Preventing Sleep Disruption With Bright Light Therapy During Chemotherapy for Breast Cancer: A Phase II Randomized Controlled Trial.

Purpose: The goal of this study was to examine whether daily increased morning light exposure would maintain or improve sleep and the circadian pattern of relatively more activity in the day and less during the night in women undergoing chemotherapy for breast cancer. Patients and Methods: Participants were 39 women with newly diagnosed breast cancer, randomized to either 30-mins of daily morning bright white light (BWL) or dim red light (DRL). Sleep/wake was measured objectively for 72-h with wrist actigraphy and subjectively with the Pittsburgh Sleep Quality Index (PSQI) prior to and during chemotherapy cycles 1 and 4. The study was registered with the National Institutes of Health ClinicalTrials.gov (Clinical Trials number: NCT00478257). Results: Results from actigraphy suggested that compared to the DRL group, women in the BWL group had longer night-time sleep, fewer sleep disturbances during the night, and had fewer and shorter daytime naps at the end of cycle 4 of chemotherapy as well as exhibiting less activity at night and more activity during the day by the end of cycle 4. Results from PSQI indicated that components of sleep quality improved but daytime dysfunction deteriorated during cycle 4 treatment in the BWL group; meanwhile the DRL group used more sleep medications in the treatment weeks which might have led to the improved sleep quality during the recovery weeks of both cycles. Conclusion: These results suggest that bright white light therapy administered every morning on awakening may protect women undergoing chemotherapy for breast cancer from nighttime sleep and daytime wake disruption. Randomized clinical trials in larger samples are needed to confirm these findings.

Post-Prostatectomy Incontinence: How Common and Bothersome Is It Really?

INTRODUCTION: The implications of post-prostatectomy urinary incontinence (PPI) on quality of life pose a matter of great concern for urologists and patients alike. Efforts to mitigate this devastating complication have met with varying degrees of success and the literature has shown a discrepancy between patient- and surgeon-reported outcomes. AIM: To describe the multifactorial physiology of PPI, its evaluation, and its effect on health-related quality of life and sexual function and to review preoperative predictive factors for PPI and explore the disparity between patient- and surgeon-reported outcomes. METHODS: We selected a representative sample of principal studies addressing these topics pertaining to PPI. The search was executed by a relevant term search on PubMed from 1994 to the present. MAIN OUTCOME MEASURES: The main topics of consideration in this review are pathophysiology, predictors and prevalence, and methods of evaluating PPI. We also report on findings on the role of PPI in sexual activity, surgical methods to prevent PPI, and variability in methods of outcome reporting. RESULTS: The application of various measures to prevent PPI has had variable success and efforts to further refine and widely implement improvements have been complicated by the heterogeneity in measurements used to report and compare outcomes. CONCLUSION: Patient age, incontinence definitions, and preoperative baseline incontinence make collecting and interpreting urinary function data after radical prostatectomy challenging. Confusion in the literature is compounded by the discrepancy between patient- and surgeon-reported outcomes. On a patient-physician level, there is the issue of potentially under-counseling patients during preoperative discussions on the profound impact of PPI on quality of life in general and on sexual function and satisfaction in particular. Trofimenko V, Myers JB, Brant WO. Post-Prostatectomy Incontinence: How Common and Bothersome Is It Really? Sex Med Rev 2017;5:536-543.

Fertility and sexual dysfunction issues in adults with genitourinary congenital anomalies.

PURPOSE OF REVIEW: As growing numbers of adolescents with a history of congenital genitourinary anomalies successfully enter adulthood, their spectrum of urologic concerns broadens to include sexual function and reproduction. RECENT FINDINGS: In hypospadias repair, preoperative testosterone was found to reduce rates of postoperative complications of urethrocutaneous fistula formation and meatal stenosis. Following hypospadias correction, dissatisfaction with surgical outcomes has been observed to correlate with psychological outcomes, rather than objective measurements such as location of meatus degree of curvature. In women with a congenital absence of a vagina, sigmoid vaginoplasty and dilation yield similar sexual outcomes, however, vaginoplasty was associated with a 20% rate of reoperation. Ilioinguinal-to-dorsal neurorrhaphy for restoration of penile sensation in myelomeningocele has shown success in a small pilot study. Both sexual activity and paternity rates are higher in women, compared with men who are born with bladder exstrophy. SUMMARY: The extent and complexity of issues related to sexual function and fertility in the population of patients with a history of genitourinary malformation requires a thoughtful approach to timely surgical management and consistent care through their transition from childhood to adulthood.

