Primary and secondary hyperparathyroidism present different expressions of calcium-sensing receptor.

BACKGROUND: Decreased calcium-sensing receptor (CaSR) has been observed in hyperparathyroidism (HPT) without a known mechanism. The purpose of this study was to evaluate the expression of CaSR in primary (PHPT) and secondary (SHPT) subtypes. METHODS: Immunohistochemical (IHC) staining and quantitative real-time PCR (qRT-PCR) assay were used to measure the differences in expression of CaSR protein and gene in PHPT and SHPT human samples, compared to matched controls. RESULTS: CaSR protein was differentially downregulated in SHPT and PHPT compared to normal parathyroid tissues (2.42 ± 0.5 vs. 3.2 ± 0.62, P < 0.05; 1.8 ± 0.83 vs. 3.2 ± 0.62, P < 0.05, respectively). Furthermore, SHPT tissues exhibited significantly higher levels of CaSR mRNA (0.29 ± 0.23 vs. 0.01 ± 0.12, P < 0.05) and protein (2.42 ± 0.5 vs. 1.8 ± 0.83, P < 0.05) than those in PHPT tissue samples. CONCLUSION: Depressed CaSR expression was a critical pathological hallmark of HPT. We found a differential decline of CaSR, in terms of both mRNA and protein levels, in PHPT and SHPT human samples. We think that CaSR dysregulation occurred at the very beginning of disease onset in PHPT, while a similar pathological scenario appeared at the later stage of SHPT. Future studies should be directed to dissect the mechanistic involvement of CaSR in PHPT and SHPT in order to bring treatment precisions in HPT management.

Associations between isoflavone exposure and reproductive damage in adult males: evidence from human and model system studies†.

It is controversial whether exposure to isoflavones exerts male reproductive toxicity. The aim of this study was to investigate whether isoflavone exposure during adulthood could have deleterious impacts on male reproductive health by the cross-sectional study, animal experiments, and in vitro tests. In the cross-sectional study, we observed that urinary isoflavones were not significantly associated with semen quality including sperm concentrations, sperm count, progressive motility, and total motility, respectively. However, negative associations were found between plasma testosterone and urinary Σisoflavones, genistein, glycitein, and dihydrodaidzein. In the animal experiments, serum and intratesticular testosterone levels were decreased in mice exposed to several dosages of genistein. Genistein administration caused upregulation of estrogen receptor alpha and downregulation of cytochrome P45017A1 protein levels in testes of mice. In vitro tests showed that genistein caused a concentration-dependent inhibition of testosterone production by TM3 Leydig cells. Elevated protein expression of estrogen receptor alpha and decreased messenger RNA/protein level of cytochrome P45017A1 were also observed in genistein-treated cells. Protein level of cytochrome P45017A1 and testosterone concentration were significantly restored in the estrogen receptor alpha small interferring RNA-transfected cells, compared to cells that treated with genistein alone. The results demonstrate that exposure to isoflavones during adulthood may be associated with alterations of reproductive hormones. Particularly, genistein, which inhibits testosterone biosynthesis through upregulation of estrogen receptor alpha in Leydig cells of mice, might induce the disruption of testosterone production in human. The present study provides novel perspective into potential targets for male reproductive compromise induced by isoflavone exposure.

Implications of regulator of G-protein signaling 5 expression in the pathogenesis of primary and secondary hyperparathyroidism.

OBJECTIVE: To study the protein and mRNA expressions of regulator of G-protein signaling 5 (RGS5) in the pathogenesis of hyperparathyroidism. METHODS: The expression of RGS5 protein in 20 primary hyperparathyroidism (PHPT), 31 secondary hyperparathyroidism (SHPT), and 20 control cases were studied by immunohistochemistry (IHC). The expression of RGS5 mRNA in 15 PHPT, 102 SHPT, and 7 normal parathyroid tissue were measured by quantitative real-time PCR (qRT-PCR) method. RESULTS: The expressions of RGS5 in PHPT tissues were significantly higher than that in SHPT and normal parathyroid tissues (P < 0.05). While the differences in RGS5 protein expressions between SHPT and respective control samples were not statistically significant (P > 0.05). Likewise, the RGS5 mRNA expression in PHPT was significantly higher than that in SHPT (P < 0.05) and normal parathyroid (P < 0.05) samples. In a similar line, the differences in RGS5 gene expressions between SHPT and control tissues were not statistically significant (P > 0.05). CONCLUSIONS: The characteristic RGS5 protein and mRNA levels in hyperparathyroidism might be helpful in discovering the pathomechanism of hyperparathyroidism and novel therapeutic targets as well.

