A variety of methods for testosterone replacement therapy (TRT) exist, and the major potential risks of TRT have been well established. The risk of developing polycythemia secondary to exogenous testosterone (T) has been reported to range from 0.4% to 40%. Implantable T pellets have been used since 1972, and secondary polycythemia has been reported to be as low as 0.4% with this administration modality. However, our experience has suggested a higher rate. We conducted an institutional review board-approved, single-institution, retrospective chart review (2009-2013) to determine the rate of secondary polycythemia in 228 men treated with subcutaneously implanted testosterone pellets. Kaplan-Meyer failure curves were used to estimate time until the development of polycythemia (hematocrit >50%). The mean number of pellets administered was 12 (range: 6-16). The mean follow-up was 566 days. The median time to development of polycythemia whereby 50% of patients developed polycythemia was 50 months. The estimated rate of polycythemia at 6 months was 10.4%, 12 months was 17.3%, and 24 months was 30.2%. We concluded that the incidence of secondary polycythemia while on T pellet therapy may be higher than previously established.

Varicocele recurrence is one of the most common complications associated with varicocele repair. A systematic review was performed to evaluate varicocele recurrence rates, anatomic causes of recurrence, and methods of management of recurrent varicoceles. The PubMed database was evaluated using keywords "recurrent" and "varicocele" as well as MESH criteria "recurrent" and "varicocele." Articles were not included that were not in English, represented single case reports, focused solely on subclinical varicocele, or focused solely on a pediatric population (age <18). Rates of recurrence vary with the technique of varicocele repair from 0% to 35%. Anatomy of recurrence can be defined by venography. Management of varicocele recurrence can be surgical or via embolization.

A variety of methods for testosterone replacement therapy (TRT) exist, and the major potential risks of TRT have been well established. The risk of developing polycythemia secondary to exogenous testosterone (T) has been reported to range from 0.4% to 40%. Implantable T pellets have been used since 1972, and secondary polycythemia has been reported to be as low as 0.4% with this administration modality. However, our experience has suggested a higher rate. We conducted an institutional review board-approved, single-institution, retrospective chart review (2009-2013) to determine the rate of secondary polycythemia in 228 men treated with subcutaneously implanted testosterone pellets. Kaplan-Meyer failure curves were used to estimate time until the development of polycythemia (hematocrit >50%). The mean number of pellets administered was 12 (range: 6-16). The mean follow-up was 566 days. The median time to development of polycythemia whereby 50% of patients developed polycythemia was 50 months. The estimated rate of polycythemia at 6 months was 10.4%, 12 months was 17.3%, and 24 months was 30.2%. We concluded that the incidence of secondary polycythemia while on T pellet therapy may be higher than previously established.
Adult ; Aged ; Androgens/adverse effects* ; Drug Implants ; Hematocrit ; Hormone Replacement Therapy/methods* ; Humans ; Hypogonadism/drug therapy* ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Polycythemia/epidemiology* ; Retrospective Studies ; Testosterone/adverse effects*

Purpose: Interprofessional education (IPE) is a concept that allows students from different health professions to learn with and from each other as they gain knowledge about their chosen professions and the professions of their colleagues. The purpose of this systematic review was to determine the effectiveness of IPE in the academic preparation of students of the health professions. Methods: A search was conducted of the PubMed and CINAHL databases using the following eligibility criteria: IPE including students from 3 or more healthcare professions, IPE exposure within academic coursework, measurement of attitudes and/or perceptions as outcomes, and quantitative reporting of results. Articles were screened by title, abstract, and full text, and data were extracted. Results: The search yielded 870 total articles. After screening, 7 articles remained for review. All studies reported a positive impact of IPE on the education of students of the health professions. Conclusion Evidence showed that IPE activities were an effective tool for improving attitudes toward interdisciplinary teamwork, communication, shared problem-solving, and knowledge and skills in preparation for collaboration within interdisciplinary teams.

BACKGROUNDHeterosexual sex has become the dominant transmission route in China. Recently studies reported high heterogeneity in heterosexual transmission risk in resource-limited countries. The aim of this study was to summarize the risk of HIV transmission among Chinese serodiscordant couples.

METHODSA systematic review and meta-analysis of observational studies of heterosexual HIV transmission among serodiscordant couples in China was conducted. Two reviewers conducted a literature search using the China National Knowledge Infrastructure (CNKI), Chinese Medical Current Contents (CMCC), and Medline databases. Pooled transmission estimates per 100 person-years (PY) were calculated using a random-effects model. Meta-regression analysis and subgroup analysis stratified by study design, transmission direction and period of antiretroviral therapy (ART) availability were conducted to assess the factors associated with transmission.

RESULTSEleven eligible studies were identified reporting on 11 984 couples and 405 HIV transmission events. HIV transmission risk from HIV-positive individuals to heterosexual partners was 1.68 (95%CI 0.74 - 2.62) per 100 PY. Study design did not reach statistical significance in meta-regression analysis. The pooled female-to-male transmission estimate was 1.11 (95%CI 0.09 - 2.14) per 100 PY and male-to-female transmission estimate was 1.43 (95%CI 0.19 - 2.68) per 100 PY. The pooled estimate for those before the availability of the Chinese National Free Antiretroviral Therapy Program (2.13 (95%CI 0.00 - 4.63) per 100 PY) was higher than that for those after the implementation of this program (1.44 (95%CI 0.62 - 2.26) per 100 PY).

CONCLUSIONSTransmission estimates in China were lower than other developing countries, but higher than developed countries. Research that better defines HIV secondary transmission rates and the associated behavioral, treatment adherence, and health-related risk factors among heterosexual serodiscordant couples in China is needed.

China ; Female ; HIV Infections ; etiology ; transmission ; Heterosexuality ; Humans ; Male ; Risk