The seminal vesicles (SVs), like much of the male reproductive tract, depend on androgen-driven stromal-epithelial interactions for normal development, structure, and function. The primary function of the SVs is to synthesize proteins that contribute to the seminal plasma and this is androgen dependent. However, the cell-specific role for androgen action in adult SVs remains unclear. This study analyzed the SV in mice with targeted ablation of androgen receptors specifically in smooth muscle cells (PTM-ARKO) to determine in vivo whether it is androgen action in a subset of the SV stroma, the smooth muscle cells, that drives epithelial function and identity. These mice have significantly smaller SVs in adulthood with less smooth muscle and reduced epithelial cell height. Less epithelial cell proliferation was observed in adult PTM-ARKO SVs, compared with controls, and production of seminal proteins was reduced, indicating global impairment of epithelial cell function in PTM-ARKO SVs. None of these changes could be explained by altered serum testosterone or estradiol concentrations. We also demonstrate altered SV responsiveness to exogenous testosterone and estradiol in PTM-ARKO mice, indicating that smooth muscle androgen receptors may limit the SV epithelial proliferative response to exogenous estrogens. These results therefore demonstrate that the smooth muscle cells play a vital role in androgen-driven stromal-epithelial interactions in the SV, determining epithelial cell structure and function as well as limiting the SV epithelial proliferative response to exogenous estrogens.

Introduction Although pain and depression co-exist in 36.5% of cancer patients, the precise nature of the relationship between these symptoms requires elucidation. This study aimed to further understanding of the relationship by determining whether improved pain is associated with a significant reduction in depression and increased quality of life in cancer patients. Methods A secondary data analysis of patients enrolled in pain intervention studies (n=123) was undertaken. Pain, depression and quality of life were measured at baseline and endpoint using the Brief Pain Index (BPI), Hospital and Anxiety and Depression Score (HADS) and EuroQol Thermometer assessment tools respectively. The Mann-Whitney U-test and Fisher's Exact Test were used to statistically analyse score differences between pain response groups. Results Baseline BPI, HADS and EuroQol scores were well matched between the groups. Patients responding to pain interventions had an average 2.95 point decrease in endpoint HADS scores, contrasting with a 0.89 increase in non-responding patients (score range 0–42). There was a statically significant difference in the endpoint total HADS scores between the two groups (p=0.0015). Similar mean changes in EuroQol scores revealed increased quality of life scores occurring in patients with (10.64) and without (12.41) improved pain. Conclusions Improving pain results in reduced depression scores. This supports a unidirectional relationship between pain and depression. Further study is required to establish the presence of a bidirectional relationship. Understanding the relationship between pain and depression allows prioritisation of targeted management of co-existent pain and depression, which may improve the clinical care of cancer patients.

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.