Semen Quality in Chinese College Students: Associations With Depression and Physical Activity in a Cross-Sectional Study.

OBJECTIVE: Behavioral and psychosocial factors have been associated with a decline of the quality of semen. However, the relationship of depression and physical activity (PA) with semen quality remains unclear. METHODS: Data were obtained from 587 young male Chinese college students in June 2013. Participants completed a questionnaire assessing life-style factors, the Zung self-rated depression scale, and three items related to PA. They underwent a physical examination and provided a semen sample and a blood sample for reproductive hormones (testosterone, estrogen, progesterone, follicle-stimulating hormone, luteinizing hormone, and prolactin). RESULTS: Men with high depression scores (n = 63, 10.7%) had lower sperm concentration (M (SD) = 66.9 (74.5) versus 72.6 (56.9) [10/ml], p = .043) and total sperm count (M (SD) = 241.6 (299.7) versus 257.0 (204.0) [10], p = .024) than nondepressed men. Participants with low PA levels (n = 99, 16.9%) had lower total sperm count (M (SD) = 204.4 (153.7) versus 265.8 (225.8) [10/ml], p = .017) than participants with higher activity levels. After adjusting for potential confounders, depressed men had 18.90% (95% confidence interval [CI] = 1.14%-33.47%) lower sperm concentration and 21.84% (95% CI = 3.39%-36.90%) lower total sperm count than nondepressed men. Men with low PA levels had 23.03% (95% CI = 2.80%-46.89%) lower total sperm count than physically active participants. An interaction effect between depression and PA on sperm concentration was detected (p = .033). There were no significant associations of depression and PA with reproductive hormones (p > .05). CONCLUSIONS: Depression and low levels of PA are associated with lower levels of semen quality, which may have implications for reproductive health.

Exposures to Atmospheric PM10 and PM10-2.5 Affect Male Semen Quality: Results of MARHCS Study.

Studies have shown that the effects of ambient particulate matter (PM) may be related to particle's size. However, results on the relationships between different PM and reproductive health are controversial. To explore the impacts of various PM fractions on male reproductive health, a total of 796 eligible subjects recruited in 2013 baseline investigation. In addition, there were 656 (82.4%) and 568 (71.3%) subjects participated follow-up surveys in 2014 and 2015, respectively. We used multivariable regression analysis and mixed-effect model to investigate the associations between air pollutants PM10, PM10-2.5, and PM2.5 exposures and semen quality, sperm DNA fragmentation and serum reproductive hormones of subjects. In the preliminary regression analysis, PM10, PM10-2.5, and PM2.5 exposure all associated with sperm concentration, morphology, sperm high DNA stainability (HDS), serum estradiol and testosterone levels. However, in mixed models, we only found that PM10 exposure were negatively associated with sperm normal morphology (95% CI: -14.13, -24.47) but positively associated with sperm progressive motility (95% CI: 23.00, 8.49), and PM10-2.5 exposure was inversely associated with sperm concentration (95% CI: -9.06, -27.31) after multiplicity adjustment. Our results provide the evidence that air PM10 and PM10-2.5 exposures, not PM2.5, are risk factors of semen quality.

Anogenital distance is associated with serum reproductive hormones, but not with semen quality in young men.

