Do sperm and lubricants gel well with each other? A systematic review.

Vaginal lubricants are commonly used to aid sexual pleasure and/or to help combat vaginal dryness and dyspareunia. Several studies have reported their impact on sperm function, however there are no published guidelines to help healthcare professionals and couples select a vaginal lubricant that is 'sperm-safe'. To address this, we conducted a literature search using both PubMed and Scopus to identify and appraise manuscripts that reported the impact of lubricants on sperm function. We did not restrict the literature search by year of publication, and we only included manuscripts that looked at the impact of vaginal lubricants on human sperm. The quality of the eligible studies was assessed using the Björndahl et al., (2016) checklist for semen analysis, as most of the studies reported the findings of a basic semen analysis. A total of 24 articles were eligible for analysis with a total of 35 vaginal lubricants (that were available to buy over the counter) being included, 2 of which studied the effect of vaginal lubricants on sperm function in vivo, and 22 being conducted in vitro. KY Jelly, PreSeed and Astroglide were most studied, with most manuscripts focussing on their impact on sperm motility. A paucity of data on most lubricants combined with methodological variations between studies and limited/no reporting on pregnancy outcomes means greater efforts are required before an evidence-based guideline can be published.

Accuracy of imaging modalities for adnexal torsion: a systematic review and meta-analysis.

BACKGROUND: Adnexal torsion (AT), a serious gynaecological emergency, often presents with non-specific symptoms leading to delayed diagnosis. OBJECTIVE: To compare the test accuracy of ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) to diagnose AT. SEARCH STRATEGY: We searched EMBASE, MEDLINE and Cochrane CENTRAL until December 2019. SELECTION CRITERIA: Studies reporting on the accuracy of any imaging modality (Index Test) in female patients (paediatric and adult) suspected of AT compared with surgical diagnosis and/or standard clinical/radiological follow-up period until resolution of symptoms (Reference Standard). DATA COLLECTION AND ANALYSIS: We assessed study quality using QUADAS-2. We conducted test accuracy meta-analysis using a univariate model or a hierarchical model. MAIN RESULTS: We screened 3836 citations, included 18 studies (1654 women, 665 cases), and included 15 in the meta-analyses. Ultrasound pooled sensitivity (n = 12, 1187 women) was 0.79 (95% CI 0.63-0.92) and specificity was 0.76 (95% CI 0.54-0.93), with negative and positive likelihood ratios of 0.29 (95% CI 0.13-0.66) and 4.35 (95% CI 2.03-9.32), respectively. Using Doppler with ultrasound (n = 7, 845 women) yielded similar sensitivity (0.80, 95% CI 0.67-0.93) and specificity (0.88, 95% CI 0.72-1.00). For MRI (n = 3, 99 women), the pooled sensitivity was 0.81 (95% CI 0.63-0.91) and specificity was 0.91 (95% CI 0.80-0.96). A meta-analysis for CT was not possible with two case-control studies and one cohort study (n = 3, 232 women). Its sensitivity range was 0.74-0.95 and specificity was 0.80-0.90. CONCLUSIONS: Ultrasound has good performance as a first-line diagnostic test for suspected AT. Magnetic resonance imaging could offer improved specificity to investigate complex ovarian morphology, but more evidence is needed. TWEETABLE ABSTRACT: To investigate adnexal torsion, ultrasound is a good first-line diagnostic test with a pooled sensitivity of 0.79 and specificity of 0.76.

Provision of obstetrics and gynaecology services during the COVID-19 pandemic: a survey of junior doctors in the UK National Health Service.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic is disrupting health services worldwide. We aimed to evaluate the provision of obstetrics and gynaecology services in the UK during the acute phase of the COVID-19 pandemic. DESIGN: Interview-based national survey. SETTING: Women's healthcare units in the National Health Service. POPULATION: Junior doctors in obstetrics and gynaecology. METHODS: Participants were interviewed by members of the UK Audit and Research in Obstetrics and Gynaecology trainees' collaborative between 28 March and 7 April 2020. We used a quantitative analysis for closed-ended questions and a thematic framework analysis for open comments. RESULTS: We received responses from 148/155 units (95%), most of the participants were in years 3-7 of training (121/148, 82%). Most completed specific training drills for managing obstetric and gynaecological emergencies in women with COVID-19 (89/148, 60.1%) and two-person donning and doffing of Personal Protective Equipment (PPE) (96/148, 64.9%). The majority of surveyed units implemented COVID-19-specific protocols (130/148, 87.8%), offered adequate PPE (135/148, 91.2%) and operated dedicated COVID-19 emergency theatres (105/148, 70.8%). Most units reduced face-to-face antenatal clinics (117/148, 79.1%) and suspended elective gynaecology services (131/148, 88.5%). The 2-week referral pathway for oncological gynaecology was not affected in half of the units (76/148, 51.4%), but half reported a planned reduction in oncology surgery (82/148, 55.4%). CONCLUSION: The provision of obstetrics and gynaecology services in the UK during the acute phase of the COVID-19 pandemic seems to be in line with current guidelines, but strategic planning is needed to restore routine gynaecology services and ensure safe access to maternity care in the long term. TWEETABLE ABSTRACT: Provision of obstetrics and gynaecology services during the acute phase of COVID-19 is in line with current guidelines, strategic planning is needed to restore routine services and ensure safe access to care in the long term.

