Average sperm count remains unchanged despite reduction in maternal smoking: results from a large cross-sectional study with annual investigations over 21 years.

STUDY QUESTION: How are temporal trends in lifestyle factors, including exposure to maternal smoking in utero, associated to semen quality in young men from the general population? SUMMARY ANSWER: Exposure to maternal smoking was associated with lower sperm counts but no overall increase in sperm counts was observed during the study period despite a decrease in this exposure. WHAT IS KNOWN ALREADY: Meta-analyses suggest a continuous decline in semen quality but few studies have investigated temporal trends in unselected populations recruited and analysed with the same protocol over a long period and none have studied simultaneous trends in lifestyle factors. STUDY DESIGN, SIZE, DURATION: Cross-sectional population-based study including ~300 participants per year (total number = 6386) between 1996 and 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS: The study is based on men from the Greater Copenhagen area, Denmark, with a median age of 19 years, and unselected with regard to fertility status and semen quality. The men delivered a semen sample, had a blood sample drawn and a physical examination performed and answered a comprehensive questionnaire, including information on lifestyle and the mother's pregnancy. Temporal trends in semen quality and lifestyle were illustrated graphically, and trends in semen parameters and the impact of prenatal and current lifestyle factors were explored in multiple regression analyses. MAIN RESULTS AND THE ROLE OF CHANCE: Throughout the study period, 35% of the men had low semen quality. Overall, there were no persistent temporal trends in semen quality, testicular volume or levels of follicle-stimulating hormone over the 21 years studied. The men's alcohol intake was lowest between 2011 and 2016, whereas BMI, use of medication and smoking showed no clear temporal trends. Parental age increased, and exposure in utero to maternal smoking declined from 40% among men investigated in 1996-2000 to 18% among men investigated in 2011-2016. Exposure to maternal smoking was associated with lower sperm counts but no overall increase in sperm counts was observed despite the decrease in this exposure. LIMITATIONS, REASONS FOR CAUTION: Information of current and prenatal lifestyle was obtained by self-report, and the men delivered only one semen sample each. WIDER IMPLICATIONS OF THE FINDINGS: The significant decline in in utero exposure to maternal smoking, which was not reflected in an overall improvement of semen quality at the population level, suggest that other unknown adverse factors may maintain the low semen quality among Danish men. STUDY FUNDING/COMPETING INTEREST(S): The study has received financial support from the ReproUnion; the Research fund of Rigshospitalet, Copenhagen University Hospital; the European Union (Contract numbers BMH4-CT96-0314,QLK4-CT-1999-01422, QLK4-CT-2002-00603, FP7/2007-2013, DEER Grant agreement no. 212844); the Danish Ministry of Health; the Danish Environmental Protection Agency; A.P. Møller and wife Chastine McKinney Møllers foundation; and Svend Andersens Foundation. None of the funders had any role in the study design, collection, analysis or interpretation of data, writing of the paper or publication decisions. TRIAL REGISTRATION NUMBER: N/A.

Possible involvement of the glucocorticoid receptor (NR3C1) and selected NR3C1 gene variants in regulation of human testicular function.

Perceived stress has been associated with decreased semen quality but the mechanisms have not been elucidated. It is not known whether cortisol, the major stress hormone in humans, can act directly via receptors in the testis, and whether variants in the gene encoding the glucocorticoid receptor (NR3C1) can possibly modulate the effect. To address these questions, we investigated the expression of the glucocorticoid receptor in human testicular tissue, including adult and fetal samples (n = 20) by immunohistochemical staining, and in silico analysis of publicly available datasets. In the adult testis NR3C1 protein was detected in peritubular cells, a subset of Leydig cells, Sertoli cells (weak), and spermatogonia, but not in spermatids. The NR3C1 expression pattern in fetal testis samples differed by a notably stronger reaction in Sertoli cells, lack of staining in gonocytes but the presence in a subset of pro-spermatogonia, and the almost absent reaction in nascent peritubular cells. In parallel, we explored the association between adult testicular function and three single nucleotide NR3C1 polymorphisms (BcII [rs41423247], 9ß [rs6198], and Tth111I [rs10052957]) affecting glucocorticoid sensitivity. Testicular function was determined by semen analysis and reproductive hormone profiling in 893 men from the general population. The NR3C1 SNP BclI was associated with semen quality in an over-dominant manner with heterozygotes having better semen parameters compared to both homozygote constellations, and with sperm motility showing the strongest association. This association was supported by a higher inhibin B and inhibin B/FSH ratio, as well as a lower FSH in BclI heterozygotes. The SNPs 9ß and Tth111I were not associated with semen parameters. Although the clinical impact of the findings is limited, the results substantiate a suggested link between stress and testicular function. Hence this investigation should be regarded as a discovery study generating hypotheses for future studies.

