A comparison of clinical outcomes of acute testicular torsion between prepubertal and postpubertal males.

SHORT INTRODUCTION/BACKGROUND: Surgical intervention for acute testicular torsion can require either orchiopexy or orchiectomy. The decision of which surgery to perform is dependant on the amount of time that the testicle experienced ischemia and the viability of the testicle after reperfusion. OBJECTIVE: It is hypothesized that (1) there is a difference in orchiectomy and orchiopexy rates between prepubertal and postpubertal males with acute testicular torsion and (2) presenting symptoms may vary between the two age groups as prepubertal males may present with atypical symptoms, which could result in delayed presentation and diagnosis. STUDY DESIGN: A retrospective chart review was conducted on pediatric patients who were diagnosed with acute testicular torsion between June 2010 and August 2017. Demographic and clinical characteristics were extracted: age, ethnicity, referral pattern, primary insurance status, symptoms at presentation, prior history of ipsilateral testicular pain or intermittent torsion, recent trauma to genitalia, duration of symptoms (hours), gradual vs. acute onset of symptoms, time/weekday/season at presentation, and time interval from arrival at the study institution to surgical intervention (minutes). Patients were categorized into two groups: prepubertal group (age 1-12 years) and postpubertal group (age 13-18 years). Statistical analyses were performed using R, version 3.3.1. RESULTS: Ninety-one patients were included in the study. The overall orchiectomy rate was 30.8%. More prepubertal males underwent orchiectomy than postpubertal males (42.4% vs. 24.1%, respectively). Prepubertal males were more likely to present with abdominal pain than postpubertal males (27.3% vs. 10.3%, respectively). Those who underwent orchiectomy were more likely to present with longer duration of symptoms, testicular swelling, and abdominal pain than those who underwent orchiopexy. The risk of orchiectomy decreased by 14% per 1-year increase in age (odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.94-1.00, p = .009). A steady decline in the proportion of patients undergoing orchiectomy was seen from 1 to 12 years of age. DISCUSSION: This study found that prepubertal males are at higher risk for orchiectomy than postpubertal males. The risk of orchiectomy decreases by 14-16% per 1-year increase in age. Prepubertal males are more likely to present with atypical symptoms and delayed presentation and diagnosis, leading to delayed surgical intervention. It is important for providers to perform a genital examination in prepubertal males who present with abdominal pain to rule out acute testicular torsion. Patients presenting with longer duration of symptoms, testicular swelling, and abdominal pain are at higher risk for orchiectomy. No correlation was found between orchiectomy rate and ethnicity, referral status, primary insurance status, and time/weekday/season at presentation. CONCLUSION: Among patients presenting to a tertiary pediatric hospital with acute testicular torsion, prepubertal males (younger than 12 years) are at higher risk for orchiectomy than postpubertal males. Prepubertal males are more likely to present with atypical symptoms which results in delayed presentation and diagnosis, leading to delayed in surgical intervention.

Polymicrobial infection and bacterium-mediated epigenetic modification of DNA tumor viruses contribute to pathogenesis.

ABSTRACT The human body plays host to a wide variety of microbes, commensal and pathogenic. In addition to interacting with their host, different microbes, such as bacteria and viruses, interact with each other, sometimes in ways that exacerbate disease. In particular, gene expression of a number of viruses, including Kaposi's sarcoma-associated herpesvirus (KSHV), Epstein-Barr virus (EBV), and human immunodeficiency virus (HIV), is known to be regulated by epigenetic modifications induced by bacteria. These viruses establish latent infection in their host cells and can be reactivated by bacterial products. Viral reactivation has been suggested to contribute to periodontal disease and AIDS. In addition, bacterium-virus interactions may play a role in cancers, such as Kaposi's sarcoma, gastric cancer, and head and neck cancer. It is important to consider the effects of coexisting bacterial infections when studying viral diseases in vivo.

Regional-scale assessment of soil salinity in the Red River Valley using multi-year MODIS EVI and NDVI.

The ability to inventory and map soil salinity at regional scales remains a significant challenge to scientists concerned with the salinization of agricultural soils throughout the world. Previous attempts to use satellite or aerial imagery to assess soil salinity have found limited success in part because of the inability of methods to isolate the effects of soil salinity on vegetative growth from other factors. This study evaluated the use of Moderate Resolution Imaging Spectroradiometer (MODIS) imagery in conjunction with directed soil sampling to assess and map soil salinity at a regional scale (i.e., 10-10(5) km(2)) in a parsimonious manner. Correlations with three soil salinity ground truth datasets differing in scale were made in Kittson County within the Red River Valley (RRV) of North Dakota and Minnesota, an area where soil salinity assessment is a top priority for the Natural Resource Conservation Service (NRCS). Multi-year MODIS imagery was used to mitigate the influence of temporally dynamic factors such as weather, pests, disease, and management influences. The average of the MODIS enhanced vegetation index (EVI) for a 7-yr period exhibited a strong relationship with soil salinity in all three datasets, and outperformed the normalized difference vegetation index (NDVI). One-third to one-half of the spatial variability in soil salinity could be captured by measuring average MODIS EVI and whether the land qualified for the Conservation Reserve Program (a USDA program that sets aside marginally productive land based on conservation principles). The approach has the practical simplicity to allow broad application in areas where limited resources are available for salinity assessment.

