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Objectives The aim of this randomised controlled trial was to explore the impact of the mechanical WBV experienced during simulated military land transit on the physical attributes that underpin tasks performed by dismounted combatants. Design This study used a parallel group randomised control trial design. Methods Sixty participants were randomly assigned to one of four, 2-h laboratory-based simulations (restricted posture, sealed road, cross country or a control condition). A smaller sample of 16 Australian Defence Force infantry personnel served as a validation group and were exposed to the same conditions. Neither the restricted posture nor the control conditions were exposed to any WBV, but the former were secured in place using the built-in seat harness. Prior to, and following the assigned condition, participants performed a series of battlefield relevant physical performance tests including; drop jump, 20-m sprint, reactive agility, arm-hand steadiness, isometric mid-thigh pull, and sit-and-reach. Results Medium decreases in the drop jump were observed for both the sealed road (effect size [ES] = 0.53) and cross-country (ES = 0.97) simulation conditions indicating a decrease in performance of the jump phase. A large decrease in 20-m sprint performance was observed in both the sealed road (ES = 1.37) and cross-country (ES = 0.88) exposure conditions. Additionally, a large decrease in 20-m sprint performance was observed for the restricted posture (ES = 1.02) exposure condition. Conclusions These findings indicate that exposure to WBV experienced during motorised land transit has a negative influence on aspects of lower body explosive strength.

Refereed/Peer-reviewed Objectives: Maximal aerobic speed (MAS) may be predicted from 2.0 km time trial (TT) running speed in male Australian Rules football (AF) players. Given the between-sex differences in physiological variables precursory to endurance performance, and the impact of this on MAS distance limit, this study determined running speed across various TT distances best approximating MAS in female AF players. Method: 33 female AF players completed assessments of MAS and TT performance separated by at least 48 h. In a randomised order, half of the athletes completed TT distances of 1.2, 1.6 and 2.0 km, and the other half completed distances of 1.4, 1.8 and 2.2 km. Bias, limits of agreement (LOA) and linear mixed modelling determined agreement between TT-derived running speed and MAS. Results: Average speed for all TT distances were different to MAS (bias≥0.59 ± 0.45 km·h−1; p ≤ 0.015) with the exception of the 1.4 km TT (bias = −0.12 ± 0.26 km·h−1; p = 0.34). LOA was narrowest for the 1.4 km TT(±0.76 km·h−1; ±6.1%) compared to other TT distances (±0.82–1.67 km·h−1; ±6.7–12.9%). A significant linear association between bias and TT distance (r = −0.73; p < 0.001) indicated TT speed would be equal to MAS when a 1.4–1.5 km TT was completed, and that MAS may be predicted from any distance between 1.2 and 2.2 km. Conclusions: MAS was best approximated by a 1.4–1.5 km TT in female AF players, but may be predicted from TT speed for any distance between 1.2 and 2.2 km. TT-derived MAS provides a time and resource efficient method for the quantification of aerobic fitness and prescription of future training intensities.

The Functional Movement Screen (FMS) and physical performance testing are often suggested to be related to sports injury risk. This study explored if the combination of FMS and physical performance testing improved identification of non‐contact injury risk over FMS testing alone in an elite junior Australian football cohort. Over a three‐year period, 573 players completed pre‐season injury history questionnaires, FMS, physical performance testing (20‐m sprint, vertical jump, planned agility testing, and shuttle run test), and subsequent in‐season injury surveillance. Results: Neither previous injury or FMS score

The simulation of field-based exposures, such as the random whole-body vibration (WBV) experienced during periods of military land transit, in a laboratory setting, allows for greater control over potentially confounding factors. This paper describes a method used to simulate the WBV experienced during military land transit. Acceleration data were collected during military transit. These data were used as the command signal to control a 6 degree-of-freedom Stewart platform. The accelerations of the Stewart platform were then compared to the measured military transit accelerations to validate the approach. Our analysis identified moderate accuracy in the 0–3 Hz frequency range for both simulations. The sealed road simulation demonstrated 17, 25, and 8% error and the cross-country simulation, 4, 7, and 4% error in the x, y, and z-axes, respectively. Outside of this frequency range, the error was ≤ 2%. The accurate simulation of the mechanical WBV experienced during periods of motorised military land transit will allow future laboratory-based studies to explore the impact of these forces on Australian Defence Force personnel Refereed/Peer-reviewed

