Postpubertal Boys Research Articles

Fertility-Preserving Treatments and Patient- and Parental Satisfaction on Fertility Counseling in a Cohort of Newly Diagnosed Boys and Girls with Childhood Hodgkin Lymphoma.

The purpose of this study is to evaluate the use of fertility-preserving (FP) treatments and fertility counseling that was offered in a cohort of newly diagnosed children with classical Hodgkin lymphoma (cHL). In this observational study, boys and girls with cHL aged ≤ 18 years with scheduled treatment according to the EuroNet-PHL-C2 protocol were recruited from 18 sites (5 countries), between January 2017 and September 2021. In 2023, a subset of Dutch participants (aged ≥ 12 years at time of diagnosis) and parents/guardians were surveyed regarding fertility counseling. A total of 101 boys and 104 girls were included. Most post-pubertal boys opted for semen cryopreservation pre-treatment (85% of expected). Invasive FP treatments were occasionally chosen for patients at a relatively low risk of fertility based on scheduled alkylating agent exposure (4/5 testicular biopsy, 4/4 oocyte, and 11/11 ovarian tissue cryopreservation). A total of 17 post-menarchal girls (20%) received GnRH-analogue co-treatment. Furthermore, 33/84 parents and 26/63 patients responded to the questionnaire. Most reported receiving fertility counseling (97%/89%). Statements regarding the timing and content of counseling were generally positive. Parents and patients considered fertility counseling important (94%/87% (strongly agreed) and most expressed concerns about (their child's) fertility (at diagnosis 69%/46%, at present: 59%/42%). Systematic fertility counseling is crucial for all pediatric cHL patients and their families. FP treatment should be considered depending on the anticipated risk and patient factors. We encourage the development of a decision aid for FP in pediatric oncology.

Influence of puberty on high intensity exercise induced skeletal muscle damage and inflammatory response in sedentary boys

The present investigation examined the influence of age and pubertal transition on magnitude of muscle damage and inflammatory response following high intensity incremental treadmill running till volitional exhaustion in sixty-four sedentary prepubertal (n ​= ​32) and postpubertal (n ​= ​32) boys who were randomly recruited in the study. Muscle damage and inflammatory markers like creatine kinase (CK), lactate dehydrogenase (LDH), alanine aminotransferase (ALT), aspartate aminotranferase (AST), C–Reactive Protein (CRP) and Interleukin-6 (IL–6) were estimated before and after exercise. Serum CK, LDH, AST, ALT, CRP and IL–6 levels significantly increased after exercise in both the groups in comparison to respective pre–exercise values. Although CK, LDH, CRP and IL–6 responses were significantly higher in postpubertal boys, no intergroup variation was noted in post-exercise ALT activity. Age and body mass index (BMI) had significant positive correlation with post-exercise CK, LDH, AST, CRP, and IL–6 levels. Muscle injury and inflammation were significantly higher in postpubertal boys, suggesting a rise in these responses as a function of age and muscle mass during onset of puberty. Post–exercise release pattern of ALT was not influenced by age and puberty. Data also revealed that concentric endurance exercise did not induce extensive muscle damage and inflammation in both the groups. Drastic elevation in IL–6 level despite lower muscle damage implied that this marker was released from contracting muscle fibers independent of muscle damage and acute inflammation. The magnitude of this post–exercise IL–6 release increased as a function of age and BMI.

Fragile X syndrome in Democratic Republic of Congo: dysmorphic, cognitive and behavioral findings in 14 subjects from three families.

This study reports on 14 individuals with Fragile X syndrome from 3 Congolese Families. The majority (8/14) were males, with an average age of 18.4 (±11.1 [14-38]) years old. Typical dysmorphic characteristics of Fragile-X syndrome including elongated face, large and prominent ears were found in both males and females with the full mutation. Macroorchidism was found in all post-pubertal boys. The cognitive ability in our cohort varies widely ranging from mild (IQ 50-70) to moderate (IQ 35-49) intellectual disability (Average IQ of 60). All our female patients have ID.

European Paediatric Surgeons' Association Survey on the Adherence to EAU/ESPU Guidelines in the Management of Undescended Testes.

