The Effectiveness of Clomiphene Citrate Compared to Exogenous Testosterone Therapy in Adult Males

Background: Low testosterone (T) in men is a common medical condition affecting approximately 5 million men in the United States. Low T caused by primary hypogonadism is treatable with exogenous testosterone in the form of direct injection or topical gels. However, low T due to secondary hypogonadism is amenable to treatment with exogenous testosterone forms, as well as selective estrogen receptor modulators (SERMs), such as clomiphene citrate (Clomid; CC).There are significant side effects and increased cost with exogenous testosterone therapy (mentioned above) compared to clomiphene. Generic clomiphene, used off-label, avoids these side effects and represents a significant cost savings.But what is its efficacy compared to testosterone therapy? Methods: An exhaustive search of available medical literature was conducted utilizing 3 separate, thoroughly vetted search engines, including MEDLINE-Ovid, Web of Science, and CINAHL. Keywords used included: clomiphene, hypogonadotropic hypogonadism, and ADAM or qADAM or quality of life. Results: Based on the search criteria, 6 articles were identified and reviewed for relevancy. This was narrowed down to 2 articles that met the inclusion and exclusion criteria. These 2 studies were observational, non-randomized studies. One study found that there was no statistical difference between CC, injected testosterone, or testosterone gel replacement therapy (TGRT) in regards to patient satisfaction as measured with the qADAM questionnaire. The second study found that CC was as effective as TGRT at raising serum T levels at a much lower cost without the same risks of side effects associated with TGRT. The overall quality of both studies was low and further investigation would need to be done to validate these findings. Specifically, randomized, placebo controlled, double blinded, studies with larger cohorts are necessary. Conclusion: Clomiphene citrate has been used for many years in an off-label manner to treat men with hypogonadism, mostly in specialty centers.There are only 2 studies found in the literature comparing CC to exogenous testosterone treatment and both of are low quality. Despite this limitation, and a lack of FDA approval, CC appears to be a viable option for men with low T due to secondary hypogonadism, demonstrating equal improvement in overall patient satisfaction and quality of life improvements at a lower cost while avoiding the potential side effects of testicular atrophy and reduced spermatogenesis. Keywords: Clomiphene citrate, hypogonadotropic hypogonadism, ADAM, qADAM, quality of lif

On the entanglement entropy for a XY spin chain

The entanglement entropy for the ground state of a XY spin chain is related to the corner transfer matrices of the triangular Ising model and expressed in closed form.Comment: 4 pages, 2 figure

Pancreatic cysts suspected to be branch duct intraductal papillary mucinous neoplasm without concerning features have low risk for development of pancreatic cancer.

BackgroundThe risk of developing pancreatic cancer is uncertain in patients with clinically suspected branch duct intraductal papillary mucinous neoplasm (BD-IPMN) based on the "high-risk stigmata" or "worrisome features" criteria proposed in the 2012 international consensus guidelines ("Fukuoka criteria").MethodsRetrospective case series involving patients referred for endoscopic ultrasound (EUS) of indeterminate pancreatic cysts with clinical and EUS features consistent with BD-IPMN. Rates of pancreatic cancer occurring at any location in the pancreas were compared between groups of patients with one or more Fukuoka criteria ("Highest-Risk Group", HRG) and those without these criteria ("Lowest-Risk Group", LRG).ResultsAfter exclusions, 661 patients comprised the final cohort (250 HRG and 411 LRG patients), 62% female with an average age of 67 years and 4 years of follow up. Pancreatic cancer, primarily adenocarcinoma, occurred in 60 patients (59 HRG, 1 LRG). Prevalent cancers diagnosed during EUS, immediate surgery, or first year of follow up were found in 48/661 (7.3%) of cohort and exclusively in HRG (33/77, 42.3%). Using Kaplan-Meier method, the cumulative incidence of cancer at 7 years was 28% in HRG and 1.2% in LRG patients (P<0.001).ConclusionsThis study supports using Fukuoka criteria to stratify the immediate and long-term risks of pancreatic cancer in presumptive BD-IPMN. The risk of pancreatic cancer was highest during the first year and occurred exclusively in those with "high-risk stigmata" or "worrisome features" criteria. After the first year all BD-IPMN continued to have a low but persistent cancer risk

Coupling Impedance of Cesr-B Rf Cavity for the Nsls-Ii Storage Ring.

CESR-B type superconducting cavities are under consideration for acceleration of the electron beam in the 3GeV NSLS-II storage ring. In this paper we present detailed investigation of longitudinal and transverse impedance of CESR-B cavity and transitions. Ferrite material is included in impedance analysis. Its effect on short range wake potential has been studied using GdfidL code. The summary results of loss factors and kick factors are presented for a 3mm rms bunch length

Yang-Baxter equation for the asymmetric eight-vertex model

In this note we study `a la Baxter [1] the possible integrable manifolds of the asymmetric eight-vertex model. As expected they occur when the Boltzmann weights are either symmetric or satisfy the free-fermion condition but our analysis clarify the reason both manifolds need to share a universal invariant. We also show that the free-fermion condition implies three distinct classes of integrable models.Comment: Latex, 12 pages, 1 figur

Dynamics of lattice spins as a model of arrhythmia

We consider evolution of initial disturbances in spatially extended systems with autonomous rhythmic activity, such as the heart. We consider the case when the activity is stable with respect to very smooth (changing little across the medium) disturbances and construct lattice models for description of not-so-smooth disturbances, in particular, topological defects; these models are modifications of the diffusive XY model. We find that when the activity on each lattice site is very rigid in maintaining its form, the topological defects - vortices or spirals - nucleate a transition to a disordered, turbulent state.Comment: 17 pages, revtex, 3 figure

Understanding/unravelling carotenoid excited singlet states.

Carotenoids are essential light-harvesting pigments in natural photosynthesis. They absorb in the blue–green region of the solar spectrum and transfer the absorbed energy to (bacterio-)chlorophylls, and thus expand the wavelength range of light that is able to drive photosynthesis. This process is an example of singlet–singlet excitation energy transfer, and carotenoids serve to enhance the overall efficiency of photosynthetic light reactions. The photochemistry and photophysics of carotenoids have often been interpreted by referring to those of simple polyene molecules that do not possess any functional groups. However, this may not always be wise because carotenoids usually have a number of functional groups that induce the variety of photochemical behaviours in them. These differences can also make the interpretation of the singlet excited states of carotenoids very complicated. In this article, we review the properties of the singlet excited states of carotenoids with the aim of producing as coherent a picture as possible of what is currently known and what needs to be learned