The Use of Neutron Analysis Techniques for Detecting The Concentration And Distribution of Chloride Ions in Archaeological Iron.

Chloride (Cl) ions diffuse into iron objects during burial and drive corrosion after excavation. Located under corrosion layers, Cl is inaccessible to many analytical techniques. Neutron analysis offers non-destructive avenues for determining Cl content and distribution in objects. A pilot study used prompt gamma activation analysis (PGAA) and prompt gamma activation imaging (PGAI) to analyse the bulk concentration and longitudinal distribution of Cl in archaeological iron objects. This correlated with the object corrosion rate measured by oxygen consumption, and compared well with Cl measurement using a specific ion meter. High-Cl areas were linked with visible damage to the corrosion layers and attack of the iron core. Neutron techniques have significant advantages in the analysis of archaeological metals, including penetration depth and low detection limits.

Hypogonadism secondary to hyperprolactinaemia: successful treatment but adverse consequences.

It is accepted that care must be taken in initiating testosterone replacement in hypogonadal individuals with historically low androgen levels. However less is reported about the influence of restoration of normal endogenous testosterone production on behaviour.Here we report how the adverse sequelae of successful treatment of hypogonadism secondary to hyperprolactinaemia, manifesting as irritability and low threshold to aggression, were managed through a joint approach between psychiatrist and physician.

Cancer of ileostomy: a late complication of colectomy for ulcerative colitis.

Cancer arising at an ileostomy site represents a rare late complication of total colectomy performed for ulcerative colitis. There are no more than 36 published cases in the literature. We describe a case of adenocarcinoma of the mucocutaneous junction at the ileostomy site, occurring 31 years after total colectomy for ulcerative colitis. Wide excision of the moderately differentiated adenocarcinoma was performed with refashioning of the ileostomy. Polypoid adenomas or adenocarcinomas of the ileostomy after colectomy performed for non-neoplastic conditions are extremely uncommon. Biopsies of polypoid lesions at the stoma site are recommended.

Increased platelet depleted plasma 5-hydroxytryptamine concentration following meal ingestion in symptomatic female subjects with diarrhoea predominant irritable bowel syndrome.

BACKGROUND: Meal ingestion is often associated with exacerbation of gastrointestinal symptoms in subjects with irritable bowel syndrome (IBS). Furthermore, recent preliminary data suggest that 5-hydroxytryptamine (5-HT) concentration in platelet poor plasma is elevated following meal ingestion in some subjects with diarrhoea predominant IBS (d-IBS) compared with healthy subjects, although it is not known whether this is related to postprandial symptomatology. AIM: To expand on previous data by evaluating a larger number of subjects but also to assess plasma 5-hydroxyindole acetic acid (5-HIAA) concentrations, 5-HT turnover, platelet 5-HT stores, and any relationship to symptomatology. METHODS: We assessed platelet depleted plasma 5-HT and 5-HIAA concentrations for two hours (60 minute intervals) under fasting conditions, and then for a further four hours (30 minute intervals) after a standard carbohydrate meal (457 kcal), together with fasting platelet 5-HT concentrations in 39 female subjects with d-IBS (aged 19-52 years; mean age 33) and 20 healthy female volunteers (aged 20-46 years, mean age 28). IBS symptomatology, in particular abdominal pain and bloating, and urgency to defecate were assessed throughout the study RESULTS: When related to fasting levels, there was no statistically significant difference in postprandial plasma 5-HT concentrations between d-IBS and healthy subjects. However, when fasting levels were not taken into consideration, d-IBS subjects exhibited higher postprandial plasma 5-HT concentrations compared with healthy subjects (p=0.040). Furthermore, d-IBS subjects who exhibited postprandial symptomatology had higher levels of postprandial plasma 5-HT, whether assessed with respect to fasting baseline levels (p=0.069) or not (p=0.047), compared with d-IBS subjects who did not report postprandial symptomatology. This appeared to be associated with a concomitant increase in plasma 5-HIAA (p=0.161) but reduction in turnover (p=0.058). Lastly, d-IBS subjects had higher platelet concentrations of 5-HT than healthy subjects (p=0.009). CONCLUSIONS: These data suggest that postprandial symptomatology may be associated with increased platelet depleted plasma 5-HT concentrations in female subjects with d-IBS. In addition, the presence of increased platelet stores of 5-HT may act as a useful marker for the diagnosis and management of d-IBS.

