Androgens and estrogens predict sexual function after autologous hematopoietic stem cell transplant in men.

BACKGROUND: Autologous hematopoietic stem cell transplantation (AHSCT) is associated with sexual dysfunction and hypogonadism. Androgens are associated with sexual function in healthy men, but the role of estrogens is less well-known, and the association of these sex steroids with sexual function during AHSCT has not been characterized. OBJECTIVES: The purpose of this study was to determine the predictive value of sex hormones before and acutely after AHSCT on sexual function recovery. MATERIALS AND METHODS: We examined sex hormones and self-reported sexual function before (PRE) and 1-month post-AHSCT (MONTH1; n = 19), and sexual function again 1-year post-AHSCT in men (YEAR1; n = 15). RESULTS: Sexual function decreased from PRE to MONTH1 (p ≤ 0.05) with no differences between PRE and YEAR1. Erectile dysfunction was prevalent at PRE (68.4%) and increased at MONTH1 (100%; p ≤ 0.05) but was not different between PRE and YEAR1 (60.0%). From PRE to MONTH1, total testosterone (TT), dihydrotestosterone (DHT), follicle-stimulating hormone, and sex-hormone-binding globulin (SHBG) increased (p ≤ 0.02) while estradiol (p ≤ 0.026) and estrone decreased (p ≤ 0.001). MONTH1 TT and DHT were associated with sexual function at MONTH1, while PRE SHBG, MONTH1 estradiol, and change in estrone predicted sexual function at YEAR1. DISCUSSION: Sexual dysfunction is very prevalent prior to AHSCT and is transiently and severely worsened acutely after. AHSCT induces acute decreases in total and free estrogens, with SHBG increases leading to increases in total androgens, without changes in free androgens. CONCLUSION: Androgens and estrogens are both adversely affected by AHSCT but may predict sexual dysfunction in this population. This supports the premise that estrogen impacts sexual function independent from androgens and that steroid hormones are associated with acute changes in sexual function in this setting. Larger, controlled trials with long-term sex hormone assessment will need to confirm the association between early changes in estrogens and long-term sexual function recovery.

Assessing Cachexia Acutely after Autologous Stem Cell Transplant.

Autologous hematopoietic stem cell transplantation (AHCT) is an accepted strategy for various hematologic malignancies that can lead to functional impairment, fatigue, muscle wasting, and reduced quality of life (QOL). In cancer cachexia, these symptoms are associated with inflammation, hypermetabolism, and decreased anabolic hormones. The relative significance of these factors soon after AHCT setting is unclear. The purpose of this study was to characterize the acute effects of AHCT on physical function, body composition, QOL, energy expenditure, cytokines, and testosterone. Outcomes were assessed before (PRE) and 30 ± 10 days after (FU) AHCT in patients with multiple myeloma (n = 15) and non-Hodgkin lymphoma (n = 6). Six-minute walk test (6MWT; p = 0.014), lean mass (p = 0.002), and fat mass (p = 0.02) decreased; nausea and fatigue increased at FU (both p = 0.039). Recent weight change and steroid exposure were predictors of reduced aerobic capacity (p < 0.001). There were no significant changes in interleukin (IL)-1ß, IL-6, tumor necrosis factor (TNF), energy expenditure, or bioavailable testosterone. Alterations in cytokines, energy expenditure, and testosterone were not associated with functional impairment acutely following AHCT. Recent history of weight loss and steroid exposure were predictors of worse physical function after AHCT, suggesting that targeting nutritional status and myopathy may be viable strategies to mitigate these effects.

Biomechanical comparison of the docking technique with and without humeral bioabsorbable interference screw fixation.

BACKGROUND: Surgical reconstruction of the ulnar collateral ligament has evolved since Frank Jobe's original description. The "docking technique" is a popular modification that allows for securing the graft within a single humeral tunnel. More recently, interference screw fixation has been introduced as a means of improving the ultimate strength, stiffness, and kinematics of these constructs. PURPOSE: This study was conducted to compare the biomechanical performance of the docking technique with and without interference screw fixation in the humerus. STUDY DESIGN: Controlled laboratory study. METHODS: Nine matched pairs of human cadaveric elbows (age 49.9 +/- 8.0 years) were reconstructed with a tendon graft using the docking technique (group 1) or the docking technique with the addition of a 4.75-mm bioabsorbable humeral interference screw (group 2). Before the reconstruction, joint laxity was measured on each specimen with the ulnar collateral ligament intact and then after transection of the ligament. Laxity measurements were repeated after the reconstruction. Failure testing was then performed at 70 degrees of elbow flexion. The specimens were preloaded with a 1-N.m moment and then loaded to failure at a displacement rate of 14 mm/s to approximate 50% strain per second. RESULTS: Within group 1, the elbow laxity of the reconstructed state was significantly greater than the intact state at all tested flexion angles (P < .021). Within group 2, no statistically significant difference existed in elbow laxity between the intact state and the reconstructed state. When comparing laxities between groups, group 1 tended to be more lax at all tested flexion angles but was only significantly greater at 105 degrees of flexion. The most common mode of failure for both groups involved the sutures pulling out of the tendon. No significant difference was found for ultimate moment of failure between the 2 groups. However, the moment associated with 3 mm of gap formation for group 2 (12.8 +/- 4.2 N x m) was statistically greater than that of group 1 (7.5 +/- 1.2 N x m) (P = .001). The stiffness of group 2 (14.7 +/- 6.4 N/mm) was significantly greater than group 1 (9.9 +/- 3.1 N/mm) (P = .044). CONCLUSION: The biomechanical performance of the docking technique with and without a humeral interference screw is similar. CLINICAL RELEVANCE: The stiffness of the construct, along with the difference in moment that allows a 3-mm gap formation, suggests that the addition of a humeral interference screw is potentially beneficial. Further research in a healing model will help clarify this benefit.