The aim of this study was to assess the adherence to the European Association of Urology (EAU)/European Society for Pediatric Urology (ESPU) 2016 guidelines in the management of undescended testes (UDT). An online questionnaire was sent in 2023 to members of the European Paediatric Surgeons' Association (EUPSA). Among 157 members, 46 and 44% perform orchidopexy before 12 and 18 months, respectively. In total, 92% recommend conservative management of retractile testes and 58% offer close follow-up. In case of nonpalpable testes, 78% favor laparoscopy and 18% ultrasonography. If a peeping testicle is identified at laparoscopy, 76% perform a single-stage orchidopexy. In case of a high testicle, a staged procedure is preferred (84%). Management of blind-ending spermatic vessel is heterogenous with a majority ending the operation, followed by exploration of the inguinal canal and removal of the testicular nubbin with optional fixation of the contralateral testis. Only a minority recommends hormonal therapy to improve fertility potential in bilateral UDT. A majority (59%) discuss testis removal in UDT in postpubertal boys. In addition, 77% declare following the EAU/ESPU guidelines. Unawareness of guidelines was the most common reason cited for nonadherence. International guidelines were found to have the greatest influence on clinical practice; however, personal experience and institutional practice seem to play an important role. Most recommendations of the EAU/ESPU guidelines are being followed by EUPSA members; however, personal and institutional practice impact decision making. Hormonal therapy in bilateral UDT, management of vanishing testes, and UDT in postpubertal boys could be improved.

Influence of Recovery Time After Warm-up on Vertical Jump Performance in Trained Prepubertal and Postpubertal Male Athletes.

Ferrari, A, Baquet, G, Blazevich, AJ, and Ratel, S. Influence of recovery time after warm-up on vertical jump performance in trained prepubertal and postpubertal male athletes. J Strength Cond Res 37(10): 1985-1992, 2023-The aim of this study was to examine the concurrent effects of maturity status and recovery delay after a standardized dynamic warm-up on vertical jump performance. Thirteen prepubertal boys (9.4 ± 1.1 years) and 12 postpubertal boys (16.6 ± 0.8 years) were tested on squat jump (SJ) and drop jump from 30 cm (DJ 30 ) before and after a standardized, 8-minute, dynamic warm-up, including low-intensity, nonspecific dynamic exercises progressing to maximal, specific exercises, over 6 separate occasions. In each session, subjects jumped at 0, 1.5, 3, 5, 7, or 10 minutes after warm-up in a randomized order. Measurements included SJ height, DJ 30 height, ground contact time (GCT), and reactive strength index (RSI) from DJ 30 . The results revealed no significant recovery time × maturity group interaction effects for SJ height ( p = 0.36), DJ 30 height ( p = 0.45), GCT ( p = 0.75), or RSI ( p = 0.09), meaning that maturity status did not have a significant effect on changes in vertical jump performance after the warm-up. However, there were significant time effects for SJ height, DJ 30 height, and RSI ( p < 0.001 for all), with DJ 30 height and RSI increasing significantly by 16.9% at 1.5 minutes ( p < 0.001) and SJ height increasing significantly by 12.0% until 3 minutes after the warm-up ( p < 0.001). To conclude, the standardized dynamic warm-up had beneficial effects on vertical jump performance within the first 3 minutes after completion of the intervention. However, vertical jump performance after the warm-up was not dependent on the children's maturity status.

Comparison of Knee Muscular Strength Balance among Pre- and Post-Puberty Adolescent Swimmers: A Cross-Sectional Pilot Study.

Muscular weakness and strength imbalance between the thigh muscles are considered risk factors for knee injuries. Hormonal changes, characteristic of puberty, strongly affect muscle strength; however, it is unknown whether they affect muscular strength balance. The present study aimed to compare knee flexor strength, knee extensor strength, and strength balance ratio, called the conventional ratio (CR), between prepubertal and postpubertal swimmers of both sexes. A total of 56 boys and 22 girls aged between 10 and 20 years participated in the study. Peak torque, CR, and body composition were measured using an isokinetic dynamometer and dual-energy X-ray absorptiometry, respectively. The postpubertal boys group presented significantly higher fat-free mass (p < 0.001) and lower fat mass (p = 0.001) than the prepubertal group. There were no significant differences among the female swimmers. Peak torque for both flexor and extensor muscles was significantly greater in postpubertal male (p < 0.001, both) and female swimmers (p < 0.001 and p = 0.001, respectively) than in prepubertal swimmers. The CR did not differ between the pre- and postpubertal groups. However, the mean CR values were lower than the literature recommendations, which brings attention to a higher risk of knee injuries.

