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PURPOSE: Patients often present to the emergency department (ED) for pain. As opioid fatalities rise, alternative treatments are warranted for pain management. Acupuncture, a nonpharmacological treatment involving the insertion of needles into skin or tissue at specific points within the body, may help to decrease acute pain. Our study aimed to assess the utilization and impact of acupuncture in the ED for acute pain management. METHODS: We conducted a retrospective analysis of purposefully collected quality improvement data. Patients who were ≥18 years old and who presented to the ED at an urban medical center in Wisconsin during 2017 were offered acupuncture services based on their emergency severity index (ESI; range: highest severity [1] - lowest severity [5]), reason for visit, and physician approval. Paired t-tests were used to examine mean differences between pre- and post-acupuncture pain, stress, anxiety, and nausea scores (range: none [0] - worst [10]). Multivariable regression models also were constructed. RESULTS: A total of 379 patients received acupuncture. Patients presented predominately with an ESI score of 3 (68.9%) or 4 (24.8%); 46.4% received opioids in the ED. Mean pre- and post-acupuncture pain scores significantly differed (6.5 vs 3.4; P<0.001); receiving opioids during the ED visit was not associated with improved pain scores (P=0.948). Stress (5.7 vs 1.9), anxiety (4.8 vs 1.6), and nausea (1.6 vs 0.6) scores also improved (P<0.001) following acupuncture. CONCLUSIONS: Emergency department acupuncture significantly decreased pain, stress, anxiety, and nausea. Our findings support a larger randomized controlled trial to further assesses the impact of acupuncture for acute pain in other ED settings.

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BACKGROUND: Screening young people for risk of mental health difficulties in schools is an effective method to facilitate monitoring and early intervention. This study is a preliminary report on the adaptation of the Youth RADAR screening instrument for primary school children. Specifically designed to be used in schools, the Child RADAR assesses a child's balance of risk and protective factors known to be associated with the development of mental health problems. METHOD: Three hundred and thirty-nine children drawn from six primary schools across NSW, Australia, completed the alpha version of the Child RADAR in addition to an assessment of depression and anxiety symptoms and subjective well-being. RESULTS: Confirmatory factor analysis revealed the Child RADAR to have an acceptable factor structure. Reliability for the Total Child RADAR was satisfactory based on both internal consistency (α = .86) and test-retest reliability (r = .85). Convergent validity was demonstrated through significant associations with symptoms of anxiety and depression. CONCLUSIONS: The Child RADAR shows preliminary promise as a school-based screener of mental health risk. Further evaluation is required to demonstrate the generalizability of the instrument across different populations.

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In the face of ongoing climate change, it is imperative to understand better the effects of temperature on immune function in freshwater teleosts. It is unclear whether previously observed changes were caused by temperature per se. We studied changes in the gill transcriptome of fathead minnows (Pimephales promelas) at low temperature to understand better the effects of temperature on immune function. De novo assembly of the transcriptome using Trinity software resulted in 73,378 assembled contigs. Annotation using the Trinotate package yielded 58,952 Blastx hits (accessions). Expression of 194 unique mRNA transcripts changed in gill tissue of fathead minnows acclimatized to 5° compared to controls at 22 °C. At 5 °C mRNAs coding for proteins involved in innate immune responses were up-regulated. Those included proteins that block early-stage viral replication and macrophage activation. Expression of mRNAs coding for pro-inflammatory molecules and mucus secretion were also enhanced. Messenger RNAs coding for proteins associated with adaptive immune responses were down-regulated at 5 °C. Those included antigen-presenting proteins and proteins involved in immunoglobin production. Messenger RNAs coding for proteins that stimulate the cell cycle were also down-regulated at 5 °C. Histological comparison revealed that gills of cold acclimated fish had fewer mucus cells but cells contained larger mucus droplets. We conclude that decreased temperature modifies the immune systems of freshwater teleosts, leading to genome-wide upregulation of innate immunity and down regulation of adaptive immunity. Such acclimation likely evolved as an adaptive strategy against seasonal changes in infectious insults.