An indicator of movement quality and potential injury risk during Functional Movement Screen (FMS) testing is the presence of asymmetry when comparing the left and right sides of the body. The aim of the study was to investigate the reproducibility of the injury risk model proposed in our previous research (Chalmers et al. 2017; derivation study) that showed an increased injury risk for elite junior Australian football players demonstrating ≥2 asymmetrical FMS subtests. We used a direct replication design. Players underwent pre-season FMS testing, and an injury surveillance system monitored 277 male participants during the subsequent regular season competition. Designated club officials monitored the weekly competition participation of players. The definition of an injury was "a trauma or medical condition which caused a player to miss a competitive game". Cox proportional hazards regression models were used to investigate the relationship between asymmetry and number of games played before first injury (ie, survival time). The level of reproducibility was determined according to statistical significance, effect size, and subjective assessment. Demonstrating asymmetry during FMS testing was not associated with a significant increase in prospective injury risk in the replication study (P > .05). Moreover, effect sizes (hazard ratios) from the derivation dataset were not within the 95% confidence intervals of the respective asymmetry predictor in the replication dataset. Subjectively, researchers were in agreement that the findings from the derivation data were not successfully reproduced. Clinicians and researchers should be cautious about using FMS asymmetry findings to derive injury risk for junior football players. Refereed/Peer-reviewed

Objectives The purpose of this study was to describe the prevalence of dysfunctional, asymmetrical, and painful movement in junior Australian Football players using the Functional Movement Screen (FMS). Design Cross-sectional study. Methods Elite junior male Australian Football players ( n =301) aged 15–18 years completed pre-season FMS testing. The FMS consists of 7 sub-tests: deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, trunk stability push-up (TSPU) and rotary stability. The shoulder mobility, TSPU, and rotary stability tests were combined with an accompanying clearing test to assess pain. Each sub-test was scored on an ordinal scale from 0 to 3 and summed to give a composite score out of 21. Composite scores ≤14 were operationally defined as indicating dysfunctional movement. Players scoring differently on left and right sides were considered asymmetrical. Players reported whether they missed any games due to injury in the preceding 22 game season. Results Sixty percent of players ( n =182) had composite scores ≤14, 65% of players ( n =196) had at least one asymmetrical sub-test, and 38% of players ( n =113) had at least one painful sub-test. Forty-two percent of players ( n =126) missed at least one game in the previous season due to injury. Previous injury did not influence composite score ( p =0.951) or asymmetry ( p =0.629). Players reporting an injury during the previous season were more likely to experience pain during FMS testing (odds ratio 1.97, 95% confidence interval 1.23–3.18; p =0.005). Conclusions Junior Australian Football players demonstrate a high prevalence of dysfunctional, asymmetrical, and painful movement during FMS testing.

Objectives: The Functional Movement Screen (FMS) is a popular screening tool, however, the postulated relationship between prospective injury and FMS scoring remains sparsely explored in adolescent athletes. The aim of the study was to examine the association between pre-season FMS scores and injuries sustained during one regular season competition in elite adolescent Australian football players. Design: Prospective cohort study. Methods: 237 elite junior Australian football players completed FMS testing during the late pre-season phase and had their weekly playing status monitored during the regular season. The definition of an injury was 'a trauma which caused a player to miss a competitive match'. Results: The median composite FMS score was 14 (mean = 13.5. ±. 2.3). An apriori analysis revealed that the presence of ≥1 asymmetrical sub-test was associated with a moderate increase in the risk of injury (hazard ratio = 2.2 [1.0-4.8]; relative risk = 1.9; p = 0.047; sensitivity = 78.4%; specificity = 41.0%). Notably, post-hoc analysis identified that the presence of ≥2 asymmetrical sub-tests was associated with an even greater increase in risk of prospective injury (hazard ratio = 3.7 [1.6-8.6]; relative risk = 2.8; p = 0.003; sensitivity = 66.7%; specificity = 78.0%). Achieving a composite score of ≤14 did not substantially increase the risk of prospective injury (hazard ratio = 1.1 [0.5-2.1]; p = 0.834). Conclusions: Junior Australian football players demonstrating asymmetrical movement during pre-season FMS testing were more likely to sustain an injury during the regular season than players without asymmetry. Findings suggest that the commonly reported composite FMS threshold score of ≤14 was not associated with injury in elite junior AF players. Refereed/Peer-reviewed