STUDY QUESTION: Is anogenital distance associated with semen parameters and serum reproductive hormone levels in males? SUMMARY ANSWER: Anogenital distance is associated with serum reproductive hormones, but not with semen quality. WHAT IS KNOWN ALREADY: Epidemiological studies have suggested that anogenital distance (AGD) may be associated with testicular dysfunction in adult men. However, the role of AGD in estimating male reproductive function remains unclear. STUDY DESIGN, SIZE, DURATION: We examined the associations between AGD and semen parameters and reproductive hormones levels in 656 young college students in a Male Reproductive Health in Chongqing College Students (MARHCSs) cohort study in June of 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS: In this study, two variants of AGD (AGDAP and AGDAS) were measured in 656 university students. Serum levels of testosterone (T), estradiol (E2), progesterone (P), prolactin (PRL), luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex hormone-binding globulin (SHBG) and inhibin-B; and semen quality outcomes, including semen volume, sperm concentration, total sperm number, sperm progressive motility, total motility and morphology, were assessed. The associations between AGD and semen parameters/reproductive hormones levels were analyzed using multiple regression analysis. MAIN RESULTS AND THE ROLE OF CHANCE: Both AGDAS and AGDAP were not associated with any semen parameters. In the non-parametric correlation analysis, AGDAP were correlated with sperm progressive motility and reproductive hormones of E2, testosterone, SHBG and the testosterone/LH ratio. However, body mass index (BMI) also significantly correlated with serum testosterone ( ITALIC! r = -0.216, ITALIC! P = <0.0001) and SHBG ( ITALIC! r = -0.229, ITALIC! P = <0.001). In the multiple regression models, AGDAP was negatively associated with the serum E2 level (95% CI, -0.198 to -0.043; ITALIC! P = 0.002) and positively associated with the ratio of T/E2 (95% CI, 0.004-0.011; ITALIC! P = 0.001) after an adjustment for BMI and other confounders. LIMITATIONS, REASONS FOR CAUTION: Using only a single semen sample to predict male reproductive function over a longer period is a potential limitation of the present study. The other limitation is the cross-sectional nature of the study design. Longitudinal data from an extended follow-up on a large cohort would be more definitive. WIDER IMPLICATIONS OF THE FINDINGS: Our results do not support previous studies where AGD is associated with male semen quality. The utility of AGD in predicting reproductive outcomes in adult males should thus be considered prudently. STUDY FUNDING/COMPETING INTERESTS: This study was supported by the Key Program of Natural Science Funding of China (no. 81130051), Young Scientist Program of NSFC (no. 81502788) and the National Scientific and Technological Support Program of China (no. 2013BAI12B02). None of authors had any competing interests to declare.

Factors predictive of critical value of hypocalcemia after total parathyroidectomy without autotransplantation in patients with secondary hyperparathyroidism.

BACKGROUND: Severe hypocalcemia is the most dangerous complication occurring after total parathyroidectomy without autotransplantation (TPTX) for secondary hyperparathyroidism (SHPT). We aim to identify the prevalence and potential risk factors of very severe hypocalcemia in patients with SHPT undergoing TPTX. METHODS: From April 2012 to August 2015, 157 patients with SHPT undergoing TPTX were reviewed. The critical value of hypocalcemia (CVH) was postoperative serum Ca(2+) levels of ≤1.5 mmol/L. RESULTS: Univariate analysis showed that patients in the CVH group were significantly younger than those in the non-CVH group. Sex ratio was significantly different between the two groups. The CVH group had significantly higher levels of preoperative PTH and ALP. Male sex and preoperative levels of PTH and ALP were significant independent risk factors by logistic regression analysis. CONCLUSIONS: Male sex, preoperative PTH and ALP were significantly associated with CVH in patients with SHPT undergoing TPTX.

Association between murine double minute 2 T309G polymorphism and risk of liver cancer.

