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Class of 2010 Abstract / OBJECTIVES: The purpose of this study was to determine the number of inpatient discharges and burden of illness due to testicular cancer with data from the national database Healthcare Cost and Utilization Project (HCUP). METHODS: This retrospective study looked at hospital discharge records to obtain information regarding the inpatient burden of illness of testicular cancer patients. The study looked at procedures, co-­‐morbidities, hospital characteristics, case-­‐mix control, and the Deyo-­‐Charlson to see how they were associated with the charges, length of stay, and inpatient mortality. Also included in the study was information regarding patient age, method of payment, and hospital type and size. A linear multivariate regression was performed to estimate determinates of hospital costs. RESULTS: During the 5-­‐year time frame of the study, 28,985 inpatient admissions with testicular cancer were identified. For the overall sample, the average total charges per hospitalization were $29,857. For the 717 patients that died while receiving inpatient treatment, the associated charges averaged $73,800, more than double that associated with the overall sample. The gamma regression of charges for the overall sample showed an association between increased charges and age, length of stay, number of procedures, all admission years in reference to 2002, admission to a large-­‐sized hospital in reference to a small hospital, admission to an urban hospital in reference to a rural hospital, admission to a teaching in reference to a nonteaching hospital and the Deyo-­‐Charlson score. CONCLUSIONS: Testicular cancer is on the rise worldwide and is associated with a high inpatient burden of illness.

Purpose: The relationship between testicular cancer and working as a firefighter has been a relatively brushed off scope of concentration until recent years and recent developments in hopes of presenting new protocols and better guidelines to screen for testicular cancer in this occupation. The purpose of this study was to perform a scoping review to present the current data concerning testicular cancer and its association to the occupation of firefighters. Methods: PubMed as a data base was used and articles concerning firefighters and testicular cancer were found and screened for eligibility with respect to the kind of study and the data it entailed. Data was reported in this study and discussed. Results: It was found that testicular cancer has the highest or second highest incidence and mortality rate among all the cancers that firefighters suffer from at the P < 0.001 significance. Among the second highest were also skin, pleural, and thyroid cancer. Conclusion: While testicular cancer is highly treatable due to its high survival rate, it has a strong and alarming prominent presence in the firefighter occupation. The results should be interpreted with caution due to the limitations of the studies evaluated, however in all studies, testicular cancer had a far more significant incidence and mortality risk than the other cancers firefighters were evaluated for.

Testicular self-examination (TSE) is an important behaviour to prevent the development of testicular cancer. This thesis examined the stages of decision making, emotions, perceived costs and benefits of screening, the self perceptions, social influences, and health routines in samples of adult males and adolescent school boys. A multi-method approach was adopted involving qualitative and quantitative methods of study. The qualitative part of the investigation comprised a series of studies including focus groups, in-depth interviews, programme evaluation and survey studies. The aim was to elucidate the meanings associated with health and illness and preventive cancer screening. Such information formed the bases for developing a survey measure and a health promotion programme to promote TSE. A comparative cross-sectional approach, including the components of three social cognition models was then carried out revealing a hybrid model (HSCM) to be most effective in explaining TSE. Acknowledging traditional social cognitions as predictors of TSE decision making, it also stresses the importance of emotional cognitions, self perceptions and routine behaviours. Using a five-stage model building approach, a longitudinal examination of stages of decision making was also carried out. Logistic analysis revealed that much of the variation in TSE practice was explained by a planning stage, implicating a two-stage motivation and volition stage rather than a five-stage model. In addition to explaining the characteristics associated with TSE practice and elucidating a stage approach to decision making, a draft health promotion programme was developed and evaluated. Two forms of the programme, a booklet and a seminar, were appraised and deemed effective as motivators of preventive action. Findings are discussed in terms of theory and practice of health education. The implications of the findings for health psychology are also discussed.

Testicular germ cell apoptosis is a process that begins in early development and continues in the adult testis. It is important during spermatogenesis for maintaining homeostasis of different types of germ cells. The number of sperm produced depends on the supportive capacity of surrounding Sertoli cells, which provide nutrition and an adaptive environment for growth and development of the germ cells. There are two major pathways that regulate germ cell apoptosis: extrinsic and intrinsic. We hypothesize that Sertoli cells use the extrinsic pathway to eliminate germ cells when exposed to phthalates, a common Sertoli cell toxicant. Death ligands, which are involved in the extrinsic pathway, were used in this research to test this hypothesis. Here, we demonstrate that: 1) the loss of FasL and TRAIL protein expression results in decreased production of mature spermatids in the adult testis, likely as a result of alterations in germ cell homeostatsis during the first wave of spermatogenesis. 2) The high baseline incidence of germ cell apoptosis in peripubertal FasL-/- and TRAIL-/- mice is correlated with increases in levels of TRAIL and FasL, respectively. 3) The decline in germ cell apoptosis observed after MEHP treatment in FasL-/- mice closely corresponds to the occurrence of increased levels of c-FLIP. 4) A more predominant role of FasL occurs in controlling the proper number of germ cells during the first wave of spermatogenesis in peri-pubertal mice. TRAIL is more critical for maintaining long-term homeostasis of the germ cell population in adult testis as well as in the reproductive function. 5) Several possible genes are involved in the altered spermatogenesis and development in the testis of gene-deficient mice. 6) Findings described in Chapter 6 indicate cellular mechanisms triggered by MEHP exposure that act to enhance tumor progression/metastasis in testicular embryonal carcinoma cells (NT2/D1). Taken together, these novel findings provide important mechanistic insights into the functional roles of FasL in the testis at distinct developmental periods and further indicate that FasL itself is required for the regulation of c-FLIP levels in the testis. Additionally, exposure to environmental toxicants, such as the phthalates, can enhance testicular cancer metastasis and invasion. / text