Purpose: Knowledge of aerobic performance capacity allows for the optimisation of training programs in aerobically dominant sports. Maximal aerobic speed (MAS) is a measure of aerobic performance; however, the time and personnel demands of establishing MAS are considerable. This study aimed to determine whether time-trials (TT), which are shorter and less onerous than traditional MAS protocols, may be used to predict MAS. Methods: 28 Australian Rules football players completed a test of MAS, followed by TTs of six different distances in random order, each separated by at least 48 h. Half of the participants completed TT distances of 1200, 1600 and 2000 m, and the others completed distances of 1400, 1800 and 2200 m. Results: Average speed for the 1200 and 1400 m TTs were greater than MAS (P < 0.01). Average speed for 1600, 1800, 2000 and 2200 m TTs were not different from MAS (P > 0.08). Average speed for all TT distances correlated with MAS (r = 0.69–0.84; P < 0.02), but there was a negative association between the difference in average TT speed and MAS with increasing TT distance (r = −0.79; P < 0.01). Average TT speed over the 2000 m distance exhibited the best agreement with MAS. Conclusions: MAS may be predicted from the average speed during a TT for any distance between 1200 and 2200 m, with 2000 m being optimal. Performance of a TT may provide a simple alternative to traditional MAS testing. Refereed/Peer-reviewed

A modification is presented for the end-to-end type of vasoepididymostomy known as the sling and blanket. We have exploited the differences in size between the vas and epididymis to gain a mechanical advantage. When the epididymis is transected the redundant tunic is preserved. The sling is created from the tunic, which is drawn forward and sutured to the vas posteriorly about 1 cm. from its cut end. The sling provides support so that the end-to-end anastomosis between the vas lumen and specific epididymal tubule may be completed in 1 plane and without rotation. The blanket is created from the remaining epididymal tunic, which is sutured anteriorly to cover the anastomosis and stabilize the vas. The procedure was performed on 8 patients with primary epididymal obstruction. The patency rate was 50% and the pregnancy rate was 25%. Although vasoepididymostomy remains a difficult microsurgical operation, this modification seems to be beneficial in selected cases.

A new technique for the management of varicoceles was carried out on 71 infertile men. The procedure combined microdissection of the spermatic cord at the external inguinal ring, ligation of the dilated veins, and controlled sclerosis of small cross-collateral veins. These procedures were performed on an outpatient basis and usually with local anesthesia. The surgery was completed within 20 to 30 minutes, and the postoperative morbidity was minimal. Twenty-four cases were followed for at least 18 months postoperatively. Among this group, the mean values for sperm density and sperm motility increased after surgery. The difference between the means were significant (P less than 0.001). The pregnancy rate among this group was 29.3%.

Artificial spermatoceles were implanted into three patients with congenital absence of the vas. In each case, the testicular biopsy demonstrated normal spermatogenesis, and the dilated epididymal tubule was packed with spermatozoa. The ciliated epididymal mucosa appeared normal despite the tubular dilatation. The spermatoceles were constructed of expanded polytetrafluoroethylene, and they were microsurgically implanted over the cut end of the epididymis. The grafts were aspirated monthly for up to six months, and the aspirates containing spermatozoa were used for artificial insemination. Spermatozoa were consistently retrieved from each patient, but no pregnancies have resulted. The most obvious finding was that the spermatozoa lacked motility. In the discussion, other problems related to artificial spermatoceles are reviewed, including epididymal development and sperm maturation, aspiration techniques, and sperm storage.

The traditional office diagnosis of prostatitis has been based on clinical history, rectal palpation of the gland, and a microscopic examination of the expressed prostatic fluid. In light of present day information this approach appears to be incomplete. We have examined 41 consecutive patients with complaints of prostatitis along with 17 controls. In each case expressed prostatic fluid was collected under sterile conditions. On each specimen, we performed a bacterial culture, microscopic examination for white blood cells, and assay for zinc. The intent of this protocol was to classify clearly those with bacterial prostatitis from those with nonbacterial prostatitis and prostatodynia. We believe this approach is simple to perform even in the setting of a busy office practice.

Vacuum constrictor devices achieve an erection-like state of the penis by means of a clear plastic cylinder, a vacuum pump, and a constrictor ring. Although these devices are noninvasive compared with penile injections and implants, they have been used less often in clinical practice. Part of the hesitancy to prescribe these devices has been related to the lack of published data concerning the effects of constriction on penile blood flow. In this report, we utilized penile plethysmography to estimate penile blood flow on 51 men before, during, and after the use of the constrictor ring. All patients demonstrated a 70-75 percent decline in the amplitude of the pulse-volume curve during constriction, but continuous blood flow was maintained in each case. Within sixty seconds after removal of the ring, the amplitude returned to baseline values for all men, including 12 patients with a penile brachial index of less than 0.7. Among 33 patients, there was evidence of a transient increase of amplitude following constriction, which was consistent with a postischemic hyperemia. These findings suggest normal penile blood flow, and indicate that the use of constrictor rings may be safe for patients with these tracings. Penile plethysmography appears to be a useful technique to help with patient selection and constrictor ring fit. Follow-up tracings probably should be scheduled at periodic intervals for men utilizing these rings and devices.