During the past decade, a number of studies were published to evaluate the association between murine double minute 2 (MDM2) T309G polymorphism and risk of liver cancer. However, the association between MDM2 T309G polymorphism and risk of liver cancer was still unclear owing to the conflicting results from those published studies. An undated meta-analysis of all eligible studies was carried out to comprehensively assess the association. The pooled odds ratio (OR) with 95 % confidence interval (95% CI) was used to evaluate the association between MDM2 T309G polymorphism and risk of liver cancer. Finally, ten studies with a total of 2,243 cases and 3,471 controls were finally included into the meta-analysis. Overall, there was an association between MDM2 T309G polymorphism and risk of liver cancer (G vs. T: OR=1.39, 95% CI 1.17-1.64, P<0.001; GG vs. TT: OR=1.87, 95% CI 1.34-2.62, P<0.001; GG/GT vs. TT: OR=1.61, 95 % CI 1.24-2.08, P<0.001). Subgroup analysis in Europeans showed that there was also an association between MDM2 T309G polymorphism and risk of liver cancer in Europeans (G vs. T: OR=1.81, 95% CI 1.45-2.27, P<0.001; GG vs. TT: OR=3.26, 95% CI 1.99-5.32, P<0.001; GG/GT vs. TT: OR=2.20, 95% CI 1.58-3.07, P<0.001). Subgroup analysis in Asians showed that there was also an association between MDM2 T309G polymorphism and risk of liver cancer in Asians (G vs. T: OR=1.27, 95% CI 1.06-1.52, P=0.010; GG vs. TT: OR=1.59, 95% CI 1.11-2.27, P=0.011; GG/GT vs. TT: OR=1.41, 95% CI 1.07-1.87, P=0.016). The meta-analysis provides a strong evidence for the association between MDM2 T309G polymorphism and risk of liver cancer.

Analysis of the risk factors for central lymph-node metastasis of cN0 papillary thyroid microcarcinoma: A retrospective study.

OBJECTIVE: Cervical lymph node (CLN) metastasis (CLNM) can be found in some patients with CLN-negative (cN0) papillary thyroid microcarcinoma (PTMC), while the risk factors are still unknown. This study aimed to examine the risk factors of CLNM in patients with cN0 PTMC, contributing to screening cN0 PTMC patients with high risk in CLNM for preventive CLN dissection (CLND). METHODS: This retrospective study included consecutive patients pathologically diagnosed with cN0 PTMC and who underwent surgery at the General Surgery Department of China-Japan Friendship Hospital between 07/2016 and 01/2020. The patients were grouped according to whether CLNM was present. Factors associated with CLNM were analyzed, and a risk prediction model was established in logistic regression analysis, and their predictive power was evaluated by receiver operating characteristic curves (ROC). RESULTS: Finally, 171 patients were included; among them, 71 (41.5%) had CLNM. There were 32 males and 139 females. The multivariable analysis showed that males (OR = 5.619, 95%CI: 2.186-14.446; P < 0.001), age ≤45 years (OR = 2.982, 95%CI: 1.446-6.151; P = 0.003), adjacent to dorsal membrane (OR = 3.022, 95%CI: 1.430-6.387; P = 0.004), and irregular borders (OR = 4.332, 95%CI: 1.104-17.000; P = 0.036) were independent risk factors of CLNM. The risk prediction model composed of the four risk factors showed a relatively high AUC, at 0.760. When the cut-off was 0.38, the sensitivity was 67.6%, and the specificity was 73.0%. CONCLUSION: Male sex, age ≤45 years, adjacent to dorsal membranes, and irregular borders are independent risk factors for CLNM in patients with cN0 PTMC. This might help identify cN0 PTMC patients needing preventive CLND.

Effect of calcium supplementation on severe hypocalcemia in patients with secondary hyperparathyroidism after total parathyroidectomy.