Biglycan is a novel binding partner of fibroblast growth factor receptor 3c (FGFR3c) in the human testis.

Regulation of spermatogonial maintenance in the human testis is currently not well understood. One pathway suggested to be involved is activated by fibroblast growth factor receptor 3 (FGFR3), which is expressed in a subset of spermatogonia. FGFR3-activating mutations have been identified in spermatocytic seminoma, thought to originate from clonal expansion of spermatogonia. In this study we aimed to characterize potential binding partners of FGFR3, and specifically its mesenchymal "c" splice isoform, in human spermatogonia. Based on expression patterns and homology to the binding site, we identified FGF1, FGF2, and FGF9 as the best candidates for natural ligands of FGFR3c in the testis. In addition, we screened non-FGF proteins and found that a proteoglycan biglycan (BGN) contains a sequence homologous to the FGFR3c binding site on FGF1, and is expressed in peritubular cells adjacent to FGFR3-expressing spermatogonia. Experiments in a cell-free system confirmed that BGN binds to FGFR3c and FGF1. In conclusion, our findings further clarify the complex regulation of FGFR3c in the human testis. We postulate that BGN is a factor secreted by peritubular cells to modulate FGFR3c signaling and thus contributes to the regulation of spermatogonial maintenance.

Equal tension in all four strands of a semitendinosus graft with a low profile tibial fixation device (Cobra LFD).

The article introduces a novel tibia fixation device, the Cobra Ligament Fixation Device (Cobra LFD), for anterior cruciate ligament reconstruction. The Cobra LFD has a low profile and is hooked upon the cortical bone of tibia. It is useful either for primary ACL reconstruction or for ACL revision surgery, mainly for fixation of hamstring grafts. Fixation in the cortical bone is of great importance, in particular for revision cases. Besides technical aspects, we also present the 4-year follow-up of 15 cases of ACL revision surgery, where the Cobra LFD has been used for the tibia fixation.

[Interfaces in rehabilitation: three models]. / Schnittstellen in der Rehabilitation - Drei Modelle.

Interfaces can cause disruptions in the care provision process. They can, however, also signify a differentiated and specialized division of labour of the care providing system. Three models for the description of interfaces are presented and compared: a linear model oriented towards the continuity of the provision of care for individuals, the Principal Agent (PA) Model from contract theory, and a complex systems model. In all three models coupling and information management are identified as essential interface functions. In regard to optimisation possibilities, the linear model leads to the case-management concept, the PA Model to integrated forms of provision and systems theory to context controlling.

[Clinical examination of the knee--which tests can be used in the diagnosis of meniscal and ligament injuries? ]. / Klinisk knaeundersøgelsesteknik--hvilke test kan bruges i diagnostikken af menisk- og ligamentskader?

The clinical diagnosis of possible meniscal tear should include more than one of the following positive tests or clinical symptoms: tenderness of either jointline, swelling of the knee; meniscal pain or clicking on rotation with movement or decreased motion of the knee joint. The diagnosis of ligament injuries should include testing of each ligament by a battery of tests and we describe the best validated of these tests for each ligament.

Separation of native and latent forms of human antithrombin by hydrophobic interaction high-performance liquid chromatography.