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BACKGROUND: General Practitioners (GPs) play a vital role in the management of the social, emotional and behavioural health of children and adolescents. Best practice usually requires collaboration with a broad range of other medical and allied health professionals, to bring about optimal outcomes for patients and their family. OBJECTIVE: This article describes the specific role of a school psychologist and outlines various ways that GPs and school psychologists can collaborate in the assessment and management of school­aged patients. DISCUSSION: Given the importance of school in the social and emotional development of children and adolescents, school psychologists should be considered a valuable partner for GPs when caring for young people.

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BACKGROUND: Acoustic cell separation uses ultrasound waves to separate cells from plasma to perform plasmapheresis. Although the fundamental process has been studied for decades, no acoustic cell separation has been studied in a disposable plastic format suitable for clinical applications. STUDY DESIGN AND METHODS: We developed a disposable, rectangular, polystyrene microchannel acoustic cell-separation system and applied acoustic energy relevant for plasmapheresis. Fresh blood from healthy volunteers was exposed in vitro to acoustic energy in an open microfluidic circuit with and without ultrasound applied. Blood was tested for perturbations in red blood cells, platelets, and coagulation using clinical assays. RESULTS: Red blood cell and platelet size parameters as well as coagulation activation all were within 3% of baseline values. P-selectin expression on platelets increased by an average of 10.9% relative to baseline. Hemolysis increased with flow through the microfluidic channel, but percentage hemolysis remained below 0.3%. CONCLUSION: Blood parameters in a single-pass, microfluidic acoustic cell-separation apparatus remained within normal limits. In vivo animal studies that model continuous separation in a physiologic environment are warranted.

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Complex suture prostheses that deliver sensory and position feedback require a more sophisticated integration with the human user. Here a micro-size active implantable system that provides many-degree-of-freedom neural feedback in both sensory stimulation and motor control is shown, as one potential human-use solution in DARPA's HAPTIX program. Various electrical and mechanical challenge and solutions in meeting both sensory /motor performance as well as ISO 14708 FDA-acceptable human use in an aspirin-size active implementation are discussed.

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Epidemiological studies indicate that as many as 1 in 5 young people will develop a mental health problem in any given year. Early detection and intervention are needed to reduce the impact that these conditions have-both for the young person and for the communities in which they live. This study reports the development of a new instrument aimed at helping identify students at risk of developing mental health difficulties. Rather than asking about the presence of symptoms of mental health conditions, the RADAR screening tool assesses a student's balance of risk and protective factors associated with the development of mental health problems. The RADAR was evaluated with a sample of 838 participants in high school Years 7-12. A robust internal factor structure was revealed using exploratory and confirmatory factor analysis. Internal consistency was satisfactory for each subscale, ranging from .73 to .90 while the reliability for the total scale was .91. Retest stability, measured over a 12 month period, was found to be strong (r = .72). Convergent validity was demonstrated with reference to standard measures of depression and behavioral problems. It is concluded that the RADAR is a promising measure for helping mental health professionals and educators decide which students may be at risk of developing mental health problems. (PsycINFO Database Record

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Direct mass spectrometric analysis of animal tissues is an emerging field enabled by recent developments in ambient ion sources. Label-free in situ analysis of metabolites, lipids, and peptides/proteins from intact tissues in whole fish specimens of different gender and age were performed by laser ablation electrospray ionization (LAESI) mass spectrometry (MS). Hypertrophied glandular tissue (gill gland) of adult male Aphyocharax anisitsi (bloodfin tetra) was compared with gill tissues in females of the same species. Comparison of a large number of sample-specific ions was aided by a multivariate statistical method based on orthogonal projections to latent structures discriminant analysis. More than 200 different ions were detected in the mass spectra corresponding to primary metabolites, hormones, lipids and peptides/proteins. The gill tissues of the sexually mature males exhibited multiply charged ions in the 6+ to 10+ charge states corresponding to a protein with a molecular weight of 11 380 Da. This protein was present only in the mature male gill glands but absent in the corresponding area of the female and immature male specimens. An additional nine proteins were detected by LAESI-MS in both the male and female gill tissues.

