Surgical ligation of scrotal varicocele for male factor infertility is a valid option of treatment

Objective: To evaluate the role of surgical ligation of scrotal varicocele for treatment of male factor infertility. Methods: We studied 60 patients who presented with infertility and were also found to have scrotal varicocele. Patients with other probable causes contributing to infertility were excluded. Diagnosis was made by clinical examination and scrotal ultrasonography. All the patients underwent either laparoscopic varicocelectomy or open retroperitoneal high ligation of the testicular veins. Operative time and hospital stay was recorded. All patients were evaluated for postoperative improvement of semen parameters and development of any postoperative complication. The results were analyzed by commercially available software. Results: During the study period 5 patients were lost to follow up and were excluded. The rest of patients (n=55) were young, with age ranging from 20-35 years (Mean age 27.8 years, SD +/- 4.38). All patients had unilateral left sided varicocele; two patients (3.6%) had grade I varicocele, 21 patients (38.2%) had grade II varicocele and 32 patients (58.2%) had grade III varicocele. Statistically significant improvement in sperm density (p value \u3c 0.05), sperm activity (p value \u3c 0.05) and sperm morphology (p value \u3c 0.05) was observed after the surgical ligation. The mean operative time was 54.88 minutes (SD + 13). The mean hospital stay in laparoscopic procedure was 33.4 (SD + 15.3). Minor complications were noted in 13 patients and included superficial wound infection in 3 patients, 6 patients exhibited testicular pain and persistence of varicocele in 4 patients. Conclusion: Surgical ligation of scrotal varicocele is asafe and effective mode of treatment of male factor infertility in selected population

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Pseudorapidity distributions of charged hadrons in proton-lead collisions at root s(NN)=5:02 and 8.16 TeV

The pseudorapidity distributions of charged hadrons in proton-lead collisions at nucleon-nucleon center-of-mass energies root s(NN) = 5.02 and 8.16 TeV are presented. The measurements are based on data samples collected by the CMS experiment at the LHC. The number of primary charged hadrons produced in non-single-diffractive proton-lead collisions is determined in the pseudorapidity range vertical bar eta(lab)vertical bar vertical bar(vertical bar eta cm vertical bar) <0.5 are 17.1 +/- 0.01 (stat) +/- 0.59 (syst) and 20.10 +/- 0.01 (stat) +/- 0.5(syst) at root s(NN) = 5.02 and 8.16 TeV, respectively. The particle densities per participant nucleon are compared to similar measurements in proton-proton, proton-nucleus, and nucleus-nucleus collisions.Peer reviewe

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Measurement of exclusive Upsilon photoproduction from protons in pPb collisions at root sNN=5.02 Tev

An Erratum to this article was published on 20 April 2022: https://doi.org/10.1140/epjc/s10052-022-10276-2The exclusive photoproduction of (nS) meson states from protons, (nS) p (with n = 1, 2, 3), is studied in ultraperipheral pPb collisions at a centre-of-mass energy per nucleon pair of The measurement is performed using the decay mode, with data collected by the CMS experiment corresponding to an integrated luminosity of 32.6 nb(-1). Differential cross sections as functions of the nS) transverse momentum squared and rapidity y, are presented. The 1S) photoproduction cross section is extracted in the rapidity range < 2.2, which corresponds to photon-proton centre-of-mass energies in the range 91 W < 826 GeV. The data are compared to theoretical predictions based on perturbative quantum chromodynamics and to previous measurements.Peer reviewe

Measurement of prompt psi(2S) production cross sections in proton-lead and proton-proton collisions at root s(NN)=5.02 TeV

Measurements of prompt ψ(2S) meson production cross sections in proton-lead (pPb) and proton-proton (pp) collisions at a nucleon-nucleon center-of-mass energy of √sNN = 5.02 TeV are reported. The results are based on pPb and pp data collected by the CMS experiment at the LHC, corresponding to integrated luminosities of 34.6 nb−1 and 28.0 pb−1, respectively. The nuclear modification factor RpPb is measured for prompt ψ(2S) in the transverse momentum range 4 < pT < 30 GeV/c and the center-of-mass rapidity range −2.4 < yCM < 1.93. The results on ψ(2S) RpPb are compared to the corresponding modification factor for prompt J/ψ mesons. The results point to different nuclear effects at play in the production of the excited charmonium state compared to the ground state, in the region of backward rapidity and for pT < 10 GeV/c. © 2019 The Author. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Funded by SCOAP3.Peer reviewe

