Patient-reported Outcomes (PROs): An Approach to Evaluate Treatment Efficacy of Chinese Medicine or Integrative Medicine

Chinese medicine (CM) has been an experience based practice over the past three thousand years. The safety and efficacy of CM has been practised through experience, rather than nowadays’ modern scientific measurements. In this way, the development of CM has not been keeping pace with the advance in science and technology and the progress in orthodox medicine. In order to meet the requirements of modern science and technology, an evidence based approach must be adopted. Reassurance is needed to convince people for safety and efficacy of CM and give confidence to the evidence based demands ——“Tradition is confirmed by Modern Science” (1) .

Tissue optical clearing enhances efficacy of vascular targeted photodynamic therapy of mouse dorsal skin

Vascular-targeted photodynamic therapy(V-PDT)is an effective treatment for port wine stains(PWS).However,repeated treatment is usually needed to achieve optimal treatment outcomes,possibly due to the limited treatment light penetration depth in the PWS lesion.The optical clearing technique can increase light penetration in depth by reducing light scattering.This study aimed to investigate the V-PDT in combination with an optical clearing agent(OCA)for the therapeutic enhancement of V-PDT in the rodent skinfold window chamber model.Vascular responses were closely monitored with laser speckle contrast imaging(LSCI),optical coherence tomography angiography,and stereo microscope before,during,and after the treatment.We further quantitatively demonstrated the effects of V-PDT in combination with OCA on the blood flow and blood vessel size of skin microvasculature.The combination of OCA and V-PDT resulted in significant vascular damage,including vasoconstriction and the reduction of blood flow.Our results indicate the promising potential of OCA for enhancing V-PDT for treating vascular-related diseases,including PWS.

Significance of Primary Treatment Selection in the Efficiency of Wastewater Treatment in Constructed Wetlands (CWs)

This research explores strategies to enhance the efficiency of secondary treatment in Vertical Flow Constructed Wetlands (CW) in Montenegro. The focus is on selecting appropriate primary treatment methods alongside three distinct substrate types to improve wastewater treatment efficacy. The study examines the combination of two primary treatments with different substrate types in constructed wetlands (CW1, CW2, and CW3). The primary treatments include the existing wastewater treatment plant (WWTP) in Podgorica, involving coarse material removal through screens, inert material separation in aerated sand traps, and sediment and suspended matter removal in primary sedimentation tanks. The Extreme Separator (ExSep) was employed to evaluate its efficacy as a primary treatment method. The research demonstrates that the efficiency of CW can be significantly enhanced by selecting suitable primary treatment methods and substrates in Podgorica’s conditions. The most promising results were achieved by combining ExSep as a primary treatment with secondary treatment in CW-3. The removal efficiencies after CW3 for COD, BOD, and TSS exceeded 89%, 93%, and 91%, respectively. The outcomes underscore the significance of primary treatment in mitigating pollutant loads before discharge into the constructed wetlands, emphasizing potential areas for further optimization in wastewater treatment practices to enhance environmental sustainability and water quality management.

The Effect of Transverse Tibial Bone Transfer in the Treatment of Diabetic Foot

To analyse the effectiveness of performing a transverse tibial bone graft in the treatment of patients with diabetic foot. We retrospectively analysed the clinical details of 51 diabetic foot patients in our hospital from February 2023 to February 2024 and divided them into two groups according to the different treatment modalities, in which the control group received open debridement and the treatment group received transverse tibial bone transfer and compared the differences between the two groups. There were large differences in VAS score, Toronto Clinical Symptom Score, quality of life score, internal lumen diameter, blood flow velocity in the affected limb, perfusion volume, vascular endothelial growth factor, epidermal growth factor and CRP between the two groups after surgery (P < 0.05). Patients with diabetic foot should be treated with transverse tibial bone grafting, which is safer and more effective and can have a significant impact on improving the status of the affected limb, the inflammation and the patient’s quality of life.