BACKGROUND: Severe hypocalcemia (SH) is a dreaded complication of total parathyroidectomy (TPTX) without auto-transplantation. AIM: To compare conventional and preventive calcium supplementation (CS) regimens in terms of SH occurrence after TPTX. METHODS: This retrospective study included patients who underwent TPTX between January 2015 and May 2018 at the China-Japan Friendship Hospital. From January 2015 to May 2016, conventional CS was performed in patients who underwent TPTX, with calcium amounts adjusted according to postoperative serum calcium levels. From October 2016 to May 2018, preventive CS was performed according to preoperative alkaline phosphatase (ALP) levels. The patients were defined as low-risk (ALP < 500 U/L) and high-risk (ALP > 500 U/L) for SH. All preoperative blood samples were collected in the fasting state on the day before surgery. Postoperative blood samples were obtained at 6-7 AM from the first postoperative day. RESULTS: A total of 271 patients were included. These patients were 47.7 ± 11.1 years old, and 57.6% were male. Their mean body mass index (BMI) was 22.9 ± 3.8 kg/m2. There were no significant differences in sex, age, BMI, preoperative ALP, serum calcium, serum phosphorus, calcium-phosphorus ratio, and intact parathyroid hormone (iPTH) between the two CS groups. Compared with conventional CS, preventive CS led to lower occurrence rates of hypocalcemia within 48 h (46.0% vs 74.5%, P < 0.001) and SH (31.7% vs 64.1%, P < 0.001). Multivariable analysis showed that preoperative iPTH levels [odds ratio (OR) = 1.001, 95% confidence interval (CI): 1.000-1.001, P = 0.009), preoperative ALP amounts (OR = 1.002, 95%CI: 1.001-1.003, P = 0.002), preoperative serum phosphorus levels (OR = 8.729, 95%CI: 1.518-50.216, P = 0.015) and preventive CS (OR = 0.132, 95%CI: 0.067-0.261, P < 0.001) were independently associated with SH. In patients with preoperative ALP ≥ 500 U/L, only preventive CS (OR = 0.147, 95%CI: 0.038-0.562. P = 0.005) was independently associated with SH. CONCLUSION: This study suggests that preventive CS could reduce the occurrence of SH, indicating its critical value for hypocalcemia after TPTX.

Lifestyle-related risk factors correlated with mental health problems: A longitudinal observational study among 686 male college students in Chongqing, China.

Aim: Public concerns over the mental health problems of college students are rising. Previous research show that female tend to suffer more from mental health problems than males, with few studies focusing on males. This study sought to explore the association of lifestyle-related risk factors with the prevalence of mental health problems among male college students in China. Methods: The lifestyle information and mental health status of 686 male college students from Chongqing, China, were assessed in 2014, and 582 of them were followed up a year later. Participants completed a questionnaire assessing demographic and lifestyle factors which include sleep quality, computer usage, sedentariness, physical activity, smoking, current alcohol, coke, coffee, and milk tea drinking, and current tea/fried food/baked food consumption. Mental health problems were measured using the Depression Anxiety Stress Scale-21 (DASS-21). Results: Univariate analyses indicated that age, sleep latency, sleep duration, computer usage time, milk tea drinking, and fried food consumption were potential risk factors for mental health problems (p's < 0.05). Multivariate analysis further revealed that, either at baseline or during follow-up, participants with (i) more computer usage time were at a higher risk of having depression symptoms (p's < 0.05) and (ii) a higher frequency of fried food consumption were associated with a higher risk of having depression, anxiety, and stress symptoms (p's < 0.05). Additionally, the cross-lagged analysis showed that (i) computer usage time in 2014 is positively correlated with depression status (ß = 0.106, p < 0.05) but not anxiety (ß = 0.047, p > 0.05) and stress (ß = 0.019, p > 0.05) status a year later and (ii) fried food consumption in 2014 is positively correlated with depression (ß = 0.129, p < 0.01), anxiety (ß = 0.168, p < 0.001), and stress (ß = 0.113, p < 0.01) status a year later. Conclusions: Computer usage time and fried food consumption were lifestyle-related risk factors for mental health problems in male college students in Chongqing, China. These results might emphasize further preventive strategies for mental health problems, especially in male college students.

Axillary mass in a woman with progressive exertional limbs numbness and fatigue: a case report.

Occult breast cancer (OBC) is a very rare type of breast cancer which accounts for only 0.2% to 0.9% of all breast cancer defined as histologically proven breast cancer found from outside the breast especially axillary with the absence of a primary tumor in the breast. With the development of high-resolution ultrasound, mammography, especially breast-enhanced MRI, the incidence of OBC has decreased in recent years. A standard approach for OBC is to perform a modified radical mastectomy (MRM) at the time of axillary lymph node dissection (ALND). The five-year survival rates after treatment of an occult primary breast cancer with axillary metastases range from 59% to 93%, averaging about 75%. Paraneoplastic neurological syndromes (PNS) are a very rare heterogeneous group of disease caused by mechanisms of the remote effects of malignant tumors other than tumor metastases, infections or side effects of tumor treatment. Malignant tumors with PNS account for only less than 0.01% of all tumors. The treatment of PNS include removal of the tumors and suppression of the immune response. The prognosis of PNS depends on the degree of neuronal damage during the treatment of the disease. PNS is a rare neurological complication in patients with breast cancer and particularly rare in the patients with OBC. Here, we report a rare case of a 62-year-old woman diagnosed as OBC who presented with PNS as the first symptom.

