Gonadotropins for pubertal induction in males with hypogonadotropic hypogonadism: systematic review and meta-analysis.

OBJECTIVE: Hypogonadotropic hypogonadism is characterized by inadequate secretion of pituitary gonadotropins, leading to absent, partial, or arrested puberty. In males, classical treatment with testosterone promotes virilization but not testicular growth or spermatogenesis. To quantify treatment practices and efficacy, we systematically reviewed all studies investigating gonadotropins for the achievement of pubertal outcomes in males with hypogonadotropic hypogonadism. DESIGN: Systematic review and meta-analysis. METHODS: A systematic review of Medline, Embase, Global Health, and PsycINFO databases in December 2022. Risk of Bias 2.0/Risk Of Bias In Non-randomized Studies of Interventions/National Heart, Lung, and Blood Institute tools for quality appraisal. Protocol registered on PROSPERO (CRD42022381713). RESULTS: After screening 3925 abstracts, 103 studies were identified including 5328 patients from 21 countries. The average age of participants was <25 years in 45.6% (n = 47) of studies. Studies utilized human chorionic gonadotropin (hCG) (n = 93, 90.3% of studies), human menopausal gonadotropin (n = 42, 40.8%), follicle-stimulating hormone (FSH) (n = 37, 35.9%), and gonadotropin-releasing hormone (28.2% n = 29). The median reported duration of treatment/follow-up was 18 months (interquartile range 10.5-24 months). Gonadotropins induced significant increases in testicular volume, penile size, and testosterone in over 98% of analyses. Spermatogenesis rates were higher with hCG + FSH (86%, 95% confidence interval [CI] 82%-91%) as compared with hCG alone (40%, 95% CI 25%-56%). However, study heterogeneity and treatment variability were high. CONCLUSIONS: This systematic review provides convincing evidence of the efficacy of gonadotropins for pubertal induction. However, there remains substantial heterogeneity in treatment choice, dose, duration, and outcomes assessed. Formal guidelines and randomized studies are needed.

Sarcopenia and Sarcopenic Obesity on Body Composition Analysis is a Significant Predictor of Mortality in Severe Acute Pancreatitis: A Longitudinal Observational Study.

BACKGROUND: The prevalence and impact of sarcopenia and sarcopenic obesity noted on body composition analysis in severe acute pancreatitis (SAP) is unknown. This study investigates the prevalence of sarcopenia at different timepoints and its effect on post-pancreatitis complications and mortality. METHODS: A prospective database of SAP admissions with organ failure at a single institution from 2015 to 2019 were analysed. Sarcopenia was determined by IMAGE J software on CT. Database was further queried for post-pancreatitis complications and mortality. RESULTS: 141 patients with a median age of 59 (range 18-88) and M:F ratio 1.52:1 of were analysed. Sarcopenia was present in 111/141 (79%) patients at admission, 78/79 (99%) at 3 months and 26/36 (72%) at 12 months. 67/111 patients with sarcopenia on admission had sarcopenic obesity. The mortality at 30 days, 3 months and 12 months was 16/141 (11%), 30/141 (21%) and 42/141 (30%) respectively. Mortality was significantly higher in sarcopenic patients at admission (35.14%) compared to the non-sarcopenic group (10%), P = 0.008). Mortality in the sarcopenic obesity group was significantly higher (45%) compared to the sarcopenic non-obese group (20%), P = 0.009) at admission. Multivariate logistic regression identified sarcopenic obesity (OR: 2.880), age (OR: 1.048) and number of organ failures (OR: 3.225) as significant predictors of mortality. CONCLUSIONS: Sarcopenia and Sarcopenic obesity are highly prevalent in SAP patients on admission and during follow up. Furthermore, sarcopenic obesity was shown to be a significant predictor of mortality at admission, suggesting that body composition analysis could be a potential predictive marker of mortality in SAP patients.

Recent gravity-assist trajectories for interplanetary and solar exploration.

This paper describes how lunar and planetary gravity assists have been used to design trajectories that have enabled challenging missions, currently flying or in development, at the Applied Physics Laboratory (APL) of Johns Hopkins University, to explore the Sun, and the planets closest to and farthest from it. This is a continuation of a paper presented at the first New Trends in Astrodynamics and Applications conference, January 2003. That paper concentrated on the Third International Sun-Earth Explorer (ISEE-3) halo orbit mission, later known as the International Cometary Explorer, or ICE, and the Near Earth Asteroid Rendezvous (NEAR) mission of APL, and the ground-breaking orbits that those spacecraft used to accomplish their ambitious goals. This paper gives much more information about current APL missions, MESSENGER, STEREO, and New Horizons, which were only briefly described in the previous paper.

Background and applications of astrodynamics for space missions of the johns hopkins applied physics laboratory.

This paper describes astrodynamic techniques applied to develop special orbital designs for past and future space missions of the Applied Physics Laboratory (APL) of Johns Hopkins University, and background about those techniques. The paper does not describe the long history of low Earth-orbiting missions at APL, but rather concentrates on the astrodynamically more interesting high-altitude and interplanetary missions that APL has undertaken in recent years. The authors developed many of their techniques in preparation for, and during, the Third International Sun-Earth Explorer (ISEE-3) halo orbit mission while they worked for the Goddard Space Flight Center (GSFC) of NASA during the 1970s and 1980s. Later missions owed much to the ground breaking work of the trajectory designs for ISEE-3 (later known as the International Cometary Explorer, or ICE). This experience, and other new ideas, were applied to the APL near Earth asteroid rendezvous (NEAR) and comet nucleus tour (CONTOUR) discovery missions, as well as to APL's future MESSENGER, STEREO, and New Horizons missions. These will be described in the paper.