The use of cold therapy in the postoperative management of patients undergoing arthroscopic anterior cruciate ligament reconstruction.

In this prospective, randomized study we assessed the use of cold therapy after arthroscopic anterior cruciate ligament reconstruction. Seventy-one patients were randomly allocated, without the knowledge of the single surgeon, to one of three groups: Group I had an ice water-filled CryoCuff fitted in the operating theater after surgery, Group II had room temperature water in the CryoCuff, and Group III patients had no CryoCuff. Patients were well matched for age, sex, and associated surgery. An independent observer measured blood loss, analgesic use, range of motion, and visual analog pain scores postoperatively. There were no differences between any of the three groups regarding the variables measured. The use of cold therapy devices as an adjunct to the postoperative management of these patients must be questioned.

Localization of insulin-like growth factor-I immunoreactivity in larval and juvenile barramundi (Lates calcarifer).

Antisera to mammalian IGFs cross-react with several fish species, suggesting a long phylogenetic history of IGF-like peptides and their functional importance to all vertebrates. In this study, the tissue distribution of IGF-I-immunoreactivity (IGF-I-IR) was studied at various larval and juvenile stages of the life cycle of barramundi (Lates calcarifer). It was shown that the distribution of IGF-I-IR in this species was tissue-specific and age-dependent. In newly hatched larvae, presumptive musculature in the trunk and the pectoral fin rudiments reacted positively for IGF-I. As specimen age increased, however, IGF-I-IR in these tissues became less evident. In the retinas of barramundi 42 hr and older, a distinct band of IGF-I-IR was consistently detected between the presumptive outer nuclear and bacillary layers. Examination of sections from specimens 9 days and older revealed strong reactivity for IGF-I in a large proportion of renal tubule epithelial cells. In sections from larvae 13 to 28 days old, diffuse cytoplasmic IGF-I-IR was identified in cells lining the gill structures. At these same developmental stages, IGF-I reactive cells were also observed in the islets of Langerhans. In young juveniles (22 to 28 days posthatching), sparsely scattered clusters of neurons in the lower brain were observed which exhibited granular IGF-I-IR in perikarya. In all instances reported, IGF-I-IR in barramundi tissue was abolished by replacing antisera with normal rabbit serum or by preabsorption of antisera with purified IGF-I peptide, indicating the specificity of the reactions obtained. The distribution patterns of IGF-I-IR in barramundi tissues were broadly consistent with the reported distributions of IGF-I-like peptides and transcripts in other teleost species. The findings of this study are in general agreement with the hypothesis that IGF-I-like peptides may be involved in the regulation of tissue growth, differentiation, and function during early barramundi development.

Failure strengths of different meniscal suturing techniques.

The aim of this study was to measure the failure strengths of three arthroscopic meniscal suturing methods. The techniques investigated were a single horizontal loop, a double vertical loop, and a single vertical loop. Eleven human, lateral menisci obtained at autopsy were cut with a scalpel to simulate peripheral longitudinal tears. The menisci were then repaired with one suture at a time, using each of the three methods in turn. The two parts of the meniscus were then pulled apart using a computer-controlled materials testing machine until failure occurred, either by the suture itself failing or by the suture pulling out because of tearing of the meniscus. The horizontal sutures had a mean failure strength of 29.3 N, whereas the double vertical loop failed at 63.2 N and the single vertical loop at 67.3 N. The horizontal loop sutures and the double vertical loop sutures all failed by pulling out of the meniscus. The single vertical loop sutures failed by rupture of the suture itself. This study showed the superior mechanical characteristics of the single vertical loop suturing system over the other techniques tested. Owing to the more consistent failure strength, decreased costs, and shorter surgical time over the double vertical loop system, the single vertical loop technique is recommended for arthroscopic meniscal repair.