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PURPOSE: To review experience performing percutaneous nephrolithotomy (PCNL) on patients with neurogenic bladder, evaluating predictors for increased length of stay (LOS), intensive care unit (ICU) stay, stone-free rate, and number of procedures and outcomes measures between spinal cord injury (SCI) and spina bifida (SB) patients. PATIENTS AND METHODS: We retrospectively reviewed our PCNLs from January 1, 2002 to December 31, 2009 and identified 47 patients. Data collected included LOS, ICU stay, stone-free rate, complications, and total procedures. RESULTS: A total of 66 PCNLs were performed on 47 patients. The mean LOS was 5.3 days, and nine patients needed ICU stay (mean 13.9 d). Initial stone-free rate was 60.6%, and final stone-free rate was 69.7%. Multiple access was associated with increased LOS (P=0.01), ICU stay (P<0.01), transfusion (P<0.01), and pulmonary complications (P=0.03). Upper-pole access was associated with decreased initial stone-free rate (P=0.04). Midpolar access predicted increased final stone-free rate (P=0.04). Mean stone size was 3.31 cm and was predictive of an increased number of procedures (P=0.04). Larger stone size was also predictive of decreased initial stone-free rate (P=0.03) and final stone-free rate (P=0.05). There were no statistically significant differences between SCI and SB patients in terms of outcomes. CONCLUSIONS: Increasing stone size and multiple access were predictors of adverse outcomes, and location of access affected stone-free status. We found no differences in outcomes between SB and SCI patients. To our knowledge, this is the largest series reported regarding PCNLs in this patient population.

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The structure and form of gill gland among inseminating and externally fertilizing species of the Cheirodontinae are described under light microscopy, scanning electron microscopy, and transmission electron microscopy, and compared to other members of the family Characidae. At least one species from thirteen cheirodontine genera were analyzed, totaling seventeen species. Gill glands were found in all analyzed mature males of Cheirodontinae and were always absent in females, being located on the anteriormost portion of the lower branch of the first gill arch, extending posteriorly through a variable number of gill filaments. Gill glands of all cheirodontines and of all characid species in which this organ has been described possess the same structure, being considered homologous and supporting a single origin of the structure in a common ancestor to Clade A and Clade B characids.

A estrutura e forma da glândula branquial de queirodontíneos inseminadores e de fecundação externa são descritas com base em análises de microscopia óptica, microscopia eletrônica de varredura e microscopia eletrônica de transmissão, e comparadas com outros membros da família Characidae. Pelo menos uma espécie de treze gêneros de Cheirodontinae foram analisadas, num total de dezessete espécies. Glândulas branquiais foram encontradas em todos os machos maduros analisados de Cheirodontinae, localizadas na parte mais anterior do ramo inferior do primeiro arco branquial, estendendo-se posteriormente por um número variável de filamentos branquiais, estando sempre ausentes nas fêmeas. As glândulas branquiais de todos os queirodontíneos analisados e de todas as espécies de Characidae em que este órgão foi descrito possuem a mesma estrutura, sendo consideradas homólogas e suportando uma origem única em um ancestral comum aos Clados A e B de Characidae.

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This study presents details of sperm ultrastructure for Gymnotus aff. carapo (Gymnotidae), Eigenmannia trilineata (Sternopygidae), and three Brachyhypopomus species (B. draco, B. bombilla, and B. gauderio - Hypopomidae) from southern Brazil. Differences were found among the representatives of the different families. For example, nuclear rotation was present in E. trilineata and in the Brachyhypopomus species, but absent in Gymnotus aff. carapo, and the presence of flagellar fins was only observed in E. trilineata. Some intraspecific variations could also be noticed among the Brachyhypopomus species analyzed. Most of the characters found in the spermatozoa of the species studied herein are shared with species of Gymnotiformes previously analyzed.

Este estudo apresenta detalhes sobre a ultraestrutura do espermatozoide de Gymnotus aff. carapo (Gymnotidae), Eigenmannia trilineata (Sternopygidae), e três espécies de Brachyhypopomus (B. draco, B. bombilla, e B. gauderio - Hypopomidae) do sul do Brasil. Diferenças foram encontradas entre os representantes das diferentes famílias, como por exemplo a presença de rotação nuclear em E. trilineata e nas espécies de Brachyhypopomus e a ausência em G. aff. carapo, e a presença de aletas laterais no flagelo observada somente em E. trilineata. Algumas variações intraespecíficas também puderam ser registradas entre as espécies de Brachyhypopomus analisadas. A maioria das características encontradas nos espermatozoides das espécies aqui analisadas são compartilhadas com as demais espécies de Gymnotifomes previamente analisadas.