Baseline proteinuria, urinary osmotic pressure, and renal function as positive predictors of corticosteroids plus cyclophosphamide treatment efficacy in IgA nephropathy

Background Very limited data are available on factors predictive of corticosteroids plus cyclophosphamide treatment efficacy on IgA nephropathy （IgAN）.The aim of the study was to research the clinical factors predictive of treatment efficacy in IgAN.Methods One hundred and fifty-nine patients with IgAN （proteinuria ≥2 g/d and estimated glomerular filtration rate 30-89 ml·min-1·1.73 m-2） were treated with corticosteroids/cyclophosphamide followed by a 12-month follow-up.According to their response,these patients were divided into remission group （proteinuria ＜0.5 g/d） and non-remission group （proteinuria ≥0.5 g/d）,and their clinical data collected.Results In the present study,72.96％ of the individuals underwent a complete remission,and their response was related to baseline proteinuria,urinary osmotic pressure,and renal function （P ＜0.05）.Patients with baseline proteinuria more than 3 g/d,urinary osmotic pressure greater than 600 mOsm/L,and eGFR 60-89 ml·min-1·1.73 m-2 responded well to the combination of corticosteroids and cyclophosphamide （86.90％ vs.57.33％,P=0.000; 81.48％ vs.64.10％,P=0.014; 83.17％ vs.55.17％,P=0.000）.Conclusion The response to the combination of corticosteroids and cyclophosphamide might be well associated with baseline proteinuria,urinary osmotic pressure,and renal function in patients with IgAN.

Correlations between alterations of T-helper 17 cells and treatment efficacy after concurrent radiochemotherapy in locally advanced cervical cancer (stage IIB-IIIB): a 3-year prospective study

Background::Recently,T-helper 17(Th17)cells have been proved to play an important role in promoting cervical cancer.But,till now,few study has been carried out to understand the involvement of these cells in efficacy of anti-tumor treatments.This study aimed to investigate the alterations in the percentage of circulating Th17 cells and related cytokines in locally advanced cervical cancer(LACC)patients before and after concurrent chemoradiotherapy(cCRT)and to analyze the correlations between the alterations in Th17 cells and treatment efficacy.Methods::A prospective study with 49 LACC(International federation of gynecology and obstetrics[FIGO]stage IIB-IIIB)patients and 23 controls was conducted.Patients received the same cCRT schedule and were followed up for 3 years.Circulating Th17 cells(CD3+CD8-interleukin[IL]-17+T cells)and related cytokines IL-17,transforming growth factor-β(TGF-β),IL-10,IL-23,IL-6,and IL-22 were detected before and after cCRT.Correlations between alterations of circulating Th17 cells and treatment efficacy were analyzed.Kaplan-Meier analysis was used for overall survival(OS)and progression-free survival(PFS).Results::We found that 40 patients finished the entire cCRT schedule and met the endpoint of this study.The percentage of circulating Th17 cells in the LACC patients was higher than that in the controls,and it significantly decreased after cCRT(P<0.05).After cCRT,patients were divided into two groups based on the average of the Th17 cells declined.The subgroup of patients with a prominent decrease in circulating Th17 cells after cCRT had a higher treatment efficacy and longer PFS and OS times.Compared with the control patients,LACC patients had higher IL-6,IL-10,IL-22,TGF-βlevels and a lower IL-23 level(P<0.05).After cCRT,IL-6,IL-10,IL-17,IL-23 level significantly increased and TGF-βlevel significantly decreased compared with the levels before cCRT(P<0.05).Conclusion::Circulating Th17 cells in the LACC patients(FIGO stage IIB-IIIB)were higher than those in the controls,but they generally decreased after cCRT.A more pronounced decrease in circulating Th17 cells after cCRT was correlated with better therapeutic effect and longer PFS and OS times.

Clinical Efficacy of Prolonged First-Line Treatment against Helicobacter pylori in Ouagadougou

Background: Helicobacter pylori (H. pylori) infection is a public health concern. In fact, due to bacterial resistance, treatment strategy is a challenge. It is then more recommended to prolong first-line treatment. In order to be acceptable, the clinical efficacy of treatment must be higher than 90%. Aim: We aimed to assess the outcome of prolonged first-line treatment among adults. Patients and Methods: The study was cross-sectional among adults and patients were treated for H. pylori eradication for the first time during 10 to 14 days. Recruitment was made from March 2019 in six private polyclinics and two hospitals of the city of Ouagadougou. We used monoclonal antigen (Ag) test on the stool samples for diagnostic and for the patients follow up. Chi squared (X2) tests and ANOVA for the comparison of percentages and means were determined using with STATA® software program in the bilateral 95% confidence interval for the statistical analysis. Results: In the different medical centers for 19 months, 365 patients were compiled. The sex-ratio was 0.64. The average age was 43.55 years. The treatment efficacy was 92.88%. Treatment efficacy was better with p-value <10-3 depending on prescriber: gastroenterologist (94.07%), general practitioner (75%);compliance before treatment: excellent (95.88%) or bad (50%);number of consultations: ≥four (94.35%), three (96.32%), two (78.85%). Triple therapies efficacy was 90.81%;p = 0.19. Quadritherapy efficacy was 95%;p = 0.5. Conclusion: This research is a contribution to the advent of national or African recommendations.