Search for a heavy resonance decaying to a pair of vector bosons in the lepton plus merged jet final state root s=13 TeV

A search for a new heavy particle decaying to a pair of vector bosons (WW or WZ) is presented using data from the CMS detector corresponding to an integrated luminosity of 35.9 fb(-1) collected in proton-proton collisions at a centre-of-mass energy of 13 TeV in 2016. One of the bosons is required to be a W boson decaying to e nu or mu nu, while the other boson is required to be reconstructed as a single massive jet with substructure compatible with that of a highly-energetic quark pair from a W or Z boson decay. The search is performed in the resonance mass range between 1.0 and 4.4 TeV. The largest deviation from the background-only hypothesis is observed for a mass near 1.4 TeV and corresponds to a local significance of 2.5 standard deviations. The result is interpreted as an upper bound on the resonance production cross section. Comparing the excluded cross section values and the expectations from theoretical calculations in the bulk graviton and heavy vector triplet models, spin-2 WW resonances with mass smaller than 1.07 TeV and spin-1 WZ resonances lighter than 3.05 TeV, respectively, are excluded at 95% confidence level.Peer reviewe

Jet properties in PbPb and pp collisions at sN N=5.02 \sqrt{s_{\mathrm{N}\;\mathrm{N}}}=5.02 TeV

Modifications of the properties of jets in PbPb collisions, relative to those in pp collisions, are studied at a nucleon-nucleon center-of-mass energy of s NN − − − − √ =5.02 sNN=5.02 TeV via correlations of charged particles with the jet axis in relative pseudorapidity (Δη), relative azimuth (Δϕ), and relative angular distance from the jet axis Δr=(Δη) 2 +(Δϕ) 2 − − − − − − − − − − − − √ Δr=(Δη)2+(Δϕ)2 . This analysis uses data collected with the CMS detector at the LHC, corresponding to integrated luminosities of 404 μb−1 and 27.4 pb−1 for PbPb and pp collisions, respectively. Charged particle number densities, jet fragmentation functions, and jet shapes are presented as a function of PbPb collision centrality and charged-particle track transverse momentum, providing a differential description of jet modifications due to interactions with the quark-gluon plasma

Search for Pair-Produced Resonances Each Decaying into at Least Four Quarks in Proton-Proton Collisions at root s=13 TeV

This Letter presents the results of a search for pair-produced particles of masses above 100 GeV that each decay into at least four quarks. Using data collected by the CMS experiment at the LHC in 2015-2016, corresponding to an integrated luminosity of 38.2 fb(-1), reconstructed particles are clustered into two large jets of similar mass, each consistent with four-parton substructure. No statistically significant excess of data over the background prediction is observed in the distribution of average jet mass. Pair-produced squarks with dominant hadronic R-parity-violating decays into four quarks and with masses between 0.10 and 0.72 TeV are excluded at 95% confidence level. Similarly, pair-produced gluinos that decay into five quarks are also excluded with masses between 0.10 and 1.41 TeV at 95% confidence level. These are the first constraints that have been placed on pair-produced particles with masses below 400 GeV that decay into four or five quarks, bridging a significant gap in the coverage of R-parity-violating supersymmetry parameter space.Peer reviewe

Search for vector-like T and B quark pairs in final states with leptons at s=13 \sqrt{s}=13 TeV

A search is presented for pair production of heavy vector-like T and B quarks in proton-proton collisions at s √ =13 s=13 TeV. The data sample corresponds to an integrated luminosity of 35.9 fb−1, collected with the CMS detector at the CERN LHC in 2016. Pair production of T quarks would result in a wide range of final states, since vector-like T quarks of charge 2e/3 are predicted to decay to bW, tZ, and tH. Likewise, vector-like B quarks are predicted to decay to tW, bZ, and bH. Three channels are considered, corresponding to final states with a single lepton, two leptons with the same sign of the electric charge, or at least three leptons. The results exclude T quarks with masses below 1140–1300 GeV and B quarks with masses below 910–1240 GeV for various branching fraction combinations, extending the reach of previous CMS searches by 200–600 GeV