Exposure to fine particulate matter-bound polycyclic aromatic hydrocarbons, male semen quality, and reproductive hormones: The MARCHS study.

Exposure to outdoor fine particulate matter (PM2.5)-bound polycyclic aromatic hydrocarbons (PAHs) is linked to reproductive dysfunction. However, it is unclear which component of PAHs is responsible for the adverse outcomes. In the Male Reproductive Health in Chongqing College Students (MARHCS) cohort study, we measured the exposure levels of 16 PAHs by collecting air PM2.5 particles and assessed eight PAHs metabolites from four parent PAHs, including naphthalene, fluorene, phenanthrene, and pyrene in urine samples. We investigated compositional profiles and variation characteristics for 16 PAHs in PM2.5, and then assessed the association between PAHs exposure and semen routine parameters, sperm chromatin structure, and serum hormone levels in 1452 samples. The results showed that naphthalene (95% CI: -17.989, -8.101), chrysene (95% CI: -64.894, -47.575), benzo[a]anthracene (95% CI: -63.227, -45.936) and all the high molecular weight (HMW) PAHs in PM2.5 were negatively associated with sperm normal morphology. Most of the low molecular weight (LMW) PAHs, such as acenaphthylene, fluorene, phenanthrene, fluoranthene, pyrene, chrysene, benzo[a]anthracene, ∑LMW PAHs and ∑16 PAHs, were correlated with increased sperm motility (all corrected P < 0.05). On the other hand, sperm normal morphology was all negatively associated with urinary metabolites of ∑OH-Nap (95% CI: -5.611, -0.536), ∑OH-Phe (95% CI: -5.741, -0.957), and ∑OH-PAHs (95% CI: -5.274, -0.361). Urinary concentrations of ∑OH-PAHs were found to be negatively associated with sperm high DNA stainability (HDS) (P = 0.023), while ∑OH-Phe were negatively associated with serum testosterone level and sperm HDS (P = 0.004). Spearman correlation analysis showed that except for the urinary OH-Nap metabolites, the rest of the urinary OH-PAHs metabolites were negatively correlated with their parent PAHs in air. The results of this study suggest that various PAHs' components may affect reproductive parameters differently. Inhalation of PAHs in air, especially HMW PAHs, may be a potential risk factor for male reproductive health.

Acute effects of short-term exposure to ambient air pollution on reproductive hormones in young males of the MARHCS study in China.

Air pollution, which is associated with male reproductive health. However, it is unknown the acute effects of ambient air pollutants exposure on male reproductive hormones. The current study, we measured serum levels of reproductive hormone in 2030 blood samples gathered from The Male Reproductive Health in Chongqing College Students (MARHCS) cohort study. We derived a full coverage of ambient air pollutant (PM10, PM2.5, SO2, NO2, CO and O3) concentrations by employing machine learning algorithms, and used a mixed-effect model to estimate single-day and cumulative effects of air pollutants exposure on serum reproductive hormones. Our results showed that (1) PM10 and PM2.5 concentrations were positively associated with estradiol (E2) in both single and cumulative lag days, but were negatively associated with the ratio of Testosterone/E2 (the T/E2 ratio). NO2 was positively associated with estradiol at lag day 2 (95% CI: 0.290, 0.881; corrected P = 0.048) and lag 0-2 days (95% CI: 0.523, 1.337; corrected P = 0.003), with progesterone (P) at lag day 2 and lag day 3 (corrected P < 0.05). There was also a positive association between CO exposure and progesterone at lag day 2. (2) SO2 was inversely associated with E2 at lag day 3, 4 and lag 0-4 days, and progesterone at lag day 0, 1, 2 and lag 0-1, 0-2, 0-4 days, but positively associated with the T/E2 ratio at lag day 3, 4 and lag 0-4 days (corrected P < 0.05). O3 exposure was negatively associated with E2 at lag day 3 (95% CI: -0.216, -0.074, corrected P = 0.03). (3) No significant associations were found between the cumulative daily average air pollutant exposure of CO, O3 and hormone outcomes. This study suggests that short-term exposure to air pollutants may thus alter reproductive hormone levels, especially on serum estradiol, progesterone levels and the T/E2 ratio.