Significance of Substrate Selection in the Efficiency of Wastewater Treatment in Constructed Wetlands (CWs)

Constructed wetlands (CWs) can achieve a high-quality wastewater treatment and a quality that meets the prescribed standard, defined by legislation on wastewater discharge. A limitation in the application of constructed wetlands (CWs) is the large area requirement, which limits their application. The subject matter of this research is to check the possibility of improving the efficiency of wastewater treatment and reducing the required area for constructed wetlands (CWs) by using an adequate substrate under the conditions found in Montenegro. In the described experiment, the constructed wetlands (CW) have a vertical flow system and play the role of a secondary wastewater treatment, receiving water from the existing WWTP in Podgorica after the primary treatment. These vertical flow systems reflect experience with the use of similar systems in Slovenija, Austria and Italy. Measurements to date show that the substrate plays an important role and that wastewater treatment efficacy varies significantly with respect to the type of substrate when used under the conditions available in Montenegro.

Enhancing the Efficacy of Antihypertensive Treatment with Pharmacogenomics

In 2003,two newguidelines for hyperten—sive prevention andmanagement have beenprovided by AmericanJNC7 and European So-ciety of Hypertension.They advocated that thephysician should choosedrugs following individ—ualized treatment,

Editor's Choice—Meta analysis of acupuncture efficacy for the treatment of nervous system diseases

Meta analysis of randomized, controlled, clinical studies of acupuncture for the treatment of nervous system diseases has demonstrated that acupuncture effectively treats optic atrophy and depression. However, the quality of selected studies is low and evidence is inadequate. Therefore,

Clinical efficacy and tolerance of sunitinib in the treatment of advanced renal cell carcinoma

Objective To evaluate the clinical efficacy and side effects of sunitinib in treatment of advanced renal cell carcinoma. Methods Forty-five patients with advanced renal cell carcinorna and an average age of 48. 6 yrs were treated with sunitinib. of the study group。

Delayed Grafting as a Valid Technique in Burn Management: Experience from a Burn Unit in Oman

Background: Early excision and grafting has been the preferred method of managing major burns around the world since 1970. Considering the advances in health care and the development of new antibiotics over the past 50 years, delayed grafting as a technique for the management of burns over 15%-20% of total body surface area (TBSA) could have comparable results to that of early excision. This study aims to highlight the outcomes of practicing delayed grafting in burn patients. Methods: A case series analysis was performed of 51 patients who were admitted to the burns unit in Sultan Qaboos Hospital Salalah with over 20% TBSA between January 2014 and December 2019. The patients received prophylactic antibiotics and silver sulphadiazine dressing until the burn eschar had completely separated, followed by grafting. Results: Two patients were lost during the entire duration of the study. The mortality rate was comparable to that of early excision, while the rate of hypertrophic scarring was lower than the range reported by other studies. Conclusion: In the management of patients with over 20% TBSA, delayed grafting after complete separation of eschar is still a valid technique.

Novel HBV mutations and their value in predicting efficacy of conventional interferon

