were included in the study. Women were grouped into racial/ethnic categories: non‐Hispanic whites, non‐Hispanic blacks, and Hispanic. The main outcomes were the prevalence of insulin resistance, metabolic syndrome, and hyperandrogenemia in the different racial/ethnic groups. RESULTS: Body mass index (35.1 ± 9.8 vs 35.7 ± 7.9 vs 36.4 ± 7.9 kg/m2) and waist circumference (106.5 ± 21.6 vs 104.9 ± 16.4 vs 108.7 ± 7.3 cm) did not differ significantly between non‐Hispanic white, non‐Hispanic black, and Hispanic women. Hispanic women with polycystic ovarian syndrome had a significantly higher prevalence of hirsutism (93.8% vs 86.8%), abnormal free androgen index (75.8% vs 56.5%), abnormal homeostasis model assessment (52.3% vs 38.4%), and hyperglycemia (14.8% vs 6.5%), as well as lower sex hormone binding globulin compared to non‐Hispanic whites. Non‐Hispanic black women had a significantly lower prevalence of metabolic syndrome (24.5% vs 42.2%) compared with Hispanic women, and lower serum triglyceride levels compared to both Hispanics and non‐Hispanic whites (85.7 ± 37.3 vs 130.2 ± 57.0 vs 120.1 ± 60.5 mg/dL, P < .01), with a markedly lower prevalence of hypertriglyceridemia (5.1% vs 28.3% vs 30.5%, P < .01) compared to the other 2 groups. CONCLUSION: Hispanic women with polycystic ovarian syndrome have the most severe phenotype, both in terms of hyperandrogenism and metabolic criteria. Non‐Hispanic black women have an overall milder polycystic ovarian syndrome phenotype than Hispanics and in some respects, than non‐Hispanic white women.

Epinephrine is associated with both erectile dysfunction and lower urinary tract symptoms

OBJECTIVE To determine whether patients with erectile dysfunction (ED) have a higher incidence of insulin resistance (IR) when compared with controls. DESIGN Prospective case-control study. SETTING Academic medical center. PATIENT(S) Twenty-nine nondiabetic men aged 18-66 years were enrolled. Of these, 28 completed the study: 17 had ED, and 11 did not. INTERVENTION(S) Validated ED questionnaires, examination, serum hormones evaluation, and oral glucose tolerance testing. MAIN OUTCOME MEASURE(S) Association of IR with ED. RESULT(S) The association between worsening degrees of both lower urinary tract symptoms (LUTS) and ED was reaffirmed, as was a potential correlation between the two-epinephrine. There was a negative association between serum levels of epinephrine and scores on the 5-item version of the International Index of Erectile Dysfunction for ED (Spearman correlation coefficient = -0.38). On the other hand, men with ED were not more likely to have IR compared with controls. CONCLUSION(S) Epinephrine may be the common link between ED and LUTS.

Major depression, antidepressant use, and male and female fertility

OBJECTIVE To determine if maternal major depression (MD), antidepressant use, or paternal MD are associated with pregnancy outcomes after non-IVF fertility treatments. DESIGN Cohort study. SETTING Clinics. PATIENT(S) Participants in two randomized trials: PPCOS II (clomiphene citrate versus letrozole for polycystic ovary syndrome), and AMIGOS (gonadotropins versus clomiphene citrate versus letrozole for unexplained infertility). INTERVENTION(S) Female and male partners completed the Patient Health Questionnaire (PHQ-9). Female medication use was collected. PHQ-9 score ≥10 was used to define currently active MD. MAIN OUTCOME MEASURE(S) Primary outcome: live birth. SECONDARY OUTCOMES pregnancy, first-trimester miscarriage. Poisson regression models were used to determine relative risks after adjusting for age, race, income, months trying to conceive, smoking, and study (PPCOS II versus AMIGOS). RESULT(S) Data for 1,650 women and 1,608 men were included. Among women not using an antidepressant, the presence of currently active MD was not associated with poorer fertility outcomes (live birth, miscarriage), but rather was associated with a slightly increased likelihood of pregnancy. Maternal antidepressant use (n = 90) was associated with increased risk of miscarriage, and male partners with currently active MD were less likely to achieve conception. CONCLUSION(S) Currently active MD in the female partner does not negatively affect non-IVF treatment outcomes; however, currently active MD in the male partner may lower the likelihood of pregnancy. Maternal antidepressant use is associated with first-trimester pregnancy loss, which may depend upon the type of antidepressant. CLINICAL TRIAL REGISTRATION NUMBERS NCT00719186 and NCT01044862.

PD49-11 METABOLIC DYSFUNCTION AND HYPOGONADISM IN A COHORT OF YOUNG, HEALTHY MEN

and neuronal nitric oxide synthase (nNOS), tyrosine hydroxylase (TH) and TUNEL assay expression were measured 72h. Gene expression of nNOS, TH, beta-tubulin, Schwann cells (glial fibrillary acidic protein; GFAP), markers of nerve injury (activating transcription factor 3; ATF3) and regeneration (growth associated protein 43, GAP43) was also measured in irradiated MPGs (n1⁄46/grp). RESULTS: In dissociated MPG neuronal cultures, there was an early increase in neuron length, while branching and nNOS positive neurons decreased (p<0.05). Early radiation caused a 2-fold increase in apoptotic neurons (p<0.05). However, the gene expression of neuronal markers beta-tubulin, nNOS, TH and markers of injury and repair (ATF3, GAP43) were all unchanged. There was a marked increase in the gene expression of Schwann cell marker GFAP 2 weeks post-RT (p<0.001). At 10 weeks post-RT, there was a 20% decrease in neuron length, decreased neuron branching, and 20-30% less nNOS and TH positive neurons (p<0.05). Additionally, there was a 2.5 fold increase in the number of TUNEL positive apoptotic neurons (p<0.05). Gene expression of nNOS, TH, GAP43 and ATF3 were all decreased (p<0.05) while GFAP remained considerably elevated (p<0.005). Interestingly, erectile function was not impaired at either time point following radiation. CONCLUSIONS: This is the first study to characterize the health and regeneration potential of MPG neurons following RT. While this model lead to minimal changes in erectile function, neuronal injury was apparent early post-RT and persisted by increasing over time. The nerves are very susceptible to apoptosis and damage from prostatic RT and additional research is necessary to develop radioprotective strategies for exposed benign periprostatic tissues.

MP60-16 HYPOGONADISM IS ASSOCIATED WITH LOWER SPERM MORPHOLOGY AND LOWER LIVE BIRTH RATES IN MEN WITH UNEXPLAINED INFERTILITY

JC Trussell*, Fayetteville, NY; Robert Coward, Chapel Hill, NC; Nanette Santoro, Denver, CO; Christy Stetter, Allen Kunselman, Hershey, PA; Michael Diamond, Augusta, GA; Karl Hansen, Oklahoma City, OK; Stephen Krawetz, Detroit, MI; Richard Legro, Hershey, PA; James Smith, San Francisco, CA; Anne Steiner, Chapel Hill, NC; Pasquale Patrizio, New Haven, CT; Robert Wild, Oklahoma City, OK; Esther Eisenberg, Rockville, MD; Heping Zhang, New Haven, CT; Mark Lindgren, Oklahoma City, OK