A Contemporary Review of Cryptorchidism Management in Adults: A Rare Presentation of Bilateral Cryptorchidism Presenting as Pelvic Pain in an Adult Patient.

This case report presents a rare case of adult cryptorchidism, found incidentally in a 25-year-old gentleman who initially presented with abdominal and suprapubic pain and was successfully treated with staged orchidopexy. To our knowledge, to date, our case is the first published instance of bilateral cryptorchidism in an adult presenting with nonspecific suprapubic pain. Cryptorchidism is the most common genital abnormality in newborn boys, and due to its association with an increased risk of infertility and malignancy, current management involves surgical correction with orchidopexy by 12 to 18 months of life. Adult presentation of cryptorchidism is very unusual due to early intervention; therefore, bilateral cryptorchidism is even more rare. As a result, current guidelines do not address proper management for adult cryptorchidism. Therefore, after performing a thorough review of the literature on contemporary guidelines for cryptorchidism management, we aim to highlight our approach to management in this rare case of adult bilateral cryptorchidism. We suggest bilateral orchiectomy as the safest option, if the patient is amendable, or bilateral orchiopexy with long-term follow-up for testicular cancer. Although the American Urological Association guidelines recommend orchiectomy for postpubertal cryptorchid children, currently, no explicit guidelines exist for the preferred method of managing adult cryptorchidism. Due to the increased risk of infertility and testicular cancer with cryptorchidism, orchiectomy instead of orchiopexy may be the preferred surgical approach in some instances. Still, in the case of bilateral cryptorchidism, orchiectomy may not always be the most viable solution, making orchiopexy with long-term follow-up for testicular cancer the best option, such as in our case.

Case Report: Novel Copy Number Variant 16p11.2 Duplication Associated With Prune Belly Syndrome.

Prune belly syndrome (PBS) is a rare congenital disease that predominantly occurs in males and is identified by its classic triad of abdominal wall musculature deficiencies, cryptorchidism, and urinary tract abnormalities. However, numerous anomalies involving the kidneys, heart, lungs, and muscles have also been reported. A multitude of chromosomal abnormalities have been implicated in its pathogenesis. PBS can occur in association with trisomy 18 and 21. Gene duplications and deletions have also been reported; however, a definite cause of PBS is still unknown. We report the first PBS patient with a copy number variant in 16p11.2.

Case Report: Rare Presentation of Mixed Germ Cell Tumor in an Infant.

The estimated incidence of pediatric testis tumor is 0.5-2.0 per 100,000 children, accounting for 1-2% of all pediatric tumors. Mixed germ cell tumors (MGCT) in prepubertal males are exceedingly rare, with only one previous case report found in the literature. We report a case of a MGCT in an infant. For prepubertal males, GCTs typically present with a painless scrotal mass, though trauma, testis torsion and hydrocele are also common presentations. Similar to such tumors in postpubertal males, ultrasonography, computed tomography, and tumor markers are integral to determine the best treatment. The patient described in this report presented with a painless scrotal mass. Following orchiectomy, the patient was found to have MGCT that was limited to the testis. With prudent management, these patients tend to have favorable prognoses.

Robotic microsurgical spermatic cord denervation for chronic orchialgia: a case series.

CONTEXT: Chronic orchialgia is a frustrating urologic condition that is commonly refractory to conservative modes of therapy. Microscopic spermatic cord denervation is a proven solution for patients who do not achieve relief from nonsurgical treatments. However, current widely used techniques require additional training in microsurgery. OBJECTIVE: To describe an adaptation and improvement of spermatic cord microdenervation technique that leveraged the robotic surgical training common for new urologists and is also accessible for urologists not specifically trained in microsurgery. METHODS: Robotic-assisted microdenervation of the spermatic cord was performed in three patients using a fluorescence vascular imaging tool to improve visualization of vascular structures (Firefly™; Innovative Surgical, Sunnyvale, CA, USA), along with a tissue matrix allograft to allow for better healing (AminoFix™; MiMedx®, Marietta, GA, USA). RESULTS: All three patients (100%) experienced postoperative resolution of their chronic orchialgia, and none reported any new pain. CONCLUSION: Utilization of robotic-assisted surgery offers more urologists the ability to use familiar techniques to treat chronic orchialgia when conservative measures are unsuccessful.

Improved recovery of human islets from young donor pancreases utilizing increased protease dose to collagenase for digesting peri-islet extracellular matrix.