Image-guided vacuum-assisted breast biopsy in the diagnosis of breast microcalcifications.

Objective The present study was performed to assess the accuracy and clinical value of image-guided vacuum-assisted breast biopsy in the diagnosis of mammography-detected breast microcalcifications. Methods This prospective study involved 100 patients with suspicious mammography-detected microcalcifications who underwent image-guided vacuum-assisted breast biopsies from January 2013 to October 2016. Stereotactic vacuum-assisted breast biopsy (SVAB) was performed in 64 patients, and ultrasound (US)-guided vacuum-assisted breast biopsy (US-VAB) was performed in 36 patients in whom application of SVAB was difficult. The microcalcifications were detectable by mammography or US. The mean follow-up duration was 32 months (range, 9-57 months). The biopsy results were correlated with the pathological examination results. Results The positive predictive value of microcalcifications detected by mammography and US in the diagnosis of breast cancer was 37.0% (37/100) and 52.8% (19/36), respectively. The negative predictive value of microcalcifications detected by US in the diagnosis of breast cancer was 71.9% (46/64). No recurrence was observed in the 37 patients with breast cancer. No evidence of malignancy was found among the 63 patients with benign lesions. Conclusion Image-guided vacuum-assisted breast biopsy is accurate and minimally invasive. It can be used as a safe approach for diagnosis in patients with breast microcalcifications.

Indocyanine green detects sentinel lymph nodes in early breast cancer.

Objective To explore the clinical value of indocyanine green (ICG) for the fluorescence-guided detection of sentinel lymph nodes (SLNs) during sentinel lymph node biopsy (SLNB) in patients with early breast cancer. Methods This retrospective study included female patients with breast cancer. Patients were administered methylene blue and ICG using standard techniques. All SLNs that were collected during surgery were submitted for pathological examination. SLNs were defined as those that were either fluorescent, blue, fluorescent and blue or palpably suspicious. Surgical complications, axillary recurrence, distant metastasis and overall survival rates were observed postoperatively. Results A total of 60 patients were enrolled in the study. The fluorescence detection rate of SLNs was 100% ( n = 177), with a mean of 2.95 SLNs per patient. The methylene blue staining rate was 88.3% ( n = 106), with a mean of 1.77 SLNs per patient. Pathological assessment of intraoperative frozen specimens revealed SLN metastases in 10 patients, who immediately underwent axillary lymph node dissection. No patient had axillary recurrence or distant metastases, with a survival rate of 100%. Patients who underwent SLNB showed good appearance in the axillary wound, with no limited shoulder joint abduction and upper limb oedema. Conclusion Fluorescence-guided SLNB has several advantages and is suitable for clinical application.

Risk Factors for Elevated Preoperative Alkaline Phosphatase in Patients with Refractory Secondary Hyperparathyroidism.

Elevated preoperative levels of alkaline phosphatase (ALP) in patients with refractory secondary hyperparathyroidism are correlated with postoperative hypocalcemia and mortality. The aim of this study was to identify the predictors of preoperative ALP in patients with secondary hyperparathyroidism. From April 2012 to December 2015, 220 patients with refractory secondary hyperparathyroidism undergoing total parathyroidectomy without autotransplantation were reviewed. A total of 164 patients presented with elevated preoperative ALP. Univariate analysis showed that patients with elevated ALP were significantly younger. The elevated ALP group had significantly higher levels of preoperative parathyroid hormone (PTH), lower preoperative serum calcium, higher preoperative phosphorus, lower postoperative hypocalcemia, and a longer hospital stay. Logistic regression analysis showed that elevated preoperative PTH was a significant independent risk factor for elevated preoperative ALP (P = 0.000), and its value of 1624 pg/mL was the optimal cutoff point. Factors predictive of elevated preoperative ALP in patients with secondary hyperparathyroidism include preoperative PTH. Earlier surgery, aggressive calcium supplementation, and more careful or aggressive postoperative care for high-risk patients are needed.