Phthalates are endocrine-disrupting chemicals (EDCs) that are known testicular toxicants, used commonly as industrial plasticizers that are found in everyday items. Di-(2-ethylhexyl) phthalate (DEHP) is the most abundant phthalate in the environment, and its primary metabolite mono-(2-ethylhexyl) phthalate (MEHP) is ten-fold more potent. The purpose of this study is to examine the cellular and molecular effects of MEHP in the development of testicular cancer. Proliferation was measured for NT2 cells exposed to 10µM and 100µM MEHP at 24 and 48 hours and for cells under controlled conditions. Methylation-specific PCR (MSP) was used to determine the methylation status of the promoter region of key testicular genes post exposure to MEHP. MEHP caused a dose-dependent negative effect on proliferation and significantly altered methylation levels for key testicular genes following exposure to 10µM MEHP and 100µM, as compared to controls. This suggests that MEHP alters proliferation and methylation of testicular tumour cells in a time- and dose-dependent manner.

Indiana University-Purdue University Indianapolis (IUPUI) / Testicular cancer is the most common solid tumor among young men. Although testicular cancer survivors (TCS) are expected to live for over 40 years after cancer diagnosis, they are at risk for chemotherapy adverse effects such as hearing loss (HL), tinnitus, and psychosocial effects. The aim of this study was to investigate factors associated with discrepancies between subjective and objective HL, factors associated with HL, and factors associated with the use of medications for anxiety/depression. TCS were enrolled in the Platinum Study. Sociodemographic characteristics, health behaviors, morbidities, and prescription medications were assessed though self-reporting using validated questionnaires. Bilateral pure-tone air conduction thresholds were collected at frequencies 0.25-12 kHz. To assess HL severity, hearing thresholds were classified according to American Speech-Language-Hearing Association criteria. Multivariable multinomial, ordinal, and binomial logistic regressions were used to test factors for association with discrepancy between subjective and objective HL, cisplatin-induced HL, and use of medications for anxiety/depression, respectively. Patients with HL at only extended high frequencies (10-12 kHz) could perceive hearing deficits; thus, it would be preferable for these frequencies to be included in audiometric assessments of cisplatin-treated adult-onset cancer survivors. Age, no noise exposure, and mixed/conductive HL were significantly associated with more underestimation of HL severity. Hearing aid use and education were significantly associated with less underestimation of HL severity. Having tinnitus was associated with more overestimation of HL severity. Age, cumulative cisplatin dose, and hypertension showed significant association with greater HL severity, whereas post-graduate education was associated with less HL severity. Factors associated with more use of medications for anxiety/depression were tinnitus, and peripheral sensory neuropathy, while being employed and engaging in physical activity were significantly associated with less use of anxiety/depression medications. The sole use of patient-reported measures of HL might not be well-suited to evaluate HL in cancer survivors; thus, the use of audiometry may complement patient-reported HL. In terms of modifiable risk factors of cisplatin-induced HL, healthcare providers should monitor patients’ blood pressure and manage hypertension appropriately. In addition, healthcare providers need to effectively manage tinnitus and peripheral neuropathy to improve treatment outcomes of anxiety and depression. / 2022-05-19

Yes / Germ cell tumours (GCTs) are a heterogeneous group of rare neoplasms that present in different anatomical sites and across a wide spectrum of patient ages from birth through to adulthood. Once these strata are applied, cohort numbers become modest, hindering inferences regarding management and therapeutic advances. Moreover, patients with GCTs are treated by different medical professionals including paediatric oncologists, neuro-oncologists, medical oncologists, neurosurgeons, gynaecological oncologists, surgeons, and urologists. Silos of care have thus formed, further hampering knowledge dissemination between specialists. Dedicated biobank specimen collection is therefore critical to foster continuous growth in our understanding of similarities and differences by age, gender, and site, particularly for rare cancers such as GCTs. Here, the Malignant Germ Cell International Consortium provides a framework to create a sustainable, global research infrastructure that facilitates acquisition of tissue and liquid biopsies together with matched clinical data sets that reflect the diversity of GCTs. Such an effort would create an invaluable repository of clinical and biological data which can underpin international collaborations that span professional boundaries, translate into clinical practice, and ultimately impact patient outcomes. / ALF, JFA, and MJM declare funding from St Baldrick’s Foundation; grant reference number 358099.

This thesis explores the possibility that graphic design can have a positive impact on the morale of a male undergoing chemotherapy for testicular cancer. The paper explains the concept of “morale,” why it is vital for patients at a cancer infusion center, and subsequently how graphic design can boost morale. The supporting research fostered a socially-responsible design solution—a mobile application that intertwines design, health, and technology. The application is geared to the patient experience. As such, it can reduce anxiety by providing a distraction in the form of entertainment (as well as providing tools and an anonymous connection for the individual patient to a similar patient population). Furthermore, the application is also designed for research purposes by establishing a framework for collecting measurable data. In turn, this data can be used to enhance the chemotherapy experience—thus contributing to a positive impact on the morale of the cancer patient.