Hydrophobic interaction high-performance liquid chromatography (HIC-HPLC) was utilized for the separation of native human antithrombin (AT) and a partially denaturated form of AT, known as the latent form (L-AT). The AT used in this study is commercially available (Atenativ, Pharmacia & Upjohn, Sweden) and contains albumin as the main stabilizer. The AT was reconstituted and heat treated in order to generate L-AT. This latent form of AT has been shown to exhibit a strong antiangiogenic activity and also to suppress tumor growth. The HPLC system included a TSK Phenyl 5PW column and a segmented gradient, 4.5-0 mol/L sodium chloride. Antithrombin was eluted at about 13 min, and L-AT, at 30 min, corresponding to about 4.2 and 1.6 mol/L sodium chloride, respectively. A reference sample gave 42% L-AT when analyzed by the HIC method and 41% L-AT when analyzed by the heparin affinity chromatography method. The resolution between AT and L-AT was higher with the HIC method than with the heparin affinity method. Incubation of Atenativ at 45 degrees C for 15 h gave about 18% L-AT and was shown by native polyacrylamide gel electrophoresis to contain only monomeric AT. A good resolution between AT and L-AT, but not between albumin and L-AT, was also achieved by a linear gradient of 2-0 mol/L ammonium sulfate, in 25 mmol/L Tris/HCl, pH 8.0.

Early arthroscopic treatment of primary traumatic anterior shoulder dislocation. A follow-up study.

This study evaluates the results of early arthroscopic Bankart repair in patients with primary traumatic anterior dislocation of the shoulder. The patients' age range was 17-34 years. Arthroscopic Bankart repair was performed within 12 days after the dislocation. First follow-up was at 18 months. According to Rowe's score, 11 patients (73%) were excellent, 3 (20%) were good and 1 (7%) was poor. The median external rotation deficit was 4 degrees in the adducted position. At a second follow-up at 34 months, two patients had redislocated. Both of these patients had severe generalized joint laxity. Another patient reported frequent subluxations. We conclude that in young patients with primary anterior traumatic shoulder dislocation, early arthroscopic Bankart repair implies a low recurrence rate and restores shoulder function to normal. Generalized joint laxity could indicate an increased risk for recurrent dislocation.

[Ségond fracture in acute knee injuries]. / Ségond-fraktur ved akutte knaetraumer.

Two patients with a lateral tibia avulsion fracture (Ségond fracture) are presented. The correlation between the Ségond racture and rupture of the anterior cruciate ligament is pointed out, as well as the fact that patients with Ségond fracture and rupture of the anterior cruciate ligament often have other injuries such as meniscus lesions and lesion of the medial collateral ligament.

[Shoulder instability]. / Skulderinstabilitet.

The importance of the labrum and glenohumeral ligament complex for the stability of the shoulder joint has been known since the beginning of this century. Shoulder instability may be classified into two large groups. TUBS, characterized by Traumatic, Unidirectional instability and Bankart lesion which often requires Surgery. The second group AMBRI, is characterized by Atraumatic, Multidirectional, Bilateral instability that often responds to Rehabilitation, but in case of surgery Inferior capsular shift is indicated. The high recurrence rate after primary traumatic anterior dislocation in young adults has caused an ongoing discussion about the indications for primary surgery. Anatomical reconstruction focusing on the pathoanatomy is recommended due to better results and a lower complication rate as compared to non-anatomical reconstruction that alters the normal anatomy and kinematics. The recurrence rate after arthroscopic Bankart repair is still generally higher than after open surgery but may be improved by better patient selection.

Isolated popliteus muscle rupture in polo players.

Isolated rupture of the popliteus muscle seems to be extremely rare, with only two cases described in the English literature. We present two cases of magnetic resonance imaging-verified isolated rupture of the popliteus muscle in polo players with the same injury mechanism-external rotation trauma on a flexed knee. Functional testing of the popliteus muscle in the figure of four position was positive in both cases. Full recovery was observed after 6 weeks of physiotherapy.

Late follow-up results of operative ankle arthroscopy in patients under local anaesthesia.