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The reproductive biology and development of the gill gland are described for Macropsobrycon uruguayanae, an inseminating characid species of the tribe Compsurini, subfamily Cheirodontinae. Between April 2001 and March 2002, 117 males and 143 females of this species were collected in the rio Ibicuí, Uruguay basin in the State of Rio Grande do Sul, Brazil. Reproductively active individuals were present during most months sampled, indicating lack of a well-defined seasonal reproductive period. Several maturing females were found to be inseminated before completing full maturation. Histological analyses demonstrated spermatozoa within the ovaries of females in different stages of gonadal maturation collected during most months. No immature females had inseminated ovaries. Standard length at first gonadal maturation was estimated to be 24 mm for both males and females. Mean absolute fecundity was 191.08 (± 48.83 SD) oocytes per female, one of the lowest among characids. Relative fecundity was 0.539 (± 0.069 SD) oocytes per mg weight of the female, a value similar to that found for the majority of species of Cheirodontinae. The presence of two cohorts of oocytes within ovaries of M. uruguayanae indicates synchronous development, with total spawning. The mean diameter of mature oocytes was 0.6711 (± 0.1252 SD) mm, smaller than that found for the majority of species of Characidae. Gill glands occurred in all mature males, as well as in males undergoing advanced maturation. In the latter case, fewer gill filaments comprised the glands. Gill glands were not observed in immature males, males undergoing the initial stages of maturation, or in any female. A given gill gland may comprise as many as 24 filaments of the lateral hemibranch of the first gill arch. Secondary lamellae within most of the gill gland are greatly reduced, with columnar cells being present between them. These columnar cells contain abundant vesicles, suggesting secretory activity. ...

São descritos a biologia reprodutiva e o desenvolvimento da glândula branquial de Macropsobrycon uruguayanae, uma espécie de caracídeo inseminador da tribo Compsurini, subfamília Cheirodontinae. Foram capturados 117 machos e 143 fêmeas da espécie entre abril de 2001 e março de 2002 no rio Ibicuí, bacia do rio Uruguay no Estado do Rio Grande do Sul, Brasil. Indivíduos em reprodução foram observados na maioria dos meses amostrados, não havendo período reprodutivo sazonalmente definido. Fêmeas em maturação apresentavam-se inseminadas antes de completar a maturação plena. Análises histológicas mostraram espermatozoides nos ovários de fêmeas em diferentes estádios de maturação gonadal coletadas na maioria dos meses. Nenhuma fêmea imatura apresentou ovários inseminados. O tamanho de primeira maturação gonadal foi estimado em 24 mm de comprimento padrão para machos e fêmeas. A fecundidade absoluta média foi de 191,08 (± 48,83 SD) ovócitos por fêmea, uma das mais baixas entre caracídeos. A fecundidade relativa foi de 0,539 (± 0,069 SD) ovócitos por mg do peso da fêmea, valor semelhante ao encontrado para a maioria das espécies de Cheirodontinae. A espécie mostrou desenvolvimento ovocitário do tipo sincrônico em dois grupos, indicando desova total. O diâmetro médio dos ovócitos maduros foi de 0,6711 (± 0,1252 SD) mm, menor do que o encontrado para a maioria das espécies de Characidae. A glândula branquial ocorreu em todos os machos maduros analisados, sendo também observada em machos em maturação avançada, porém envolvendo um número menor de filamentos branquiais. A glândula branquial não foi observada em machos em maturação inicial ou imaturos e em fêmeas em qualquer fase de maturação. Esta glândula pode compreender até 24 filamentos da hemibrânquia externa do primeiro arco. As lamelas secundárias da glândula branquial são reduzidas e há proliferação de células secretoras colunares entre elas. Estas células são preenchidas por inúmeros vacúolos, ...

