Erectile dysfunction predicts mortality in middle-aged and older men independent of their sex steroid status

BACKGROUND

erectile dysfunction is associated with mortality, whereas the association between low testosterone (T) and higher mortality remains controversial. Sexual dysfunction and low T often coexist, but the relative importance of sexual symptoms versus low T in predicting mortality is not known. We studied the interrelationships between sex steroids and sexual symptoms with all-cause mortality in a large prospective cohort of European men.

DESIGN

survival status was assessed in 1,788 community-dwelling men, aged 40-79, who participated in the European Male Ageing Study (EMAS). Sexual symptoms were evaluated via a validated questionnaire (EMAS-SFQ). Sex steroids were measured by mass spectrometry. Cox proportional hazard models were used to study the association between hormones, sexual symptoms and mortality.

RESULTS

about 420 (25.3%) men died during a mean follow-up of 12.6 ± 3.1 years. Total T levels were similar in both groups, but free T was lower in those who died. Men with three sexual symptoms (erectile dysfunction, reduced morning erections and lower libido) had a higher mortality risk compared with men with none of these symptoms (adjusted hazard ratio (HR) and 95% confidence intervals: 1.75 (1.28-2.40, P = 0.001)). Particularly, erectile dysfunction and poor morning erections, but not lower libido, were associated with increased mortality (HR 1.40 (1.13-1.74, P = 0.002), 1.28 (1.04-1.59, P = 0.023) and 1.12 (0.90-1.39, P = 0.312), respectively). Further adjusting for total T, free T or oestradiol did not influence the observed risk.

CONCLUSIONS

sexual symptoms, in particular erectile dysfunction, predict all-cause mortality independently of sex steroids and can be an early warning sign of a poor health status.

Aging Men With Insufficient Vitamin D Have a Higher Mortality Risk: No Added Value of its Free Fractions or Active Form

CONTEXT

Low total 25-hydroxyvitamin D (25(OH)D) has been associated with mortality. Whether vitamin D in its free form or 1,25-dihydroxyvitamin D (1,25(OH)2D), provide any additional information is unclear.

OBJECTIVE

To determine what level of 25(OH)D is predictive for mortality and if free 25(OH)D or 1,25(OH) 2 D concentrations have any added value.

METHODS

This prospective cohort comprised 1915 community-dwelling men, aged 40 to 79 years. Intervention included determination of association of total and free 25(OH)D and 1,25(OH) 2 D concentrations with survival status. Vitamin D results were grouped into quintiles. For total 25(OH)D, specific cutoff values were also applied. Cox proportional hazard models were used adjusted for center, body mass index, smoking, alcohol, physical activity, season of blood sample, kidney function, and number of comorbidities.

RESULTS

A total of 469 (23.5%) men died during a mean follow-up of 12.3 ± 3.4 years. Compared to those with normal vitamin D values (> 30 µg/L), men with a total 25(OH)D of less than 20 µg/L had an increased mortality (hazard ratio [HR] 2.03 [95% CI, 1.39-2.96]; P < .001). Likewise, men in the lowest 3 free 25(OH)D quintiles (< 4.43 ng/L) had a higher mortality risk compared to the highest quintile (HR 2.09 [95% CI, 1.34-3.25]; P < .01). Mortality risks were similar across all 1,25(OH)2D and vitamin D binding protein quintiles.

CONCLUSION

Aging men with vitamin D deficiency have a 2-fold increased mortality risk. Determinations of either the free fractions of vitamin D or measurement of its active form offer no additional information on mortality risks.

The use of electromigration as a qualitative technique to study the migration behaviour and speciation of uranium in the Boom Clay

Under the geochemical conditions prevailing in situ in the Boom Clay Formation (pH, Eh, …), calculations predict that U(OH)4 is the dominant uranium species present in the interstitial water and the concentration is solubility limited. However the boundary of the domain where the non solubility limited UO2(CO3)3 4− species dominates is very close. It is therefore of prime interest to know the correct speciation of uranium during the migration process.

Electromigration was used as technique with the advantage that it can provide information on the speciation because the movement of the species towards the electrodes depends on its charge and speciation. Electromigration experiments have been performed with preconditioned 233UO2(CO3)3 4− sources, starting from the hypothesis that this species should migrate without retardation towards the anode. Despite relatively long electromigration times, sufficient to displace strong retarded tracers, no displacement of the migration profile towards the anode was observed. All 233U remained near the source position, but the electropherograms clearly showed the presence of species moving towards the cathode. This indicates the presence of neutral or positively charged uranium species. These electropherograms are interpreted as a change in uranium valence state: reduction of UO2(CO3)3 4− and precipitation of U(IV) oxy-hydroxides near the source position. The solubility limited species, U(OH)4(aq), are carried with the pore water towards the cathode. The electromigration experiments indicate, in support of the speciation calculations, that the dominant migrating U-species is probably the solubility limited U(OH)4.

Determination of 75Se, 95Zr, 237Np and 241Am activities in Boom Clay samples from laboratory migration experiments using gamma-ray spectrometry

Percolation tests (i.e. routine laboratory migration experiments) have been performed to evaluate the diffusion behaviour of a number of long-lived radionuclides in Boom Clay, a candidate geological host formation for high level radioactive waste (HLW) in Belgium. Among the many potentially hazardous radionuclides under investigation are 79Se, 93Zr, 237Np, 241Am and 243Am. Actinide migration experiments have been carried out with 237Np and 241Am, while for the studies with Se and Zr the radioisotopes 75Se and 95Zr were used. Their transport patterns in the Boom Clay were examined using a combination of a NaI(Tl) detector and High-Purity Ge detectors either on the dissolved matrix (237Np, 241Am) or directly on the clay (75Se, 95Zr).