BACKGROUND： Accumulating studies assessing the impacts of hot spot mutations on conventional interferon（IFN） efficacy come to discrepant conclusions; studies regarding the mutations in S and RT regions are also unclear. The present study aimed to evaluate the impacts of HBV mutations on the efficacy of conventional IFN. METHODS： A total of 126 patients who received conventional IFN treatment for 48 weeks were enrolled. Biochemical and serological parameters were routinely tested. The sequences of HBV from 78 serum samples were amplified by nested-PCR; mutations were identified with sequence scanner V1.0 after ABI 3730 xl direct sequencing, HBV genotypes were determined according to RT gene sequences utilizing NCBI Genotyping Tool which was based on phylogenetic analysis.RESULTS： The baseline DNA levels of virological response（VR） group were significantly lower than those of no VR group [7.13±0.76 vs 7.69±0.56 lg（copies/m L）, P=0.001]. The baseline ALT levels were significantly higher in the HBe Ag clearance group（204.72±88.65 vs 162.80±85.81 IU/L, P〈0.05） andHBe Ag seroconversion group（204.89 ±95.68 vs 166.75±84.43 IU/L, P〈0.05）. Females and lower BMI levels（20.01±2.33 vs 21.65±3.66 kg/m^2, P〈0.05） were prone to acquired biochemical response（BR）. PC-W28STOP（ntG 1896A） was significantly higher in the combined response（CR） group than that in the no CR group（91.7% vs 39.7%, P=0.001）. Multivariate logistic regression analysis showed that baseline DNA, PC-P159T（ntC2288A）, BCP-N118T（ntA 1726C） and BCP-L134L（ntA 1775C/G/T） influenced VR independently. PC-G182C（nt G2357T）, PC-S64A/T（nt T2003G/A） and BMI were independent influence factors for HBe Ag clearance, HBe Ag seroconversion and BR, respectively. The new predicting model concluded that baseline DNA and new mutations for VR were established successfully, and ROC analysis showed that AUC was 0.842（P〈0.001） with a sensitivity of 0.652 and a specificity of 0.933.CONCLUSIONS： PC-P159T（ntC 2288A）, BCP-N118T（ntA 1726C）, BCP-L134L（nt A1775C/G/T）, PC-G182C（nt G2357T） and PCS64A/T（nt T2003G/A） were novel identified mutations that impacted IFN therapeutic efficacy. These novel mutations could serve as important predictors before conventional IFN treatment.

Analysis on the Clinical Therapeutic Effect of Hepatic Artery Chemoembolization in the Treatment of Advanced Liver Cancer

Objective:To analyze the clinical efficacy of hepatic artery chemoembolization in the treatment of advanced liver cancer.Methods:124 patients with advanced liver cancer admitted to our hospital from September 2019 to November 2020 were selected as the research subjects of this paper.The patients with advanced liver cancer were divided into experimental group and control group.The control group was treated with radiofrequency ablation alone,and the experimental group was administered hepatic arterial chemoembolization.The improvement in physical indicators and the incidence of adverse reactions between the two groups were compared.Results:The alpha-fetoprotein(AFP)index and serum total bilirubin(TBIL)index of the experimental group were lower than those of the control group,and the alanine aminotransferase(ALT)index was higher than that of the control group.There were differences in the comparison of liver function indices between the two groups which were statistically significant.After treatment,there were 3 cases of fever,4 cases of vomiting,8 cases of bone marrow transplantation,4 cases of abdominal pain,2 cases of proteinuria,and 1 case of diarrhea occurred in the experimental group;whereas there were 6 cases of fever,8 cases of vomiting,14 cases of bone marrow transplantation,7 cases of abdominal pain,5 cases of proteinuria,and 6 cases of diarrhea occurred in the control group.The difference in incidence of adverse reactions between patients after different treatment interventions was statistically significant.Analyzing the remission rate of tumor diseases in patients,the remission rate of the experimental group was higher than that of the control group,and the difference in the remission rate between the two groups of patients was statistically significant.Conclusion:The implementation of hepatic arterial chemoembolization for patients with advanced liver cancer can promote the improvement of the patient's short-term treatment efficacy,enhance the liver functions of the patient,reduce the incidence of adverse reactions,improve the efficiency of the patient's body rehabilitation,and enhance the quality of life of the patient after treatment.