Radiology workload--a solution reviewed after 14 years' experience.

A method of controlling the radiological workload in a district general hospital, based on an estimation of the reasonable capacity of the department, was introduced in 1978. Measurement of the number of examinations performed compared with the estimated reasonable capacity shows that the method has been effective. An immediate 25% reduction in examinations was followed by a workload which varied between -4% and +16% of the capacity. An increase in the proportion of complex examinations in the period under review has been recognized. The method has encouraged referring doctors to exercise restraint and adopt guidelines, and helped persuade managers to increase capacity by appointing additional radiologists.

Accidental injection of white spirit into the hand in golfers.

We report two cases in which white spirit has been injected accidentally into the hand by golfers, while attempting to remove the grip of the golf-club handle in order to replace it. One of our patients has anecdotal evidence of this happening in at least two other cases, one of which resulted in amputation of the index finger, and the other in severe damage to the thumb.

Early migration of prostheses related to long-term survivorship. Comparison of tibial components in knee replacement.

We determined the cumulative survival rates, in arthroplasty of the knee, of three designs of tibial component, using a change of position on standard radiographs or revision for aseptic loosening as criteria of failure. The average migration of each of the three designs in the first postoperative year is known from roentgen stereophotogrammetric analysis reported by other authors. The ranking order of the components as judged by cumulative survival is the same as that determined by early migration. This finding supports the view that the measurement of early migration can predict late aseptic loosening and therefore that such measurements are clinically of value.

Cellular pathology of the nerve microenvironment in galactose intoxication.

The effect of chronic hyperglycemia and polyol pathway activation on the Schwann cell has not been resolved although injury to this cell has long been suspected in diabetic neuropathy. Hyperglycemia, resulting from galactose intoxication of four months duration, induces dose-dependent accumulations of endoneurial fluid sodium and chloride that are linked to polyol pathway activity and associated with dose-dependent increases in sciatic nerve water content, endoneurial fluid pressure and (Na+, K+)-ATPase activity. In order to understand the impact of these changes on the nerve microenvironment, cellular elements of the endoneurium were quantitatively and qualitatively assessed in rats receiving 0%, 10%, 20% or 40% galactose diets. After four months of galactose intoxication, dose-dependent changes in the size distribution of myelinated nerve fibers were apparent. A shift in size-frequency histograms of galactose-intoxicated animals towards smaller fibers was accompanied by a decrease in axon diameter and the volume fraction ratio of axon to myelinated nerve fibers. In the sciatic nerve of all 40% galactose-fed rats examined by electron microscopy, Schwann cells of myelinated fibers showed both reactive and degenerative changes. Demyelination was preceded by splitting at the intraperiod line. Remyelination was identified by axons with disproportionately thin myelin sheaths. Axonal dystrophy and degeneration were infrequently seen, but there was axonal regeneration. Dose-dependent increases in mast cell number were observed with degranulation apparent in rats receiving 20% and 40% galactose. Endothelial cell number and basal lamina thickness were increased in the endoneurial vessels of galactose-intoxicated rats. Increased cytoplasmic area and degenerative changes in pericytes were also noted. These observations indicate that significant morphologic changes accompany the hyperosmotic imbalance resulting from galactose intoxication of four months duration. Schwann cell injury and demyelination are present in a disorder linked to polyol metabolism since aldose reductase, the anabolic enzyme of the polyol pathway, is localized to this myelin-forming cell.

Bleomycin lung: computed tomographic observations.

Changes characteristic of bleomycin lung were seen in 15 out of 18 patients whose lungs were examined by computed tomography following standard chemotherapy for testicular cancers. These changes affected mainly the posterior aspects of the lungs and were predominantly subpleural in nature. The total dose of bleomycin given did not appear to correlate with the grade of bleomycin damage. Amongst six patients with adequate follow-up studies there has been improvement in the CT appearance of three.

Thin-walled ring shadows in early pulmonary sarcoidosis.

The appearance of ring shadows on the chest radiograph of patients with sarcoidosis is usually associated with generalised, irreversible pulmonary fibrosis. We report three patients in whom thin-walled ring shadows appeared early in the disease. These ring shadows occurred in areas of pre-existing lung shadowing and in two patients they disappeared with corticosteroid therapy over a period of 1-2 years. We postulate that these early sarcoid ring shadows may be caused by a combination of central necrosis of areas of coalescent granulomas and a check-valve mechanism beyond partial obstruction of airways by endobronchial sarcoidosis.