Fertility treatment in spinal cord injury and other neurologic disease.

Infertility in individuals with neurologic disorders is complex in etiology and manifestation. Its management therefore often requires a multimodal approach. This review addresses the implications of spinal cord injury (SCI) and other neurologic disease on fertility, including the high prevalence of sexual dysfunction, ejaculation disorders and compromised semen parameters. Available treatment approaches discussed include assisted ejaculation techniques and assisted reproductive technology including surgical sperm retrieval and intracytoplasmic sperm injection (ICSI).

Male Factor Infertility and Clomiphene Citrate: A Meta-Analysis-The Effect of Clomiphene Citrate on Oligospermia.

INTRODUCTION: Clomiphene citrate has long been administered with inconclusive outcomes. It has often been used as empirical treatment for male factor infertility, presumably by increasing the sperm concentration. However, to our knowledge there has been no meta-analysis of the exact impact on semen parameters. We performed a systematic review and meta-analysis of the impact of clomiphene citrate on sperm parameters in men with oligospermia. METHODS: We systematically reviewed pertinent randomized, controlled, prospective trials using the bibliographic databases MEDLINE® (1966 to 2013), Embase® (1980 to 2013) and the Cochrane Collaboration. References of selected articles were reviewed for additional relevant citations. The net treatment effect of the observed change in sperm concentration was analyzed. RESULTS: Data pooled from 2 randomized, controlled trials and 1 prospective trial in men with infertility and oligospermia included a total of 197 men with a mean age of 32.8 years (range 18 to 65). In the treatment arm 115 men were treated with a minimum dose of 25 mg clomiphene citrate at least every other day for a minimum of 3 months. The placebo or no treatment arm included 82 men. Pooled meta-analysis data revealed a highly significant increase of 7.7 million sperm per ml after administering clomiphene citrate compared to placebo or no treatment. There was no evidence of significant heterogeneity across the groups. CONCLUSIONS: Available data suggest that clomiphene citrate is associated with an increased sperm count compared to placebo.

Prevention of quality-of-life deterioration with light therapy is associated with changes in fatigue in women with breast cancer undergoing chemotherapy.

PURPOSE: During chemotherapy, women with breast cancer not only experience poor quality of life (QOL), they also have little exposure to bright light, which has been shown to be associated with depression, fatigue, and poor sleep in other chronic illnesses. This study examined whether increased light exposure would have a positive effect on QOL. METHODS: Thirty-nine women with stage I-III breast cancer scheduled to receive ≥ 4 cycles of chemotherapy were randomized to a bright white light (BWL, n = 23) or dim red light (DRL, n = 16) treatment group. Data were collected before (baseline) and during cycles 1 and 4 of chemotherapy. Light was administered via a light box (Litebook(®), Ltd.). QOL was assessed with the Functional Assessment of Cancer Therapy-Breast (FACT-B) and the Functional Outcomes of Sleep Questionnaire (FOSQ). RESULTS: Compared with baseline, the DRL group demonstrated significant decline in QOL during the treatment weeks of both cycles (all ps < 0.02), whereas the BWL group had no significant decline (all ps > 0.05). Mixed model analyses revealed that there was a group-by-time interaction for FOSQ at the treatment week of cycle 4, and this interaction was mediated by fatigue. CONCLUSION: The data suggest that increased exposure to bright light during chemotherapy may prevent the decline in QOL via preventing the increase in fatigue.

Bright light therapy protects women from circadian rhythm desynchronization during chemotherapy for breast cancer.