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The family Characidae is a group of freshwater bony fishes that exhibits high species-level diversity and whose members inhabit parts of Texas, Mexico, and Central and South America. Thus far, morphological data have been of limited use in discerning relationships among subfamilies and incertae sedis genera of the family Characidae. In this study, DNA sequence data from GenBank were combined with new sequences for analyses under Bayesian and parsimony schemes. Sequences fell into four gene partitions, with three genes in the mitochondrial subset (12S, 16S, COI genes) and one gene in the nuclear subset (RAG2 gene). Inferred Bayesian and parsimony-based phylogenies reject the monophyly of certain groups (e.g., Astyanax, Hyphessobrycon, and Bryconamericus), do not reject the monophyly of others (e.g., Cheirodontinae and "clade A" of previous authors), and present new sister-group hypotheses (e.g., Brittanichthys sister to Paracheirodon). Sister to clade A is a lineage referred to herein as "clade B" which includes Exodon and exemplars from Cheirodontinae (the most basal lineage within clade B), Aphyocharacinae, Tetragonopterinae, and Characinae (excluding Gnathocharax). "Clade C" is sister to A+B and contains representatives of large incertae sedis genera (e.g., Hyphessobrycon, Hemigrammus), as well as members of Stethaprioninae. Unless certain other subfamilial names are to be disregarded, the use of Tetragonopterinae should continue to be restricted to species of Tetragonopterus because other genera previously referred to this subfamily grouped in clades A or C, quite distant from Tetragonopterus.

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PURPOSE: We reviewed our experience with percutaneous nephrolithotomy (PCNL) in patients with renal allografts over 19 years. MATERIALS AND METHODS: We cross-referenced all renal allograft recipients at our institution with all PCNLs performed. We identified 16 renal allograft recipients who underwent a total of 21 PCNL procedures between 1986 and 2005. These charts were abstracted and the outcomes reviewed. RESULTS: The mean follow-up was 7.2 years. No loss of renal function occurred in the perioperative period. Five patients lost graft function during the follow-up period; however, none of these patients' loss of function was related to the PCNL. No patient had sepsis. Thirteen of the 16 patients were rendered stone free during long-term follow-up. CONCLUSIONS: PCNL is a safe and effective method of treating nephrolithiasis in a transplanted kidney.

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OBJECTIVE: The majority of patients with microscopic hematuria undergo a complete evaluation resulting in negative findings. The outcome of patients with hematuria was analyzed in an effort to optimize the use of investigations. PATIENTS AND METHODS: The records for 404 patients who presented with hematuria were reviewed. Data were collected on demographics, type of hematuria, investigations, and final diagnosis. RESULTS: The hematuria was microscopic in 140 patients (35%) and gross in 264 patients (65%). In gross hematuria patients, 10% had urinary tract tumors and 12% had calculi. All patients with genitourinary tumors and 87% of patients with calculi had gross hematuria and/or > or =5 RBCs/HPF (red blood cells per high-power microscopic field) on urinalysis. The sensitivity and specificity were 94% and 6% for the dipstick urine test, 37% and 71% for urine cytology, 92% and 93% for computed tomography (CT), 50% and 95% for ultrasound scans, and 38% and 90% for intravenous pyelography, respectively. Logistic regression analysis showed that age and number of RBCs/HPF in the urinalyses were the only significant factors predicting genitourinary cancer. In patients < or =40 years old, there was one patient with malignancy and seven patients with stones. In older patients, there were 31 patients with malignancy and 32 patients with stones. CONCLUSIONS: Patients with <5 RBCs/HPF on three urinalyses are unlikely to have significant pathology and could possibly be followed up conservatively. Patients < or =40 years of age should have a noncontrast CT or ultrasound study if they present with microscopic hematuria, and a cystoscopy should be added if gross hematuria exists. In older patients, a pre- and postcontrast CT and a cystoscopy should be performed.

