BackgroundThe lifesaving chemotherapy and radiation treatments that allow patients to survive cancer can also result in a lifetime of side-effects, including male infertility. Infertility in male cancer survivors is thought to primarily result from killing of the spermatogonial stem cells (SSCs) responsible for producing spermatozoa since SSCs turn over slowly and are thereby sensitive to antineoplastic therapies. We previously demonstrated that the cytokine granulocyte colony-stimulating factor (G-CSF) can preserve spermatogenesis after alkylating chemotherapy (busulfan).MethodsMale mice were treated with G-CSF or controls before and/or after sterilizing busulfan treatment and evaluated immediately or 10–19 weeks later for effects on spermatogenesis.ResultsWe demonstrated that the protective effect of G-CSF on spermatogenesis was stable for at least 19 weeks after chemotherapy, nearly twice as long as previously shown. Further, G-CSF treatment enhanced spermatogenic measures 10 weeks after treatment in the absence of a cytotoxic insult, suggesting G-CSF acts as a mitogen in steady-state spermatogenesis. In agreement with this conclusion, G-CSF treatment for 3 days before busulfan treatment exacerbated the loss of spermatogenesis observed with G-CSF alone. Reciprocally, spermatogenic recovery was modestly enhanced in mice treated with G-CSF for 4 days after busulfan. These results suggested that G-CSF promoted spermatogonial proliferation, leading to enhanced spermatogenic regeneration from surviving SSCs. Similarly, there was a significant increase in proportion of PLZF+ undifferentiated spermatogonia that were Ki67+ (proliferating) 1 day after G-CSF treatment.ConclusionsTogether, these results clarify that G-CSF protects spermatogenesis after alkylating chemotherapy by stimulating proliferation of surviving spermatogonia, and indicate it may be useful as a retrospective fertility-restoring treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12958-016-0226-1) contains supplementary material, which is available to authorized users.

Study Design Case-control study; Level of evidence, 3. Objective Anterior cervical discectomy and fusion (ACDF) is one of the most common procedures for cervical diseases often with reliable outcomes. However, morbidity rates can be as high as 19.3% so appropriate patient selection and risk stratification is imperative. Our modified frailty index (MFI) predicts postoperative complications after other orthopaedic procedures. We hypothesized that this index would predict complications in a large cohort of ACDF patients. Methods We reviewed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, including patients who underwent ACDF from 2015-2020. An 8-item MFI score was calculated for each patient. We recorded 30-days postoperative complications, readmission, and reoperation rates, adjusting for baseline features using standard multivariate regression. This project was approved of by the University of Texas Health Science Center Institutional Review Board and an IRB exception was granted. Results We identified 17 662 ACDF cases. Patients with MFI of 5 or greater had a 37.53 times increased odds of incurring postoperative complications compared to patients with MFI of 0 ( P < .001) even when age, sex, race, and ethnicity were controlled for. Specifically, life-threatening Clavien-Dindo IV complications, as well as wound, cardiac, renal, and pulmonary complications were significantly increased in patients with an MFI of 5 or greater. Also, as MFI increased from 1-2 to 3-4 to 5 or greater, the odds of readmission increased from 1.36 to 2.31 to 5.42 times ( P < .001) and odds of reoperation from 1.19 ( P = .185) to 2.3 to 6.54 times ( P < .001). Frailty was still associated with increased complications, readmission, and reoperation after controlling for demographic data, including age, as well as operative time and length of stay. Conclusion Frailty is highly predictive of postoperative complications, readmission, and reoperation following ACDF. Employing a simple frailty evaluation can guide surgical decision-making and patient counseling for cervical disease.

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Introduction: Since the World Health Organization declared a pandemic in March 2020, COVID-19 has pressured the healthcare system. Elective orthopaedic procedures for American seniors were canceled, delayed, or altered because of lockdown restrictions and public health mandates. We sought to identify differences in the complication rates for elective orthopaedic surgeries before and atfter the pandemic onset. We hypothesized that complications increased in the elderly during the pandemic. Methods: We conducted a retrospective analysis of the American College of Surgeons–National Surgical Quality Improvement Program database in patients older than 65 years undergoing elective orthopaedic procedures from 2019 (prepandemic) and April to December 2020 (during the pandemic). We recorded readmission rates, revision surgery, and 30-day postoperative complications. In addition, we compared the two groups and adjusted for baseline features with standard multivariate regression. Results: We included 146,430 elective orthopaedic procedures in patients older than 65 years (94,289 before the pandemic and 52,141 during). Patients during the pandemic had a 5.787 times greater chance of having delayed wait time to the operating room ( P < 0.001), a 1.204 times greater likelihood of readmission ( P < 0.001), and a 1.761 times increased chance of delayed hospital stay longer than 5 days ( P < 0.001) when compared with prepandemic. In addition, during the pandemic, patients were 1.454 times more likely to experience any complication ( P < 0.001) when compared with patients prepandemic undergoing orthopaedic procedures. Similarly, patients were also 1.439 times more likely to have wound complication ( P < 0.001), 1.759 times more likely to have any pulmonary complication ( P < 0.001), 1.511 times more likely to have any cardiac complication ( P < 0.001), and 1.949 times more likely to have any renal complication ( P < 0.001). Conclusion: During the COVID-19 pandemic, elderly patients faced longer wait times within the hospital and increased odds of complications after elective orthopaedic procedures than similar patients before the pandemic.