Circadian rhythms (CRs) are commonly disrupted in women undergoing chemotherapy for breast cancer (BC). Bright light improves and strengthens CRs in other populations. This randomized controlled study examined the effect of morning administration of bright light therapy on CRs in women undergoing chemotherapy for BC. It was hypothesized that women receiving bright light therapy would exhibit more robust rhythms than women exposed to dim light. Thirty-nine women newly diagnosed with BC and scheduled for chemotherapy were randomized into 2 groups: bright white light (BWL) or dim red light (DRL). Women were instructed to use the light box every morning for 30 min during their first 4 cycles of chemotherapy. Wrist actigraphy was recorded at 5 time points: prior to chemotherapy (baseline), Cycle-1 treatment week (C1TW), Cycle-1 recovery week (C1RW), Cycle-4 treatment week (C4TW), and Cycle-4 recovery week (C4RW). There was a Group × Time interaction at C4TW compared to baseline such that the DRL group showed significant deterioration in the mean of the activity rhythm (mesor) and amplitude, whereas the BWL group exhibited a significant increase in both mesor and amplitude. The DRL group also exhibited significant deterioration in overall rhythm robustness at C1TW, C4TW, and C4RW. Women in the BWL group also showed significant decreases in overall rhythm robustness at C1TW and C4TW, but returned to baseline levels at both recovery weeks. The results suggest that morning administration of bright light may protect women from experiencing CR deterioration during chemotherapy.

Prevalence of Kawasaki disease in young adults with suspected myocardial ischemia.

BACKGROUND: Up to 25% of patients with untreated Kawasaki disease (KD) and 5% of those treated with intravenous immunoglobulin will develop coronary artery aneurysms. Persistent aneurysms may remain silent until later in life when myocardial ischemia can occur. We sought to determine the prevalence of coronary artery aneurysms suggesting a history of KD among young adults undergoing coronary angiography for evaluation of possible myocardial ischemia. METHODS AND RESULTS: We reviewed the medical histories and coronary angiograms of all adults <40 years of age who underwent coronary angiography for evaluation of suspected myocardial ischemia at 4 San Diego hospitals from 2005 to 2009 (n=261). History of KD-compatible illness and cardiac risk factors were obtained by medical record review. Angiograms were independently reviewed for the presence, size, and location of aneurysms and coronary artery disease by 2 cardiologists blinded to the history. Patients were evaluated for number of risk factors, angiographic appearance of their coronary arteries, and known history of KD. Of the 261 young adults who underwent angiography, 16 had coronary aneurysms. After all clinical criteria were assessed, 5.0% had aneurysms definitely (n=4) or presumed (n=9) secondary to KD as the cause of their coronary disease. CONCLUSIONS: Coronary sequelae of KD are present in 5% of young adults evaluated by angiography for myocardial ischemia. Cardiologists should be aware of this special subset of patients who may benefit from medical and invasive management strategies that differ from the strategies used to treat atherosclerotic coronary artery disease.

Light treatment prevents fatigue in women undergoing chemotherapy for breast cancer.

PURPOSE: Fatigue is one of the most disturbing complaints of cancer patients and is often the reason for discontinuing treatment. This randomized controlled study tested the hypothesis that increased morning bright light, compared to dim light, would result in less fatigue in women with breast cancer undergoing chemotherapy. METHODS: Thirty-nine women newly diagnosed with stage I-III breast cancer were randomized to either bright white light (BWL) or dim red light (DRL) treatment and were instructed to use the light box for 30 min every morning throughout the first four cycles of chemotherapy. The Multidimensional Fatigue Symptom Inventory was administered prior to the start of chemotherapy (baseline), during the chemotherapy treatment week of cycle 1 (C1TW), the last week (recovery week) of cycle 1 (C1RW), the chemotherapy treatment week of cycle 4 (C4TW), and the last week (recovery week) of cycle 4 (C4RW). RESULTS: The DRL group reported increased fatigue at C1TW (p = 0.003) and C4TW (p < 0.001) compared to baseline, while there was no significant change from baseline in the BWL group. A secondary analysis showed that the increases in fatigue levels in the DRL group were not mediated through nor associated with changes in sleep or in circadian rhythms as measured with wrist actigraphy. CONCLUSIONS: The results of this study suggest that morning bright light treatment may prevent overall fatigue from worsening during chemotherapy. Although our hypothesis that overall fatigue would improve with bright light treatment was not supported, the lack of deterioration in total fatigue scores suggests that bright morning light may be a useful intervention during chemotherapy for breast cancer.