Observations of Earth space by self-powered stations in Antarctica.

Coupling of the solar wind to the Earth magnetosphere/ionosphere is primarily through the high latitude regions, and there are distinct advantages in making remote sensing observations of these regions with a network of ground-based observatories over other techniques. The Antarctic continent is ideally situated for such a network, especially for optical studies, because the larger offset between geographic and geomagnetic poles in the south enables optical observations at a larger range of magnetic latitudes during the winter darkness. The greatest challenge for such ground-based observations is the generation of power and heat for a sizable ground station that can accommodate an optical imaging instrument. Under the sponsorship of the National Science Foundation, we have developed suitable automatic observing platforms, the Automatic Geophysical Observatories (AGOs) for a network of six autonomous stations on the Antarctic plateau. Each station housed a suite of science instruments including a dual wavelength intensified all-sky camera that records the auroral activity, an imaging riometer, fluxgate and search-coil magnetometers, and ELF/VLF and LM/MF/HF receivers. Originally these stations were powered by propane fuelled thermoelectric generators with the fuel delivered to the site each Antarctic summer. A by-product of this power generation was a large amount of useful heat, which was applied to maintain the operating temperature of the electronics in the stations. Although a reasonable degree of reliability was achieved with these stations, the high cost of the fuel air lift and some remaining technical issues necessitated the development of a different type of power unit. In the second phase of the project we have developed a power generation system using renewable energy that can operate automatically in the Antarctic winter. The most reliable power system consists of a type of wind turbine using a simple permanent magnet rotor and a new type of power control system with variable resistor shunts to regulate the power and dissipate the excess energy and at the same time provide heat for a temperature controlled environment for the instrument electronics and data system. We deployed such systems and demonstrated a high degree of reliability in several years of operation in spite of the relative unpredictability of the Antarctic environment. Sample data are shown to demonstrate that the AGOs provide key measurements, which would be impossible without the special technology developed for this type of observing platform.

Iron sulfide oxidation as influenced by calcium carbonate application.

Two overburden materials, with different FeS2 contents (1.9 and 4.1%) and low acid neutralization potential, were limed with CaCO3 at rates of 0, 25, 50, 75, 100, and 125% based on the amount of CaCO3 needed to provide an acid-base account deficit (A/Ba) of zero (A/Ba = neutralization potential--potential acidity--exchangeable acidity). The limed overburden materials were inoculated with Thiobacillus ferrooxidans and leached weekly with deionized water. Residual FeS2 and CaCO3 were determined in samples over a 378-d period. Oxidation followed zero-order kinetics with respect to FeS2 concentration at pH values greater than 4 and first-order kinetics at pH values less than 4. Zero-order oxidation rates ranged from 0.01 to 0.46 micromol g(-1) d(-1) in the overburden with 1.9% FeS2 and from 0.01 to 0.22 micromol g(-1) d(-1) in the overburden with 4.1% FeS2. Oxidation following the first-order rate law had a first-order rate constant of 0.03 d(-1) in the 1.9% FeS2 overburden and 0.01 d(-1) in the 4.1% FeS2 overburden. The calculated half-life was 23 d for the 1.9% FeS2 overburden and 69 d for the 4.1% FeS2 overburden. Additions of CaCO3 affected FeS2 oxidation by controlling the pH of the system. Liming to greater than 50% of the acid-base account deficit did not significantly affect the zero-order oxidation rate. Dissolution of the applied CaCO3 was found to be faster than the oxidation of FeS2 at pH values greater than 4. It was projected that at lime rates up to 125%, the CaCO3 would dissolve and leach out of the system before all the FeS2 oxidized, leaving the potential for acid minesoil formation.

Use of ground-penetrating radar to study tree roots in the southeastern United States.

