Medicina
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Mean sperm counts are declining at an accelerated rate and infertility is increasingly becoming a public health concern. It is now understood that human semen, previously considered to be sterile, harbours its own specific microbiome. Via activated leucocytes and the generation of reactive oxygen species, bacteria have the capability of evoking an immune response which may lead to sperm damage. ⋯ However, various themes have emerged and evidence of highly conserved clusters of common bacteria can be seen. Depletion or over-representation of specific bacteria may be associated with aberrations in traditional and functional seminal parameters. Currently, the evidence is too limited to inform clinical practice and larger studies are needed.
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Background and Objectives: The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard method for diagnosing central precocious puberty (CPP), although it requires multiple blood samplings over 120 min. This study aimed to evaluate if a shorter test may have an equivalent diagnostic accuracy. Materials and Methods: We retrospectively reviewed the GnRH tests of 188 consecutive pediatric patients (169 females) referred for signs of early pubertal development. ⋯ The LH/FSH ratio at 30 min showed a sensitivity of 94.9%, with an AUC of 0.997 and a value ≥0.76. Conclusions: A short-duration GnRH test of 60 min provided optimal results for the diagnosis of CPP. Extending the test for an extra hour is therefore unnecessary and inadvisable.
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Background and Objectives: To present a new spinal shortening technique for tethered cord syndrome. Tethered cord syndrome (TCS) is a debilitating condition leading to progressive neurological decline. Surgical detethering for TCS is the gold standard of treatment. ⋯ Manual muscle testing results and the sensory function of the left leg had recovered almost fully upon final follow-up at one year. Conclusions: A retethered spinal cord after initial untethering is difficult to treat. This new spinal shortening technique can represent another good option to release the tension of the spinal cord.
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Botulinum toxin injections are commonly used for the treatment of spasticity. However, injection procedures are associated with pain and procedural anxiety. While pharmacological approaches are commonly used to reduce these, innovative technology might be considered as a potential non-pharmacological alternative. Given this context, immersive virtual reality (VR) has shown effectiveness in the management of procedural pain. Our retrospective pilot study aimed to assess the potential added value of virtual reality in the management of pain and anxiety during intramuscular injections of botulinum toxin. ⋯ VR was useful for managing procedural pain related to botulinum toxin injection in adults, with a high level of satisfaction reported by the patients. VR should be considered as a valuable alternative to pharmacological approaches to manage procedural pain during botulinum toxin injection in adults.
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Randomized Controlled Trial
Clinical Outcomes of Three versus Four Mini-Implants Retaining Mandibular Overdenture: A 5-Year Randomized Clinical Trial.
Background and Objectives: Due to a lack of long-term clinical studies that would clarify whether the insertion of three mini-implants (MDIs) can be as successful treatment as the insertion of four MDIs for the retention of mandibular overdentures (ODs), this 5-year prospective cohort study was set up. Materials and Methods: Participants (n = 83) randomly received either four or three MDIs and a mandibular OD. Clinical examinations were performed at the baseline, as well as after one, three, and five years, respectively. ⋯ The success rate (together with successful survival) was 93.8% in the four-MDI group and 91.7% in the three-MDI group. The log-rank (Mantel-Cox) test revealed no significant differences between them (X2 = 0.373; p = 0.541). Conclusions: In patients with narrow ridges, the insertion of three MDIs in the mandible for overdenture retention can be equally as successful as the insertion of four MDIs.