Effect of maturation on parasympathetic modulation during exercise and recovery

Objectives This study examined the effect of maturation on parasympathetic nervous system (PNS) response from rest to light- to moderate-intensity exercise and recovery from maximal exercise in pre- (n = 10; maturity offset = −3.0 ± 1.2 years; age = 10.1 ± 1.9 years), mid- (n = 9; maturity offset = −0.1 ± 0.6 years; age = 13.7 ± 1.0 years), and postpubertal (n = 10; maturity offset = 1.9 ± 0.6 years; age = 15.6 ± 1.2 years) boys and men (n = 10; age = 24.1 ± 2.0 years). Design Participants completed seated rest, light-intensity exercise (50% HRmax), and moderate-intensity exercise (65% HRmax). Following moderate-intensity exercise, intensity was ramped to elicit maximal HR and followed by 25 min of seated recovery. Log transformed values for root mean square of successive differences (lnRMSSD), high-frequency power (lnHF) and normalized HF power (lnHFnu) assessed PNS modulation during 3 min of rest, light-intensity exercise, moderate-intensity exercise, and 3-min epochs throughout recovery. Results During light-intensity exercise, lnRMSSD and lnHF were greater in prepubertal (lnRMSSD = 3.4 ± 0.3 ms; lnHF = 5.4 ± 0.7 ms2) compared to men (lnRMSSD = 2.8 ± 0.5 ms; lnHF = 4.0 ± 0.9 ms2). During moderate-intensity exercise, lnHF differed between prepubertal and men (2.8 ± 1.0 vs. 1.4 ± 1.0 ms2). During recovery, HRV variables were greater in prepubertal compared to postpubertal and men. Conclusions Prepubertal boys have reduced PNS withdrawal during light-intensity exercise and greater PNS reactivation following exercise.

Editorial

In the UK (as I write this in early June) we are approaching 60% of the population having had at least one COVID-19 vaccine and almost 50% of all adults fully vaccinated. But there are still major issues with differential vaccination rates in various communities and the even greater problem of very limited rollout of vaccines across the world. Until we achieve high rates of international vaccination, we will not be able to consider ourselves in a postpandemic situation. For our profession, the effect of the pandemic has been, and continues to be, significant. The initial ruling that the vaccine could not be offered to pregnant (or even breastfeeding) women exemplified the lack of drug research in these vulnerable populations, which has, over the years, led to most medicines being prescribed off-licence. We now have a very confused pregnant population fearful of COVID-19 but, for many, more fearful of the vaccine. The impact of the pandemic on waiting lists in gynaecology has brought us back to a position we have not seen since the 1990s. We are in the fortunate position at TOG of having a large number of articles accepted for publication; this means that there are currently delays between acceptance and publication, and we are having to choose our articles with even greater care than usual. Please carry on submitting proposals for articles but be aware that your proposal (or article) may be rejected at the time of initial submission or after the full article is reviewed. You will have noticed that we have published little in TOG on COVID-19. The Editorial Board decided that as our journal does not have the facility to offer fast turnaround of papers, in general we would not publish articles on coronavirus on the basis that they would be out of date by the time of publication. This edition of the journal, as ever, covers topics from across our speciality. We have a Commentary from Sambit Mukhopadhyay and Mala Arora discussing how doctors in South-East Asia can benefit from the new RCOG CPD programme. I encourage everyone to read this as it has relevance for all of us, independent of where we work. There is an excellent Review that will be useful not only for members of our profession but also for general practitioners (GPs) and others caring for women’s sexual health by Ritchie et al. on the potential benefits of intrauterine contraceptive devices. They discuss use in the nulliparous population (with increased insertion failure rate but the benefits of long acting contraception). There is an excellent accompanying infographic that can be viewed on TOG online. There are two articles of interest to the obstetric readership in particular. The article by Crosby et al. on diagnosis and management of venous thromboembolism (VTE) in pregnancy will be relevant to all of us. This article will help your understanding of the best way to diagnose VTE and current management including the use (or not) of inferior vena cava filters. For the specialist – and I hope of interest to the generalist – there is an article on the investigation and management of fetal anaemia. Morris et al. have written an article that will ensure we are all able to give our women knowledge-based advice as they go through these investigations and treatments. One of the distressing aspects of cancer in young people is the potential impact on fertility for the survivors. Hartington et al. have reviewed the options for fertility preservation in pre- and postpubertal girls and boys. I recommend this article to all those who are supporting these families, including paediatric oncologists and GPs who may be inquisitive but do not know where to source this information to help their patients. Over the last few years we have published numerous articles on the pros and cons of mesh in the management of prolapse and urinary incontinence. I am grateful to Krishnaswamy et al. on their article on non-mesh surgery for urinary incontinence, bringing together the options available in 2021. It covers the ‘rediscovery’ of the techniques and benefits of colposuspension and discusses the use of autologous fascial slings. We need to consider the training (and potentially retraining) needs of our workforce and the need for collection of data to ensure long-term effects are identified as early as possible. I am, as ever, grateful to my Editorial Board for the huge amount of work they do. I am sorry that Mohamed Mehasseb is leaving us after many years of hard work supporting TOG and I am delighted to welcome Rasiah Bharathan as our newest member of the Board.