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Macropsobrycon uruguayanae is a small, inseminating characid (tetra) of the tribe Compsurini. Although spermatozoa can be found within the ovarian cavity close to oocytes, the exact moment of fertilization has not yet been determined. Spermatozoa have moderately elongate nuclei with electron-dense chromatin. During spermiogenesis, nuclear rotation takes place. Elongate mitochondria with lamellar cristae are found posterior to the nucleus. Centrioles are parallel to one another with the proximal centriole slightly anterior to the longer distal one. The anterior tip of the proximal centriole is located within a shallow nuclear fossa. Electron-dense spurs are associated within the anterior and posterior ends of the distal centriole. Striated centriolar rootlets radiate both anteriorly and posteriorly from the distal centriole. Nine longitudinal accessory microtubules surround the axoneme in the proximal flagellum. The flagellum has a typical 9 + 2 axoneme with no intratubular differentiation. Atypical spermatozoa are also found in the testicular lumen. These cells resemble spermatozoa in most aspects, except that their nuclei are variable in shape, with the granular chromatin less electron-dense than that seen in spermatozoa. The origin and function of these cells could not be determined. The specializations seen in the spermatozoa are discussed as possible adaptations related to the habit of insemination.

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PURPOSE: The use of screening computerized tomography angiography has resulted in the increased detection of incidental nephrolithiasis in potential living renal donor candidates. We reviewed current acceptance guidelines for donors with stone disease as well as data on stone related outcomes in donors with stone disease and recipients who received a kidney with a stone left in situ. MATERIALS AND METHODS: We performed a medical literature search in English using MEDLINE/PubMed that addressed renal donor allograft lithiasis. We then analyzed the literature with respect to the historical evolution of this concept, current guidelines regarding the acceptance of donors with stones and stone related morbidity in recipients and donors. RESULTS: The prevalence of asymptomatic solitary nephrolithiasis has increased with the widespread use of screening computerized tomography angiography during renal donor evaluation. Few studies have addressed the risk of stone related morbidity in donors and recipients. Short-term studies have shown little stone related morbidity in patients who donate or receive an allograft with a stone left in situ. Consensus statements from transplant societies around the world offer guidance for determining donor eligibility. CONCLUSIONS: The available literature on stone related morbidity in donors and recipients is extremely limited. It would appear that the risk of recurrence and subsequent morbidity in renal donors with a solitary kidney is low but not insignificant. Rare stone related adverse events are reported for recipients of an allograft with a stone left in situ. Renal donors and recipients should be educated regarding their unique risk perspectives. Long-term followup is mandatory.

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Spermiogenesis and sperm ultrastructure were analyzed in two species of characids with different modes of fertilization: externally fertilizing Hemigrammus erythrozonus and inseminating Corynopoma riisei. Spermiogenesis in H. erythrozonus is characterized by lateral development of the flagellum, nuclear rotation, formation of a shallow nuclear fossa, condensation of the chromatin by elimination of the electron-lucent area from the peripheral region of the nucleus, and renewal of the nuclear membrane. Multilammelated membrane and multivesicular bodies were also observed during elimination of the excess cytoplasm. The spermatozoon exhibits characters typical of "aquasperm," i.e. a spherical head containing a spherical nucleus with highly condensed chromatin, several small mitochondria located at the base of the nucleus within a cytoplasmic collar that extends into a long cytoplasmic sleeve surrounding the anterior part of the single flagellum, which is contained within a cytoplasmic canal. The flagellum lacks fins. The proximal and distal centrioles are nearly parallel to one another, with the anterior tips of both located within shallow nuclear fossae. Spermiogenesis in C. riisei is characterized by nuclear elongation alongside the forming flagellum, formation of an elongate cytoplasmic canal, displacement and elongation of the mitochondria, and uniform condensation of chromatin throughout the nucleus through enlargement of the diameter of the chromatin granules. The spermatozoon has an elongate nucleus with two elongate mitochondria localized to one side. Mitochondria are also located posterior to the nucleus forming a mitochondrial region. The single flagellum, which lacks fins, is lateral to the nucleus and initially contained within the greatly elongate cytoplasmic canal before exiting the canal at its posterior terminus. The spermatozoon of C. riisei exhibits several characters typical of "introsperm," such as an elongate nucleus...