The objectives of our study were to assess the feasibility of using ground-penetrating radar (GPR) to study roots over a broad range of soil conditions in the southeastern United States. Study sites were located in the Southern Piedmont, Carolina Sandhills and Atlantic Coast Flatwoods. At each site, we tested for selection of the appropriate antenna (400 MHz versus 1.5 GHz), determined the ability of GPR to resolve roots and buried organic debris, assessed root size, estimated root biomass, and gauged the practicality of using GPR. Resolution of roots was best in sandy, excessively drained soils, whereas soils with high soil water and clay contents seriously degraded resolution and observation depth. In the Carolina Sandhills, 16 1 x 1-m plots were scanned with the 1.5 GHz antenna using overlapping grids. Plots were subsequently excavated, larger roots (> 0.5 cm diameter) sketched on graph paper before removal, and all roots oven-dried, classified by size and weighed. Roots as small as 0.5 cm in diameter were detected with GPR. We were able to size roots (0.5 to 6.5 cm in diameter) that were oriented perpendicular to the radar sweep (r(2) = 0.81, P = 0.0004). Use of image analysis software to relate the magnitude of radar parabolas to actual root biomass resulted in significant correlations (r(2) = 0.55, P = 0.0274). Orientation and geometry of the reflective surface seemed to have a greater influence on parabola dimensions than did root size. We conclude that the utility of current GPR technology for estimating root biomass is site-specific, and that GPR is ineffective in soils with high clay or water content and at sites with rough terrain (most forests). Under particular soil and site conditions, GPR appears to be useful for augmenting traditional biomass sampling.

Axillary vein transfer in trabeculated postthrombotic veins.

PURPOSE: This study assessed whether axillary vein transfer can be successfully performed in trabeculated veins and whether patients with this severe form of postthrombotic syndrome can be helped by an aggressive approach. METHODS: A total of 102 axillary vein transfer procedures were carried out in 83 limbs with trabeculated veins. More than one venous segment was repaired in 38 limbs with a second axillary valve in 19, and a different technique was used in the remainder. The superficial and deep femoral veins were the most common target sites. "Bench repair" of leaky axillary valves was performed before the transfer in 32 cases. Venous stasis dermatitis or ulceration was present in 90% of the limbs. The operability rate and chance of successful valve reconstruction was high, even in the presence of severe venographic appearance. RESULTS: The actuarial transplant patency rate was 83% at 10 years. The actuarial freedom from recurrent ulceration rate was more than 60% at 10 years, similar to the results obtained in a matched group of axillary vein transfers to nontrabeculated veins. Severe preoperative ambulatory venous hypertension (venous filling time [VFT] of less than 5 seconds), which was present in 67% of patients, did not adversely affect outcome, but short VFTs that persisted after surgery did. VFT and VFI90 (venous filling index, air plethysmography) improved after valve transfer. Swelling disappeared or was significantly reduced in 55% of patients (11 of 20 patients) who had moderate or severe preoperative swelling. In 82% of patients (31 of 37 patients) who had mild or no preoperative swelling, the swelling remained stable after surgery, and in 18% of patients (6 of 37 patients), it became worse. Pain was significantly diminished in 70% of patients; 23% of patients with severe pain had complete resolution. CONCLUSION: Axillary vein transfer, in combination with other antirefluxive procedures when indicated, is safe, effective, and durable in patients with trabeculated veins and severe forms of postthrombotic syndrome. It may be considered as an option when conservative therapy or other types of surgery fail.

Passive immunotherapy in advanced HIV infection and therapeutic plasmapheresis in asymptomatic HIV-positive individuals: a four-year clinical experience.

We have been treating patients with advanced HIV disease using passive immunotherapy (PIT). Earlier studies of PIT which have been published concerned relatively short periods of treatment: our study is by far the longest and reports also on the long-term effects of plasmapheresis on healthy HIV-infected individuals. Fifty-nine patients with an average CD4+ T-cell count of 55 per cu.mm. at baseline were transfused at monthly intervals with 500 ml of hyperimmune plasma. No disease progression or death occurred among the 8 asymptomatic patients under the treatment, which lasted for 36.25 months on average. Seven of the 15 ARC patients progressed to AIDS but none died in an average period of 25.9 months. Seven of the 36 symptomatic AIDS patients with advanced disease died in an average period of 19.6 months. PIT appears to be nontoxic and to have beneficial effects lasting at least four years under continuous treatment. It probably delays disease progression in ARC and AIDS patients, and almost certainly does so in asymptomatic late HIV infection with a very low CD4+ T-cell count. None of the 51 donors suffered adverse effects, nor did any progress to ARC or AIDS in an average period of 30.1 months. Their laboratory parameters indicated a nearly stable condition: in particular, their average CD4+ T-cell count rose from 478 to 498. The study of our plasma donors indicated that repeated and frequent plasma donation by asymptomatic HIV-infected individuals could delay disease progression, although further studies are needed to investigate this.

Vestibular dysfunction in Parkinson disease.

Symptoms and signs of postural instability are often present in patients with Parkinson disease (PD). Because vestibular dysfunction might contribute to the postural instability, we carried out bithermal caloric tests and electronystagmography in 36 patients with PD and 316 controls. Significantly more PD patients had reduced and absent vestibular responses than controls. Decreased or absent vestibular responses in patients with PD were associated with postural instability and increasing severity of other symptoms. Vestibular dysfunction may contribute to the postural instability of PD.