Fertility on ice: an overview of fertility preservation for children and adolescents with cancer

Key content Continued advances in oncology treatments have led to better survival rates for children and young adults with cancer. An important ‘late effect’ of cancer treatment is the loss of fertility. Although many survivors of childhood cancers go on to conceive without difficulty, the potential loss of fertility is a concern for children and young adults with cancer, their parents and caregivers. We review current options for fertility preservation (FP) for prepubertal and postpubertal girls and boys, including oocyte cryopreservation, ovarian tissue cryopreservation, sperm cryopreservation and testicular tissue cryopreservation. Learning objectives To understand the different FP methods available for children and adolescents, the barriers to FP and ethical and psychological considerations To raise awareness of the importance of early discussions about FP with patients who are at risk of infertility from their cancer treatment. Ethical Issues Autotransplantation of ovarian tissue in survivors of haematological malignancies, particularly leukaemia, carries a strong risk of re‐introducing the malignancy and should be avoided. Clinicians must consider suitability of the patient for FP, taking into account emotional maturity, patient and parent desire for FP and the physical fitness of the patient, including their immunosuppressive state.

High intensity exercise induced alteration of hematological profile in sedentary post-pubertal boys and girls: A comparative study

Objectives: High-intensity exercise induces intensity dependent leukocytosis due to increased trafficking of white blood cells in circulation and also causes red blood cell (RBC) damage and hemolysis due to osmotic and mechanical stress. The present study was aimed to investigate the high-intensity exercise-induced perturbations of hematological profile in sedentary post-pubertal boys and girls. Materials and Methods: Blood samples were collected from sedentary post-pubertal boys (n = 22, age = 16.10 ± 0.74 years) and girls (n = 22, age = 16.04 ± 0.63 years) before and immediately after exercise to assess hematological parameters such as RBC Count, hematocrit, hemoglobin concentration (Hb), total leukocyte counts, and differential count. Results: Pre- and post-exercise RBC count, Hb and hematocrit had no significant inter-group variation. Pre- and post-exercise hematocrit and Hb were significantly (P &lt; 0.001) higher in post-pubertal boys. Leukocyte count had insignificant intergroup variation before the exercise but it increased significantly (P &lt; 0.001) following exercise in both the groups. Monocytosis and neutrophilia were significantly (P &lt; 0.01) higher in post-pubertal boys. Percentage change in monocyte, eosinophil and basophil did not depict significant inter-group variation while percentage increase in neutrophil was significantly (P &lt; 0.01) higher in boys as compared to girls. Post-exercise absolute lymphocyte count as well as percentage increase in this variable was significantly (P &lt; 0.001) higher in girls as compared to boys. Absolute eosinophil count increased significantly in both the groups but its relative count declined substantially probably due to higher rate of mobilization of lymphocyte and neutrophil. Basophil count was also perturbed following exercise. Conclusion: Gender appeared to have insignificant impact on exercise-induced perturbation in hematological profile at post-pubertal stage except for neutrophil and lymphocyte.

Comparison of corporal plication for the correction of congenital penile curvature in pre-pubertal and post-pubertal patients: Does age matter?

We retrospectively reviewed and compared the results of corporal plication procedures for the correction of congenital penile curvature (CPC) between pre-pubertal and post-pubertal boys and find whether age matters in the success rates. We reviewed the records of 32 patients with CPC without hypospadias treated by simple plication near the 12 o'clock position between 1998 and 2018 in our clinic. Patients under 13years of age and not had puberty yet were accepted as pre-pubertal. Residual curvature less than 10° during follow-up was accepted as a surgical success. The mean age of the pre-pubertal group was 8.3 (2-12) years, while 16.2 (14-21) for the post-pubertal patients. The mean follow-up was 38.7 (24-154) months in the pre-pubertal group and 45.1 (23-150) months in the post-pubertal group. The success rates of corporal plication in pre-pubertal and post-pubertal groups were 78% and 83% respectively (p=.753). The success rates of corporal plication were similar between pre-pubertal and post-pubertal boys. However, as the series was small further studies should be favoured to determine the effect of age on success rates.

