Reviewing the Evidence on Vitamin D Supplementation in the Management of Testosterone Status and Its Effects on Male Reproductive System (Testis and Prostate): Mechanistically Dazzling but Clinically Disappointing.

PURPOSE: Vitamin D supplementation has been suggested to increase testosterone levels. The primary purpose of this literature review was to critically assess the physiologic effects of vitamin D supplementation on serum testosterone concentrations in men and the secondary purpose was to evaluate the feasibility of vitamin D status toward urologic health (testis and prostate). METHODS: A structured literature review was performed using the Cochrane, MEDLINE, and Web of Science databases. The literature search encompassed studies published between 2011 and 2019. FINDINGS: Observational studies suggest an association between higher testosterone and serum vitamin D concentrations. Conversely, most randomized clinical trials that investigated the effect of vitamin D administration on testosterone levels have failed to detect any significant effect. Physiologically, vitamin D is engaging in spermatogenesis, but it remains unclear whether vitamin D is a determinant of fertility. With prostate support, the management of vitamin D status has been associated with a decreased prevalence of benign prostatic hyperplasia and symptoms (ie, lower urinary tract symptoms). However, with prostate cancer, there is a paucity of evidence pertaining to vitamin D supplementation. IMPLICATIONS: Mechanistically, vitamin D exhibits essential roles in the testis and prostate; otherwise, there is no apparent evidence to support the use of vitamin D supplementation to increase testosterone levels and to improve clinical outcomes related to the male reproductive system.

Communicating marine climate change impacts in the Caribbean and Pacific regions.

The scientific literature on marine and coastal climate change has proliferated in recent decades. Translating and communicating this evidence in a timely, and accessible manner, is critical to support adaptation, but little is being done to summarise the latest science for decision makers. For Small Island Developing States (SIDS), which are highly vulnerable to marine and coastal climate change impacts, there is an urgent need to make the latest science readily available to inform national policy, leverage climate funding and highlight their vulnerability for international reports and climate negotiations. Climate change report cards are a proven successful way of presenting climate change information in an easily accessible and informative manner. Here we compare the development of marine climate change report cards for Caribbean and Pacific Commonwealth SIDS as a means of translating the latest science for decision makers. Regional engagement, priority issues and lessons learnt in these regions are compared, and future opportunities identified.

Necessity of axillary dissection in elderly women with early breast cancer.

The need for axillary dissection for staging and treating early breast cancer has been questioned recently. Can a patient forego axillary dissection, with its associated costs, risks, and morbidity, if it does not affect survival? The study attempted to find a subset of patients with early breast cancer in whom disease-free survival was independent of axillary lymph node status. If survival does not depend on lymph node status, axillary dissection could be omitted in the care of these patients. This study included 378 women over age 70 with T1 breast cancer diagnosed and treated during January 1992 to December 1999 at both of our institutions: a large tertiary teaching hospital in Columbus, Ohio and a breast cancer treatment center in West Columbia, South Carolina. We compared the disease-free survival, using the Kaplan-Meier estimate, in 334 node-negative patients and 44 node-positive patients with T1 breast cancer. The 3- and 5-year survival rates of patients with T1N0 tumors were 86% and 77%, respectively; and the 3- and 5-year survival rates for T1 node-positive tumors were 81% and 69%, respectively (p = 0.0673). There was no statistical difference between the node-negative and node-positive groups. Axillary dissection in women over 70 years of age with early breast cancer may be unnecessary, as the presence of lymph node metastases does not appear to affect disease-free survival rates significantly in this patient group.