The purpose of this study was to evaluate our long-term results of operative ankle arthroscopy in local anaesthesia, without tourniquet and antibiotic prophylaxis, and to see whether we could produce the same results other investigators had published using general anaesthesia. Between 1987 and 1992, 51 operative ankle arthroscopies were performed--all as out-patient procedures. Thirty-six patients had local anaesthesia, 7 had general anaesthesia, one had spinal anaesthesia and one had epidural anaesthesia. No prophylactic antibiotics were given. Indications for surgery were the same for patients who had local anaesthesia as for those who had the other types of anaesthesia. Nineteen patients had partial synovectomies, 8 had removals of osteophytes, 7 had debridements of osteochondral fractures, 6 had debridements of mild degenerative osteoarthritis, 3 had loose bodies and 2 had septic arthritis. After a mean of 3 years (range 1-8) the patients were sent a questionnaire. They were asked to rate activity level, pain, swelling, and limb stiffness on a four-grade scale pre- and postoperatively and to rate their total subjective improvement. They were also asked if they would undergo the same procedure again knowing the outcome of the procedure. Forty-five patients (88%) were available for follow-up. Thirty-four patients (76%) were improved, 10 remained unchanged, and one became worse after surgery. No correlation existed between preoperative symptom duration, sex, trauma, type of anaesthesia, postoperative diagnosis or type of surgical procedure. Minor complications occurred in 11% of patients. Eighty-four percent of the patients said they would undergo the same procedure again. The type of anaesthesia used did not influence this decision.(ABSTRACT TRUNCATED AT 250 WORDS)

Injuries in badminton.

Though badminton is one of the most widely played sports in the world, it has received little sports medical interest. Based on the few existing studies on injuries in badminton, compared to other sports it is of relatively low risk and dominated by overuse injuries. The injury duration is relatively long, but only a few working days are lost. Anatomically, most injuries are localised to the foot and ankle. The single most frequent injuries are Achilles tendinitis and tennis elbow. Rupture of the Achilles tendon is a rare injury, which is typically seen in older recreational players. When the time of exposure is taken into account men are found to have a higher injury risk than women, and recreational players a higher injury risk than elite players. In contrast to most other sports the relative injury risk is higher during training than in competition. Based on suggested causes of injury and injury mechanisms, together with the known injury pattern in badminton the following preventive matters are suggested: (a) changes in the badminton shoe, towards a higher heel, with shock absorption and a stiffer anatomically fitting heel counter; (b) adjustment of the friction between the individual shoe-soles and playing surfaces; and (c) specific badminton training including stretching and strengthening of the triceps surae and the muscles involved in the internal and external rotation of the shoulder and elbow during the badminton strokes.

Epidemiology of injuries in Danish championship tennis.

During the outdoor tennis season of 1984 a prospective injury registration was done in 104 randomly chosen elite tennis players, of whom 86% could be followed. We found 46 injuries: an incidence of 2.3 injuries/player/1000 tennis hours. Men were more frequently injured than women. The prevalence was 0.3 injury/player. Upper extremity injuries were most frequent - 45.7% (21/46). Shoulder injuries were the single most frequent injury - 17% (8/46). The pathophysiology was overuse in 67% (28/42), strains in 14% (6/42), sprains in 17% (7/42), fractures in 2% (1/42), and blisters in 5% (2/42). Players using conventional rackets had more injuries to the upper extremity compared with players using mid/oversized rackets, though the difference was nonsignificant. The importance of impact forces from the tennis stroke in the mechanism of upper extremity injuries is discussed.

Epidemiology of badminton injuries.

In the badminton season 1983/1984, a prospective injury registration was done in 375 randomly chosen elite and recreational badminton players, of whom 81% could be followed. We found 257 injuries: an incidence of 2.9 injuries/player/1000 badminton hours. Men were more frequently injured than women. The prevalence was 0.3 injury per player. It was highest in men, and there was no difference between elite and recreational badminton players; 92% of the injured were playing with their injury. The pathophysiology was overuse in 74% (169/229), strains in 12% (28/229), sprains in 11% (26/229), and fractures in 1.5% (3/229). Possibilities for reducing the number of injuries and their severity are increased injury information to players and trainers and the introduction of stretching all involved muscle groups.