Testicular tumors in children and adolescents: long-term endocrine and fertility issues.

The treatment modalities for testicular tumors (surgery, chemotherapy, and radiotherapy), have different associated gonadotoxic risks and the overall survival for most pediatric patients with testicular tumors is very good. However, necessary treatments may lead to the development of lasting gonadal dysfunction and subsequent negative health and quality of life impact. Research with long-term follow-up for patients who have undergone surgery as the sole treatment modality for testicular tumors in childhood are lacking. It is currently unclear if surgery leads to long-term negative functional outcomes. Alkylating agents (e.g., cyclophosphamide) have long been known to increase risk of infertility; platinum-based therapies used frequently for patients with germ-cell tumors (GCTs) also seem to carry some risk of gonadotoxicity, although they have not been as well studied. Radiotherapy to the gonads is toxic and Leydig cells are particularly sensitive to high doses of radiation (>12 Gy). Long-term fertility and hormonal impact vary based on the patient’s age, as well as the type and intensity of the oncological treatment prescribed. Counselling regarding fertility risk and preservation options should ideally take place before initiating potentially gonadotoxic treatments. Hypogonadism in peri-pubertal boys can present as delayed onset or failure to progress through puberty. Sperm cryopreservation should be offered for post-pubertal boys who are able to provide a semen sample. For prepubertal boys or young males who cannot provide a semen sample, only experimental options are currently available. Much of the data reviewed here is extrapolated from research done on adult males whose reproductive and hormonal outcomes may not be comparable to younger patients who do not yet have fully developed reproductive systems. Currently, a lack of good quality evidence in this age range causes this restriction to be unavoidable. Patients and their families want to be informed of the risks and treatment options for preserving testicular function. As research continues in this field, it grows more important for urologists to be aware of the outcomes and options for their patients.

Effect of Drop Height on Vertical Jumping Performance in Pre-, Circa-, and Post-Pubertal Boys and Girls.

To examine the effect of drop height on vertical jumping performance in children with respect to sex and maturity status. Thirty-seven pre-pubertal, 71 circa-pubertal, and 69 post-pubertal boys and girls performed, in a randomized order, 2 squat jumps, 2 countermovement jumps, and 2 drop jumps (DJ) from heights of 20, 30, 40, 50, 60, and 70cm. The trial with the best jump height in each test was used for analysis. No significant sex × maturity status × jump type interaction for jump height was observed. However, on average, the children jumped higher in the countermovement jump than in squat jump and DJs (+1.2 and +1.6cm, P < .001, respectively), with no significant differences between DJs and squat jumps or between DJs when increasing drop heights. Regarding DJs, 59.3% of the participants jumped higher from drop heights of 20 to 40cm. Children, independent of sex and maturity status, performed best in the countermovement jump, and no performance gain was obtained by dropping from heights of 20 to 70cm. During maturation, the use of drop heights between 20 and 40cm may be considered in plyometric training, but the optimum height must be obtained individually.

Sequencing Effects of Plyometric Training Applied Before or After Regular Soccer Training on Measures of Physical Fitness in Young Players.

Ramirez-Campillo, R, Alvarez, C, Gentil, P, Loturco, I, Sanchez-Sanchez, J, Izquierdo, M, Moran, J, Nakamura, FY, Chaabene, H, and Granacher, U. Sequencing effects of plyometric training applied before or after regular soccer training on measures of physical fitness in young players. J Strength Cond Res 34(7): 1959-1966, 2020-To compare the effects of short-term (i.e., 7 weeks) plyometric jump training applied before (PJT-B) or after (PJT-A) soccer practice on components of physical fitness in young soccer players, a single-blind randomized controlled trial was conducted. Postpubertal boys aged 17.0 ± 0.5 years were allocated to 3 groups: PJT-B (n = 12), PJT-A (n = 14), and control (CON; n = 12). The outcome measures included tests to evaluate 20-m speed, standing long jump (SLJ), squat jump (SJ), countermovement jump (CMJ), and drop jump (DJ), 20-m multistage shuttle run endurance (MSSRT), and Illinois change-of-direction speed (ICODT). Although the CON performed soccer-specific training, the PJT-A and PJT-B groups conducted the same soccer-specific sessions but replaced ∼11% of their time with plyometric training. The PJT-B group performed plyometric exercises after a warm-up program, and the PJT-A group conducted plyometric exercises ∼10 minutes after the completion of soccer training. Analyses of variance were used to detect differences between groups in all variables for pretraining and posttraining tests. Main effects of time (all p < 0.01; d = 0.19-0.79) and group × time interactions (all p ≤ 0.05; d = 0.17-0.76) were observed for all examined variables. Post hoc analyses revealed significant increases in the PJT-B group (SLJ: 9.4%, d = 1.7; CMJ: 11.2%, d = 0.75; 20-m MSSRT: 9.0%, d = 0.77) and the PJT-A group (SLJ: 3.1%, d = 0.7; CMJ: 4.9%, d = 0.27; 20-m MSSRT: 9.0%, d = 0.76). Post hoc analyses also revealed significant increases in the PJT-B group (20-m speed: -7.4%, d = 0.75; 20-cm DJ reactive strength index: 19.1%, d = 1.4; SJ: 6.3%, d = 0.44; ICODT results: -4.2%, d = 1.1). In general, our study revealed that plyometric training is effective in improving measures of physical fitness in young male soccer players when combined with regular soccer training. More specifically, larger training-induced effects on physical fitness were registered if plyometric training was conducted before soccer-specific training.