Human islet isolation from young donor pancreases (YDP) utilizing the current purified standard dose of collagenase-protease enzyme mixtures often results in the release of a high percentage of mantled islets. Mantled islets are those surrounded by exocrine tissue and are difficult to purify by density gradient centrifugation, leading to poor islet recovery. Based on difference in extracellular matrix, and total collagen content between YDP and old donor pancreas (ODP, > 35 Y) led us to compare results from islet isolation using increased collagenase combination (ICC) or increased protease combination (IPC), to the standard enzyme combination (SEC) in a "trisected" pancreas model to overcome the donor-to-donor variability. These results showed a reduced percentage of mantled islets (17% ± 7.5%) and higher postpurification islet recovery (83.8% ± 5.6%) with IPC. Furthermore, these results were confirmed in 13 consecutive whole pancreas islet isolations utilizing IPC from VitaCyte, Roche, or SERVA collagenase-protease enzyme mixtures. Results obtained from in vitro and in vivo islet functional assessment indicated that islets isolated using IPC retained normal islet morphology, insulin secretion, and the ability to reverse diabetes after transplantation in diabetic nude mice. This is the first report utilizing trisected pancreas to assess the effectiveness of different enzyme combinations to improve islet recovery from young donor pancreases.

Tales of diversity: Genomic and morphological characteristics of forty-six Arthrobacter phages.

The vast bacteriophage population harbors an immense reservoir of genetic information. Almost 2000 phage genomes have been sequenced from phages infecting hosts in the phylum Actinobacteria, and analysis of these genomes reveals substantial diversity, pervasive mosaicism, and novel mechanisms for phage replication and lysogeny. Here, we describe the isolation and genomic characterization of 46 phages from environmental samples at various geographic locations in the U.S. infecting a single Arthrobacter sp. strain. These phages include representatives of all three virion morphologies, and Jasmine is the first sequenced podovirus of an actinobacterial host. The phages also span considerable sequence diversity, and can be grouped into 10 clusters according to their nucleotide diversity, and two singletons each with no close relatives. However, the clusters/singletons appear to be genomically well separated from each other, and relatively few genes are shared between clusters. Genome size varies from among the smallest of siphoviral phages (15,319 bp) to over 70 kbp, and G+C contents range from 45-68%, compared to 63.4% for the host genome. Although temperate phages are common among other actinobacterial hosts, these Arthrobacter phages are primarily lytic, and only the singleton Galaxy is likely temperate.

Advancing the Future of Patient Safety in Oncology: Implications of Patient Safety Education on Cancer Care Delivery.

Emerging challenges in health care delivery demand systems of clinical practice capable of ensuring safe and reliable patient care. Oncology in particular is recognized for its high degree of complexity and potential for adverse events. New models of student education hold promise for producing a health care workforce armed with skills in patient safety. This training may have a particular impact on risk reduction in cancer care and ultimately improve clinical performance in oncology. A 1-day student program focused on the principles of patient safety was developed for the third-year medical school class. The core curriculum consisted of an online patient safety module, root cause analyses of actual patient safety events, and simulation scenarios designed to invoke patient safety skills. The program was successfully implemented and received an average of 4.2/5 on evaluations pertaining to its importance and effectiveness. Student surveys demonstrated that 59 % of students were not previously aware of system-based approaches to improving safety, 51 % of students had witnessed or experienced a patient safety issue, while only 10 % reported these events. Students reported feeling more empowered to act on patient safety issues as a result of the program. Educational programs can provide medical students with a foundation for skill development in medical error reduction and help enhance an organization's culture of safety. This has the potential to reduce adverse events in complex patient care settings such as clinical oncology.

Pollen-limited reproduction in blue oak: implications for wind pollination in fragmented populations.

Human activities are fragmenting forests and woodlands worldwide, but the impact of reduced tree population densities on pollen transfer in wind-pollinated trees is poorly understood. In a 4-year study, we evaluated relationships among stand density, pollen availability, and seed production in a thinned and fragmented population of blue oak (Quercus douglasii). Geographic coordinates were established and flowering interval determined for 100 contiguous trees. The number of neighboring trees within 60 m that released pollen during each tree's flowering period was calculated and relationships with acorn production explored using multiple regression. We evaluated the effects of female flower production, average temperature, and relative humidity during the pollination period, and number of pollen-producing neighbors on individual trees' acorn production. All factors except temperature were significant in at least one of the years of our study, but the combination of factors influencing acorn production varied among years. In 1996, a year of large acorn crop size, acorn production was significantly positively associated with number of neighboring pollen producers and density of female flowers. In 1997, 1998, and 1999, many trees produced few or no acorns, and significant associations between number of pollen-producing neighbors and acorn production were only apparent among moderately to highly reproductive trees. Acorn production by these reproductive trees in 1997 was significantly positively associated with number of neighboring pollen producers and significantly negatively associated with average relative humidity during the pollination period. In 1998, no analysis was possible, because too few trees produced a moderate to large acorn crop. Only density of female flowers was significantly associated with acorn production of moderately to highly reproductive trees in 1999. The effect of spatial scale was also investigated by conducting analyses with pollen producers counted in radii ranging from 30 m to 80 m. The association between number of pollen-producing neighbors and acorn production was strongest when neighborhood sizes of 60 m or larger were considered. Our results suggest that fragmentation and thinning of blue oak woodlands may reduce pollen availability and limit reproduction in this wind-pollinated species.