The split ejaculate has proven to be a reliable method for concentrating sperm in a small volume. However, there is some controversy whether the spermatozoa in the most sperm-rich fraction of the split ejaculate has better motility than the spermatozoa in whole semen. In this study, at least two specimens of whole semen and two split ejaculates were obtained from 45 infertile males. The mean values for the parameters of the semen analysis were compared statistically. Our data indicate that increased sperm density is a consistent finding with the split ejaculate, even for severely oligospermic men. However, improved sperm motility with the split ejaculate is more variable. On the other hand, patients with mild oligospermia (10 to 40 million sperm/ml of whole semen) and high semen volumes (>5.0ml) demonstrated improvement in all parameters in the split ejaculate.

Intraurethral spread of venereal warts is a serious complication. Urethral involvement may be extensive and is associated with severe irritative symptoms. Spread to the bladder is possible. Recurrences are frequent and eradication difficult. We describe the urethrographic appearance of intraurethral verrucae and believe it to be strongly suggestive of the diagnosis. Voiding cystourethrography is recommended, and satisfactory visualization may be obtained with either voiding or retrograde urethrography. Voiding urethrography following intravenously administered contrast (excretory voiding cystourethrography) is particularly advantageous since it avoids the need for urethral instrumentation and, therefore, cannot contribute to retrograde spread of these contagious growths.

We describe a noninvasive modified radionuclide technique, the “comprehensive scrotal flow and scan,” for the detection of varicoceles. The procedure utilizes in-vivo-labeled pyrophosphate red blood cells and 99m Tc-pertechnetate as a blood pool scanning agent. The procedure includes an immediate flow study along with early and delayed static images, both in the upright and supine position. These studies were examined by visual inspection and by computer analysis. Data were obtained from 50 patients and 8 control subjects. The technique demonstrated a 91.1 per cent sensitivity when compared to physical examination and an 84.6 per cent sensitivity when compared to venography from patients with subclinical or poorly palpable varicoceles.

The presence of spermagglutinating antibodies in blood and semen has been associated with reducedfertility in men. In this study 203 men were screened for infertility. An antibody measurement was performed on the blood and semen of each patient. Each semen specimen was also examined for spontaneous agglutination. Twelve patients with a positive reaction in the blood underwent a sperm-cervical mucus contact test. We have attempted to correlate the findings in blood with the observed functional results in semen and cervical mucus. We believe that these simple tests should be included in the infertility work-up in order to determine the presence of immune infertility.

Experimental hemostasis in sutureless bivalve nephrotomy was used on 25 consecutive dogs. The result of this study and the review of the literature are described.

We report 4 cases of intraurethral condylomas, the last one representing the first reported successful management of total urethral and intravesical condylomas in a male patient. The literature is reviewed and recommendations for management based on the modalities available are given.

Three patients with infertility secondary to retrograde ejaculation demonstrated motile sperm in their urine after coitus. These patients were instructed to alkalinize their urine and void directly into the vagina after intercourse. The technique was called "postcoital-voiding insemination." Three pregnancies have resulted. The technique appears to be a good alternative to bladder catheterization and artificial insemination.

Intracavernous injections and vacuum constrictor devices have been used for the nonoperative management of impotence and sexual dysfunction. Although most men are able to use these methods successfully, it currently is well known that up to 30 to 35 per cent of the patients may have only a partial response to the injections. We observed 22 men with partial tumescence after an intracavernous injection of papaverine (15 to 30 mg.) and phentolamine (0.5 to 1.0 mg.). The penis was not rigid and the buckling pressures never exceeded 50 mm. Hg after 20 minutes of observation. In each case we immediately applied a vacuum constrictor device because these devices had been used successfully by other men with similar diagnoses. A total of 21 men responded within 30 to 60 seconds and achieved a rigid erection with buckling pressures of greater than 100 mm. Hg (16) and 60 mm. Hg (5). These findings indicate that a vacuum constrictor device may be used to augment a partial response to an intracavernous injection and that the availability of injections and vacuum constrictor devices provides these men with a more complete nonoperative program.