Analysis of bone mass and its relationship with body composition in school-aged children and adolescents based on stage of puberty and site specificity: A retrospective case-control study.

The aim of this study was to better understand the relationship of bone mass with body composition based on different stages of puberty and to illuminate the contribution of site-specific fat mass and lean mass (FM and LM) compared with bone mass in school-aged children and adolescents in Chongqing, China.A total of 1179 healthy subjects of both sexes were recruited. Bone mineral content (BMC), bone mineral density (BMD), bone area, and both FM and LM were measured by dual-energy X-ray absorptiometry (DXA). The fat mass and lean mass indexes (FMI and LMI, respectively) were calculated as the FM (kg) and LM (kg) divided by the height in meters squared, respectively.Most of the bone mass indicators were significantly higher for postpubertal boys than for girls at the same stage (P < .001). The proportion of subjects with normal bone mass increased, while the proportion of subjects with osteopenia and osteoporosis decreased with increased body weight regardless of gender and puberty stage (P < .01). FM and LM were significantly positively related to bone mass regardless of gender and puberty stage (P < .0001). FMI and LMI were significantly positively related to bone mass in most conditions (P < .05 and P < .0001, respectively). Four components of the FM and LM were linearly and significantly associated with BMD and BMC for TB and TBHL. Among them, the head fat mass and head lean mass showed the greatest statistical contribution.In the process of assessing bone status, we recommend measuring fat and lean masses, including the fat and lean masses of the head.

The futility of continued surveillance of epididymal cysts - A study of the prevalence and clinico-demographics in pre- vs. post-pubertal boys.

The first description of epididymal cysts in children appears from a 1976 case study. Since then, there have been a total of 24 indexed publications relating to pediatric epididymal cysts. Risk factors that may exist for children presenting with epididymal cyst remain unknown, as has the best method of management. And there have not been any studies looking at the cost implications of this diagnosis. The aim of this study was to assess the incidence, clinico-demographics, outcomes, and costs of epididymal cysts in pre-pubertal boys compared with a post-pubertal epididymal cyst cohort, and to assess whether this cohort requires continued surveillance METHODS:: Our institutional ultrasound (US) database was searched for all scrotal US. From these, a filtered, institution review board-approved search was performed for any reports containing the word "cyst." These were then cross-referenced with a retrospective chart review (October 2006 to September 2017). Clinico-demographics, cyst characteristics, and outcomes were analysed for both pre- and post-pubertal boys using descriptive and non- parametric statistical methods RESULTS:: Of 4508 boys undergoing scrotal US during the study period, 191 were indicated to contain cysts. This was manually reduced to 109 scans (2.4%) that met inclusion criteria (85 pre-pubertal; 24 post-pubertal). Thirty-one scans were ordered by urology, including all those with abnormal testicular echotexture (n=5). The average age of the post-pubertal cohort was 15.8 years, compared with 3.8 years in the pre-pubertal cohort. Most (70.5%) epididymal cysts were incidental. There was no difference between the pre- and post-pubertal cohorts in terms of presence of hydrocoeles (p=0.9), symptoms (p=0.9), ordering service (p=0.61), rate of resolution (4.2% vs. 8.2%; p=0.68), or length of followup (4 vs. 4.5 years; p=0.44). Pre- pubertal cysts were significantly smaller in size (3.35 vs. 14.52 mm; p=0.025) and more likely to trigger repeat scanning (67 vs. 10; p=0.008). There were no operative interventions and no subsequent clinical deterioration occurred with observation. At a cost of $71.10 CAD per US, $15 002.10 CAD was expended on epididymal cyst surveillance in direct cost to the healthcare system. Epididymal cysts are comparable in both pre- and post-pubertal boys and can be safely managed non-operatively without the use of continued US surveillance or urological referral. The higher than expected rate of detection may be a result of the improved ultra-resolution of modern scanners. These children should not require continued followup with repeat surveillance imaging solely for epididymal cysts and could be managed in the primary care setting as part of routine clinical examination.