Phthalate exposure, even below US EPA reference doses, was associated with semen quality and reproductive hormones: Prospective MARHCS study in general population.

BACKGROUND: Environment-Protection-Agency Reference Doses (EPA RfDs) for phthalate intakes are based on limited evidence, especially regarding low-dose male-reproductive toxicity. This study investigates the association between phthalate exposure and semen parameters and reproductive hormones in a general population with low phthalate exposure compared to the EPA RfDs. METHODS: The MARHCS (Male-Reproductive-Health-in-Chongqing-College-Students) cohort recruited 796 male students, who experienced a relocation of campuses and shifting environmental exposure. Urine, semen and blood before and after the relocation was collected and investigated for: (1) the associations between 13 urinary phthalate metabolites and 11 semen/hormone outcomes (five semen parameters including semen volume, sperm concentration, total sperm number, progressive motility, normal morphology) and six serum reproductive hormones including estradiol, follicle-stimulating hormone, luteinizing hormone, prolactin, progesterone, testosterone; (2) re-analysis of the metabolite-outcome associations in the subjects with estimated phthalate intakes below the RfDs; (3) a change in phthalate metabolites and change in semen/hormone outcomes after the relocation; (4) the association between these changes. RESULTS: (1) All but two semen/hormone outcomes were associated with at least one phthalate metabolite, e.g., each quartile monoethyl phthalate was associated with a 5.3%, 5.7% and 2.6% decrease of sperm concentration, total sperm number and progressive motility respectively. (2) In the subjects with phthalate intakes below the RfDs, these metabolite-outcome associations remained significant. (3) All metabolites except mono(2-ethylhexyl) phthalate declined after relocation (P<0.001 respectively); at the same time, semen volume, normal morphology, estradiol and luteinizing hormone increased (by 5.9%, 25.0%, 34.2% and 10.0%) and testosterone decreased (by 7.0%). (4) The changes in semen volume, normal morphology, estradiol and testosterone, but not the change in luteinizing hormone after relocation, were associated with the changes in the phthalate metabolites. CONCLUSIONS: Phthalate exposure is associated with interrupted semen quality and reproductive hormones in the human population even with a dose given below the RfDs. These effects, however, may only partially revert back when exposure decreases, thus emphasizing the urgency of stricter phthalate administration.

Inverse U-shaped Association between Sleep Duration and Semen Quality: Longitudinal Observational Study (MARHCS) in Chongqing, China.

STUDY OBJECTIVES: To investigate the association between sleep duration and semen parameters as well as reproductive hormone levels. METHODS: We designed a cohort of male college students in Chongqing, China. A total of 796 subjects were recruited in 2013 and 656 (82.4%) were followed up in 2014. Each time, semen and peripheral blood samples were collected for semen quality and reproductive hormone measurement. Sleep duration was estimated by revised Munich Chronotype Questionnaire. In 2014, sleep quality was also measured by Pittsburgh Sleep Quality Index (PSQI). RESULTS: There was a substantial inverse U-shaped association between sleep duration and two semen parameters (semen volume and total sperm number), with 7.0-7.5 h/day of sleep showing highest parameters. Either longer or shorter sleep was associated with decreased semen parameters in a dose-response manner (P = 0.002 and 0.001, respectively). Sleeping > 9.0 h was associated with a 21.5% (95% confidence interval 9.2, 32.2) reduction in semen volume and 39.4% (23.3, 52.1) reduction in total sperm number; sleeping ≤ 6.5 h was associated with 4.6% (-10.5, 22.3) and 25.7% (-1.2, 60.1) reduction. Increase of the two parameters was found in those who changed sleep duration toward 7.0-7.5 h/day from 2013 to 2014. The U-shaped association was independent from PSQI and was replicated in another dataset of 1,346 males. No association found between sleep duration and reproductive hormone. CONCLUSIONS: Either restricted or excessive sleep may impair semen quality. Further research is needed to validate this finding.