The motile sperm count is a simple index which is equivalent to the product of sperm density (millions of sperm per milliliter) and percentage of motility (motile sperm per 100 sperm x 0.01). Since other studies have demonstrated a positive correlation between this index and the pregnancy rate, it has been hypothesized that the motile sperm count could be useful for expressing the potential fertility of individual semen specimens. Collection of semen by the split ejaculate technique and subsequent artificial insemination homologous (AIH) with the best split fraction has been used for the treatment of oligospermia. We calculated the motile sperm count for whole semen and the first fraction of split ejaculates from 45 men who were studied for infertility. Subsequently, 15 couples agreed to AIH with the first fraction of the split ejaculate. The data indicate that the motile sperm count may be a reasonable index for comparing the potential fertility of the semen specimens and thereby estimating the chances of successful AIH.

Since the prostate gland secretes specific substances, several investigators have suggested that measurement of these products may be useful for the evaluation of prostatitis. In our laboratory we have measured seminal zinc as a marker of prostatic secretion to establish normal values and define the confidence limits for this assay. Zinc assays were performed on whole semen, fractions of the split ejaculate, and expressed prostatic fluid from among a population of 456 men. We hope that these data will be useful when compared with data from patients with prostatic disease.

The concentration of zinc in human seminal plasma and in sperm is higher than in other body fluids or tissues. In blood it is between 75 and 115 mcg/100 ml while in semen it is 15-30 mg/100 ml and in sperm it is even more. Semen specimens were obtained from 18 healthy medical students 19 patients with prostatitis and 132 postvasectomy patients. Also as part of an infertility study 153 semen specimens were obtained from 72 infertile men. Semen analyses were done within 90 minutes after ejeculation. Each analysis included volume sperm density sperm morphology percentage of motility of sperm and degree of motility. Zinc analyses were done by atomic absorption spectrometry and some by neutron activation. Details of these methods are given. Some patients were treated with supplementary zinc 80 mg orally 2-3 times a day with follow-up analyses at 8-week intervals. Values obtained by neutron activation were higher (p less than .02). There was a statistically significant difference between mean values for semen zinc in student volunteers and postvasectomy patients (p less than .01). In 12 patients who had been given zinc sulfate mean values for semen zinc were significantly increased (p less than .01). The data for 153 semen specimens from the 72 infertile men showed that those with the greatest potential for fertility had the highest mean zinc concentrations. A group of 11 of these patients were given zinc therapy for 6-12 months. Mean levels of semen zinc increased mean sperm counts and motility improved and 3 pregnancies resulted. Zinc is considered important in the function of the prostate gland.

The fibrotic portion of the vas deferens is excised during the performance of a vasovasostomy until a satisfactory lumen appears on each side of the old scar. The lumen on the testicular side usually is dilated because of chronic high pressure at the site of the occlusion. On the other side the lumen of the abdominal vas usually is much smaller by comparison. A successful vasovasostomy depends on a precise mucosal-to-mucosal alignment despite the discrepancy in lumenal diameters. 2-layer anastomoses have been popularized to achieve this precise alignment. In an attempt to equalize the lumenal sizes during the anastomosis the smooth muscle relaxant papaverine (30 mg/ml) was applied to the abdominal side of the vas. Approximately 1-3 ml were dripped onto the cut end of the vas and after 1 minute the lumen was gently dilated by the lateral spring action of an angled jewelers forceps. This maneuver provided a wider lumen with excellent mucosal relaxation for the 2-layer anastomosis. Figure 1 shows the freshly cut end of the abdominal vas. The lumen measured less than 1.0 mm. When an angled jewelers forceps was introduced into the lumen the jaws barely separated by lateral spring action. Following the application of 1-3 ml of papaverine (30 mg/ml) the jaws separated to a distance of almost 1.5 mm. At this point the lumen appeared to be considerably dilated and the mucosa was relaxed for a precise 2-layer anastomosis. If the abdominal vas and its mucosa failed to relax in response to papaverine then this usually implied persistent fibrotic tissue. In these cases additional vas was removed on the abdominal side until the tissue demonstrated adequate relaxation following another application of papaverine and dilatation with the angled jewelers forceps. This maneuver seemed to be helpful for determining the adequacy of the dissection. The application of papaverine has been utilized during 61 vasovasostomies which have been followed up at least 6 months. Followup semen analyses have demonstrated 49 patients with greater than 20 million sperm/ml and greater than 40% motility. 3 patients remained azoospermic. In 4 patients late azoospermia developed. Thus far 31 pregnancies (50.8%) have been reported for all categories. Additional pregnancies are anticipated with time. It is believed that the application of 1-3 ml of papaverine (30 mg/ml) to the abdominal vas is a simple and helpful maneuver during a vasovasostomy.