High-intensity exercise-induced oxidative stress in sedentary pre-pubertal & post-pubertal boys: A comparative study.

Background & objectives:High-intensity exercise results in oxidative stress in adult population. Impact of pubertal attainment on high-intensity exercise-induced oxidative stress in sedentary paediatric population has not been investigated in detail. The present study was conducted to investigate the extent of high-intensity exercise-induced oxidative stress in sedentary pre- and post-pubertal boys through estimation of serum thiobarbituric acid reactive substances (TBARS), total thiol content and activities of superoxide dismutase (SOD) and catalase (CAT).Methods:Sixty four sedentary pre-pubertal (n=32, age = 10.21±0.67 yr) and post-pubertal (n=32, age = 15.58±0.47 yr) boys performed incremental treadmill running exercise at 80 per cent of the age predicted maximum heart rate till volitional exhaustion. Blood sample (5 ml) was drawn from each individual before and after the exercise for estimation of oxidative stress markers.Results:Pre-exercise SOD activity and total thiol level showed significant positive relationship with age and were significantly higher in post-pubertal boys. Serum TBARS level, SOD and CAT activities increased while total thiol content decreased in both the groups following exercise. Post-exercise percentage change in TBARS, SOD activity and total thiol level was significantly higher in post-pubertal boys, and these variables had significant positive relationship with age. No significant intergroup variations were noted in CAT activity before or after exercise.Interpretation & conclusions:Extent of post-exercise oxidative stress increased significantly with attainment of puberty. However, baseline and post-exercise antioxidation status also increased significantly as a function of age with pubertal maturation allowing the post-pubertal boys to counter relatively higher oxidative stress more efficiently than their pre-pubertal counterparts. Post-exercise upregulation in CAT activity might not be influenced by age or pubertal maturation in this age group.

Parasympathetic Modulation At Rest, During Exercise And Recovery From Maximal Exercise, In Boys And Men

PURPOSE: Assess heart rate variability (HRV) to examine the parasympathetic nervous system (PNS) response from rest to light- (LIE) to moderate-intensity exercise (MIE) and recovery from maximal exercise in pre- (n = 10; maturity offset (MO) = -3.0 ± 1.2 yrs; age = 10.1 ± 1.9 yrs), mid- (n = 9; MO = -0.1 ± 0.6 yrs; age = 13.7 ± 1.0 yrs), and post-pubertal (n = 10; MO = 1.9 ± 0.6 yrs; age = 15.6 ± 1.2 yrs) boys and men (n = 10; age = 24.1 ± 2.0 yrs). METHODS: Subjects completed seated rest, LIE (50% HRmax) and MIE (65% HRmax). Intensity was then ramped to elicit maximal HR, followed by a 25-min seated recovery. HRV (root mean square of successive differences [RMSSD] and high-frequency power [HF]) was assessed during the last 3 min of rest, LIE and MIE and 3-min epochs ending at 10, 15, 20 and 25 min in recovery. RMSSD and HF were natural log transformed (ln) due to non-normal distribution. Significance was established if p ≤ 0.05. RESULTS: In each group, lnRMSSD and lnHF were similar at rest and decreased from rest to LIE to MIE. During LIE, lnRMSSD was greater in pre (3.4 ± 0.3 ms) than men (2.8 ± 0.5 ms) but similar to mid (3.1 ± 0.5 ms) and post (3.0 ± 0.5 ms). During MIE, lnRMSSD was similar between groups (pre = 2.1 ± 0.4 ms; mid = 1.9 ± 0.5 ms; post = 1.7 ± 0.5 ms; men = 1.8 ± 0.6 ms). Pre had greater lnHF than men during LIE (5.4 ± 0.7 ms2 vs 4.0 ± 0.9 ms2) and MIE (2.8 ± 1.0 ms2 vs 1.4 ± 1.0 ms2), but similar to mid (LIE = 4.8 ± 1.2 ms2; MIE = 2.3 ± 1.7 ms2) and post (LIE = 4.9 ± 0.9 ms2; MIE = 2.2 ± 0.8 ms2) at each intensity. In recovery, groups increased lnRMSSD from 10 (pre = 3.2 ± 0.8 ms; mid = 2.4 ± 0.6 ms; post = 1.8 ± 0.8 ms; men = 1.9 ± 0.5 ms) to 25 min (pre = 3.8 ± 0.6 ms; mid = 3.4 ± 0.6 ms; post = 2.8 ± 0.8 ms; men = 2.7 ± 0.8 ms). For lnHF, all groups increased from 10 (pre = 4.9 ± 1.8 ms2; mid = 3.4 ± 1.2 ms2; post = 2.2 ± 1.8 ms2) to 25 min (pre = 6.5 ± 1.3 ms2; mid = 5.6 ± 1.5 ms2; post = 4.1 ± 1.7 ms2), except men (2.5 ± 1.0 ms2 vs 3.9 ± 1.6 ms2; p = 0.09). At all points, lnRMSSD and lnHF were greater in pre compared to post and men. Also, mid and post had different lnRMSSD at 15 min (2.9 ± 0.7 ms vs 2.0 ± 0.7 ms) and lnHF at 20 min (5.5 ± 1.4 ms2 vs 3.7 ± 1.2 ms2). CONCLUSIONS: The primary findings were PNS withdrawal was reduced in pre-pubertal boys than men during LIE and MIE (HF only). Otherwise, MO did not affect PNS response from rest to MIE. Throughout recovery, PNS reactivation was greater in pre-pubertal boys compared to post-pubertal boys and men.