Potential active compounds and mechanisms of Shen-Qi-Yi-Chang granule for the treatment of colorectal cancer:an analysis of network pharmacology and molecular docking

Background:In recent years,herbal formulations have assumed an influential part in preventing and treating tumors.Shenqi Yichang granules(SQYCG)have proven effective in the adjuvant treatment of colorectal cancer(CRC),but their mechanism has not been elucidated.This study aimed to explore the potential active compounds and mechanisms of SQYCG in the treatment of CRC using network pharmacology and molecular docking.Methods:The active compounds and targets of SQYCG and the CRC genes were found using the Traditional Chinese Medicine Systems Pharmacology,DrugBank,and DisGeNET databases.The intersected targets of disease genes and drug targets were depicted using a Venn diagram.The protein-protein interaction(PPI)network of these targets was obtained by String platform and visualized using Cytoscape.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis were carried using the DAVID database to obtain the core molecular mechanism of SQYCG in CRC treatment.Molecular docking techniques were used to validate the results.Results:A total of 63 compounds and 245 targets were obtained from the herbal prescription after the screening,of which 122 targets crossed with CRC genes.PPI showed that the core regulatory targets include MAPK1,TNF,TP53,JUN,RELA,MAPK14,and MAPK 8.The GO analysis indicated regulation of drug response,apoptotic process,response to hypoxia,angiogenesis,and response to lipopolysaccharide.KEGG pathway enrichment analysis mainly involves TNF,T cell receptor,Toll-like receptor,PI3K-Akt,and MAPK signal pathway.Conclusion:Through network pharmacology,we havedemonstrated that SQYCG has multiple targets,components,and pathways in treating CRC,with anti inflammation and inhibition of cell proliferation being critical components of its mechanism.

Impact of baseline steroids on the efficacy of neoadjuvant immunochemotherapy in locally advanced esophageal squamous cell carcinoma

BACKGROUND Immunochemotherapy involving the combination of programmed cell death 1/programmed cell death ligand 1 inhibitors with chemotherapy has advanced the treatment of locally advanced esophageal squamous cell carcinoma(ESCC).The use of corticosteroids as pretreatment might reduce immunotherapy efficacy.AIM To investigate the impact of baseline corticosteroid use on neoadjuvant immunochemotherapy(nIC)outcomes in locally advanced ESCC patients.METHODS Patients with locally advanced ESCC who received nIC at Sun Yat-sen University Cancer Center and the Third Affiliated Hospital of Sun Yat-sen University were included.Patients were divided into dexamethasone and antihistamine groups on the basis of the administered pretreatment.Antiallergic efficacy and safety were evaluated,as well as its impact on short-term efficacy[complete pathological response(pCR),major pathological response(MPR)]and long-term efficacy[overall survival(OS),progression-free survival(PFS)]of nIC.RESULTS From September 2019 to September 2023,142 patients were analyzed.No severe treatment-related adverse events or deaths were observed.Allergy occurrence was greater in the antihistamine group(P=0.014).Short-term efficacy was not significantly different:The pCR rates were 29.9%and 40.0%,and the MPR rates were 57.9%and 65.7%in the dexamethasone and antihistamine groups,respectively.The long-term efficacy was not significantly different:The 2 years OS rates were 95.2%and 93.5%,and the 2 years PFS rates were 90.3%and 87.8%.Subgroup analysis revealed no difference in OS between the 20 mg dexamethasone group and the<20 mg dexamethasone group,but PFS was significantly greater in the 20 mg dexamethasone group(93.9%vs 56.4%,P=0.001).CONCLUSION Dexamethasone or antihistamines can be used before nIC in locally advanced ESCC without affecting short-or long-term efficacy.Administering 20 mg dexamethasone before nIC may improve PFS in ESCC.

Transcranial direct current stimulation for auditory verbal hallucinations:a systematic review of clinical trials

Transcranial direct current stimulation(tDCS)has been reportedly beneficial for different neurodegenerative disorders.tDCS has been reported as a potential adjunctive or alternative treatment for auditory verbal hallucination(AVH).This study aims to review the effects of tDCS on AVH in patients with schizophrenia through combining the evidence from randomized clinical trials(RCTs).The databases of PsycINFO(2000–2019),PubMed(2000–2019),EMBASE(2000–2019),CINAHL(2000–2019),Web of Science(2000–2019),and Scopus(2000–2019)were systematically searched.The clinical trials with RCT design were selected for final analysis.A total of nine RCTs were eligible and included in the review.Nine RCTs were included in the final analysis.Among them,six RCTs reported a significant reduction of AVH after repeated sessions of tDCS,whereas three RCTs did not show any advantage of active tDCS over sham tDCS.The current studies showed an overall decrease of approximately 28%of AVH after active tDCS and 10%after sham tDCS.The tDCS protocols targeting the sensorimotor frontal-parietal network showed greater treatment effects compared with the protocols targeting other regions.In this regard,cathodal tDCS over the left temporoparietal area showed inhibitory effects on AVHs.The most effective tDCS protocol on AVHs was twice-daily sessions(2 mA,20-minute duration)over 5 consecutive days(10 sessions)with the anode over the left dorsolateral prefrontal cortex and the cathode over the left temporal area.Some patient-specific and diseasespecific factors such as young age,nonsmoking status,and higher frequencies of AVHs seemed to be the predictors of treatment response.Taken together,the results of tDCS as an alternative treatment option for AVH show controversy among current literatures,since not all studies were positive.However,the studies targeting the same site of the brain showed that the tDCS could be a promising treatment option to reduce AVH.Further RCTs,with larger sample sizes,should be conducted to reach a conclusion on the efficacy of tDCS for AVH and to develop an effective therapeutic protocol for clinical setting.