Foram analisadas a espermiogênese e ultraestrutura dos espermatozóides de dois caracídeos com modos de fertilização distintos: fertilização externa em Hemigrammus erythrozonus e inseminação em Corynopoma riisei. A espermiogênese em H. erythrozonus é caracterizada pelo desenvolvimento lateral do flagelo, rotação nuclear, formação de uma fossa nuclear rasa, condensação de cromatina por eliminação da área elétron-lúcida na região periférica do núcleo e renovação da membrana nuclear. Membrana multilamelada e corpos multivesiculares foram observados durante a eliminação do excesso de citoplasma. O espermatozóide exibe os caracteres típicos do "aquaespermatozóide," com uma cabeça esférica que contem um núcleo esférico com cromatina muito condensada, várias mitocôndrias pequenas localizadas na base do núcleo e dentro de um colar citoplasmático, extedendo-se em uma bainha citoplasmática longa que rodeia a parte anterior do único flagelo, que está contido dentro de um canal citoplasmático. O flagelo carece de aletas. Os centríolos proximais e distais são quase paralelos, com as partes anteriores dos dois localizadas dentro de fossas nucleares pouco profundas. A espermiogênese em C. riisei é caracterizada pelo alongamento nuclear ao longo do flagelo, a formação de um canal citoplasmático longo, deslocamento e alongamento das mitocôndrias e uma condensação uniforme da cromatina por todo o núcleo por meio do aumento do diâmetro dos grânulos de cromatina. O espermatozóide tem um núcleo alongado com duas mitocôndrias alongadas dispostas em um lado. Algumas mitocôndrias localizam-se posteriormente ao núcleo formando uma região mitocondrial. O único flagelo, que carece de aletas, é lateral ao núcleo, posicionado anteriormente dentro de um canal citoplasmático muito alongado. O espermatozóide de C. riisei exibe vários caracteres típicos de "introespermatozóides" tais como um núcleo alongado e parte média alongada (região mitocondrial). A cromatina nuclear...

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PURPOSE: We compared the exclusion rate for potential living renal donors evaluated with computerized tomography angiography and radionuclide renal scintigraphy (renal scan) vs excretory urogram, renal scan and renal arteriography. MATERIALS AND METHODS: From March 2004 through February 2006, 603 consecutive patients were evaluated as potential living renal donors. From March 2004 through February 2005, 270 consecutive patients underwent evaluation with excretory urogram, renal scan and renal angiography (group 1). Of these patients 16 underwent computerized tomography to evaluate abnormalities detected on excretory urogram. From March 2005 through February 2006, 333 consecutive patients underwent evaluation with computerized tomography angiography and renal scan (group 2). The number of patients excluded for medical reasons and/or radiographic abnormalities was determined for the 2 groups. RESULTS: More than twice as many patients evaluated with computerized tomography were excluded. In group 1, 7% of patients (20 of 270) were excluded from donation due to radiographic findings vs 16% (53 of 333) in group 2 (p=0.0016). Of the patients 26% and 23% were excluded from renal donation for medical reasons in groups 1 and 2, respectively (p=0.5059). CONCLUSIONS: Multidetector row computerized tomography angiography increases the detection of incidental radiographic abnormalities as well as the renal donor exclusion rate. The increased sensitivity of computerized tomography angiography has created a dilemma for those determining patient eligibility for kidney donation because the clinical significance of many of these findings is unclear. Additional studies should address the significance of these incidental findings so that patients are not needlessly excluded from kidney donation.

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OBJECTIVE: To determine the effect of female partner age on pregnancy rates after vasectomy reversal. DESIGN: Retrospective review. SETTING: Two academic infertility practices. PATIENT(S): Men undergoing vasectomy reversal and their partners. INTERVENTION(S): Microsurgical vasectomy reversal. MAIN OUTCOME MEASURE(S): Patency and pregnancy rates. RESULT(S): Two hundred ninety-four patients met the inclusion criteria. Groups were similar with regard to types of procedure performed (vasovasostomy or vasoepididymostomy), obstructive interval, female factors, number of repeat procedures, and quality of vasal fluid. Patency rates were 90%, 89%, 90%, 86%, and 83% for patients with female partners aged 20-24, 25-29, 30-34, 35-39, and 40+ years, respectively. Pregnancy rates were 67%, 52%, 57%, 54%, and 14% for patients with female partners aged 20-24, 25-29, 30-34, 35-39, and 40+ years, respectively. The pregnancy rate for couples with female partner aged 40 or older was lower than for those with the female partner aged 39 or younger (14% vs. 56%). CONCLUSION(S): Pregnancy rates for vasectomy reversal were good regardless of female age as long as the partner was 39 years old or younger. Pregnancy rates were lower if the female partner was 40 or more years old.

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