High-Intensity Exercise Induced Oxidative Stress and Skeletal Muscle Damage in Postpubertal Boys and Girls: A Comparative Study

Pal, S, Chaki, B, Chattopadhyay, S, and Bandyopadhyay, A. High-intensity exercise induced oxidative stress and skeletal muscle damage in post-pubertal boys and girls: a comparative study. J Strength Cond Res 32(4): 1045-1052, 2018-The purpose of this study was to examine the sex variation in high-intensity exercise induced oxidative stress and muscle damage among 44 sedentary postpubertal boys and girls through estimation of postexercise release pattern of muscle damage markers like creatine kinase, lactate dehydrogenase (LDH), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and oxidative stress markers like extent of lipid peroxidation (thiobarbituric acid-reactive substances) and catalase activity. Muscle damage markers like creatine kinase, LDH, ALT, and AST were measured before, immediately after, and 24 and 48 hours after high-intensity incremental treadmill running. Oxidative stress markers like thiobarbituric acid-reactive substances and catalase activity were estimated before and immediately after the exercise. Lipid peroxidation and serum catalase activity increased significantly in both groups after exercise (p < 0.001) with postexercise values and percentage increase significantly higher in postpubertal boys as compared to girls (p < 0.001). Creatine kinase and LDH activity also increased significantly above pre-exercise level at 24 and 48 hours after exercise in both the sexes, (p < 0.001) with values significantly higher for boys than the girls (p < 0.001). Although ALT and AST increased significantly in both the groups after exercise, the pattern of postexercise release of these markers were found to be similar in both the groups. Accordingly, it has been concluded from the present investigation that high-intensity exercise induces significant oxidative stress and increases indices of skeletal muscle damage in both postpubertal girls and boys. However, postpubertal girls are relatively better protected from oxidative stress and muscle damage as compared to the boys of similar age and physical activity level. It is further evident that sex difference may not be apparent for all the biomarkers of muscle damage in this age group.

Fertility Preservation in Prepubertal und Pubertal Children and Adolescents

Due to rising survival rates in cancer and autoimmune diseases fertility preservation before gonadotoxic therapies has become increasingly important. Although fertility can be significantly affected by gonadotoxic therapies, the possibility of fertility preservation during childhood has not been sufficiently considered so far. Selective literature research with presentation of fertility preservation methods, their indications, implementations, risks and efficacy. Measures are indicated in all girls and boys at high risk of gonadal damage. The complexity of the techniques requires special expertise in the counseling and implementation, which is offered to girls in counselling Germany especially in the centers of FertiPROTEKT (www.fertiprotekt.com). In girls, mainly cryopreservation of ovary tissue is considered. In postpubertal girls cryopreservation of oocytes is also possible. In postpubertal boys sperm can be preserved. Freezing of testicular tissue is still experimental in prepubertal boys. Success rates are still difficult to quantify; birth rates of about 50% are discussed. All procedures are not covered by health insurance. In children and adolescents, measures of fertility preservation should be considered in cases of highly gonadotoxic therapies, and appropriate advice should be given by specialists.