Analysis of clinical efficacy of different initial antimicrobial treatment in healthcare associated pneumonia patients in emergency department

Background Community acquired pneumonia （CAP） is one of the most common infectious disease in emergency department.In 2005 the concept of healthcare associated pneumonia （HCAP） was proposed by the ATS/IDSA guidelines.The clinical features and microbiology of HCAP are different from CAP,however,the initial antimicrobial treatment is still controversial.We aimed to compare the clinical efficacy between HCAP patients treated initially with HCAP guidelineconcordant antimicrobial agents and those with CAP guideline-concordant antimicrobial agents.Methods We conducted a retrospective observational study on HCAP patients who were admitted to emergency department between December 2011 and December 2012.Patients were divided into 2 groups according to their different initial antimicrobial treatment.We compared clinical features,distribution of pathogen,severity,days and spending on intravenous antimicrobial,length and charge of hospitalization and clinical outcomes,and meanwhile analyzed the clinical efficacy as well.Results Of the 125 HCAP patients,55 patients received CAP guideline-concordant antimicrobial agents and 70 received HCAP agents.The major pathogens were Klebsiella pneumoniae,methicillin-resistant staphylococcus aureus （MRSA）,Pseudomonas aeruginosa and Escherichia coll The 2 groups were similar at baseline,including old age,comorbidities,Pneumonia Severity Index scores,APACHE scores,and length of intravenous antimicrobial use and hospitalization duration,and in-hospital mortality.Overall efficacy rate occurred in 70.0％ of HCAP agent patients and 50.9％ of CAP agent patients （P=0.029）.Antimicrobial charge and total hospital charge for HCAP agent patients were significantly higher than that for CAP agent patients.Conclusions Initial treatment of HCAP patients in emergency department with HCAP guideline-concordant antimicrobial could increase clinical efficacy rate,as well as antimicrobial charge and total hospital charge,but was not associated with shortening the length of stay,or lowering in-hospital mortality.

Boron neutron capture therapy: moving towards targeted therapy for locally recurrent head and neck squamous cell carcinoma

Locally recurrent head and neck squamous cell carcinoma(HNSCC)is often unresectable,and a repeat course of radiotherapy is associated with incremental toxicities.Boron neutron capture therapy(BNCT)is a novel targeted radiotherapy modality that can achieve a high dose gradient between cancerous and adjacent normal tissues.However,the relationships among the dose resulting from BNCT,tumor response to BNCT,and survival are not completely understood.Recently,a study published in Radiotherapy and Oncology investigated the efficacy of BNCT in the treatment of patients with locally recurrent HNSCC and the factors associated with favorable treatment response and survival.In this article,the findings,strengths and limitations of this study are discussed in depth,and the significance of the study and motivations for future research are highlighted.

Recent research on vasectomy techniques

Vasectomy is a commonly used, highly effective method for the control of fertility in the human male. It is almost always performed as an outpatient procedure, is safer than tubal occlusion and has few side effects. The number of people relying on vasectomy as a method of contraception varies widely from country to country. Though vasectomy is highly effective, failures may occur due to re-canalization of the vas, surgical error, anatomical variants or failure of contraception during the post-operative waiting period. One of the disadvantages of this technique is that sperm are present in the posterior end of the vas following surgery and hence patients have to use alternative methods of contraception for a waiting period of 12 weeks to 15 weeks before relying on a vasectomy for contraception. This review summarizes recent research on vasectomy conducted by Family Health International, USA.