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Comments by opponents on the British Medical Association’s guidance on non-therapeutic male circumcision of children seem one-sided and may undermine public health

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World journal of Clinical Pediatrics 2023年第5期12卷 244-262页

作者： Stephen Moreton Guy Cox Mark Sheldon Stefan A Bailis jeffrey D Klausner brian j morris CircFacts Warrington WA51HYCheshireUnited Kingdom Australian Centre for Microscopy&Microanalysis and School of Aeronautical Mechanical and Mechatronic EngineeringUniversity of SydneySydney 2006New South WalesAustralia Medical Humanities and Bioethics Program Feinberg School of MedicineNorthwestern UniversityChicagoIL 60661United States Cornerstone Therapy&Recovery Center St.PaulMN 55101United States Department of Medicine Population and Public Health SciencesKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCA 90089United States School of Medical Sciences University of SydneySydney 2006New South WalesAustralia

The British Medical Association(BMA)guidance on non-therapeutic circumcision(NTMC)of male children is limited to ethical,legal and religious issues.Here we evaluate criticisms of the BMA’s guidance by Lempert et al.While their arguments promoting autonomy and consent might be superficially appealing,their claim of high procedural risks and negligible benefits seem one-sided and contrast with high quality evidence of low risk and lifelong benefits.Extensive literature reviews by the American Academy of Pediatrics and the United States Centers for Disease Control and Prevention in developing evidence-based policies,as well as risk-benefit analyses,have found that the medical benefits of infant NTMC greatly exceed the risks,and there is no reduction in sexual function and pleasure.The BMA’s failure to consider the medical benefits of early childhood NTMC may partly explain why this prophylactic intervention is discouraged in the United Kingdom.The consequence is higher prevalence of preventable infections,adverse medical conditions,suffering and net costs to the UK’s National Health Service for treatment of these.Many of the issues and contradictions in the BMA guidance identified by Lempert et al stem from the BMA’s guidance not being sufficiently evidence-based.Indeed,that document called for a review by others of the medical issues surrounding NTMC.While societal factors apply,ultimately,NTMC can only be justified rationally on scientific,evidence-based grounds.Parents are entitled to an accurate presentation of the medical evidence so that they can make an informed decision.Their decision either for or against NTMC should then be respected.

关键词： Circumcision,Male Child Infections Risk Policy Public health

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Circumcision reduces prostate cancer risk

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Asian journal of Andrology 2012年第5期14卷 661-662页

作者： brian j morris lake H Waskett School of Medical Sciences University of SydneySydney NSW 2006 Australia CircumcisionIndependent Reference and Commentary Service Manchester M26 1JR UK

There is a strong negative correlation between prostate cancer and circumcision rate across 181 countries （P〈0.0001）. Adding to the large protective effect of cir- cumcision seen in small studies over the past six decades, a recent large study in Seattle has shown a smaller protective effect. If verified by other large studies else- where, the finding would add to the wide array of benefits conferred by this safe, sim- ple procedure that is best performed in infancy.

关键词： INFECTION

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Reply to Letter by Dr. Christoph Kupferschmid： Commentary on ＂Countries with high circumcision prevalence have lower prostate cancer mortality＂

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Asian journal of Andrology 2016年第6期18卷 950-951页

作者： Mitchell S Wachtel Shengping Yang brian j morris Texas Tech University Health Sciences Center Lubbock Texas USA School of Medical Sciences University of Sydney Sydney New South Wales Australia

Dear Editor, We thank Dr. Kupferschmid for his interest in our study, which examined male circumcision （MC） and prostate cancer mortality〉2 Considerable strong evidence has been accumulated since 1951.3 Most of his references4-10 do not address MC and the risk of death from prostate cancer. That is a different question than MC and the risk of developing prostate cancer, which none of his references validly assess. One reference addressed bacterial colonization,6 not prostate cancer. Another7 concerned sexually transmitted infections and prostate cancer.

关键词： EPIDEMIOLOGY RISK

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Metabolic reprogramming by Syntenin-1 directs RA FLS and endothelial cell-mediated inflammation and angiogenesis

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Cellular & Molecular Immunology 2024年第1期21卷 33-46页

作者： Anja Meyer Stephanie R.Zack Wes Nijim Adel Burgos Vishwa Patel brian Zanotti Michael V.Volin M.Asif Amin Myles j.Lewis Costantino Pitzalis Shiva Arami joseph A.Karam Nadera j.Sweiss Shiva Shahrara jesse Brown VA Medical Center ChicagoILUSA Department of Medicine Division of RheumatologyThe University of Illinois at ChicagoChicagoILUSA Department of Microbiology and Immunology Midwestern UniversityDowners GroveILUSA Division of Rheumatology and Clinical Autoimmunity Center of Excellence University of MichiganAnn ArborMIUSA Centre for Experimental Medicine and Rheumatology William Harvey Research InstituteBarts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUnited Kingdom Centre for Experimental Medicine&Rheumatology William Harvey Research InstituteQueen Mary University of London and Barts NIHR BRC&NHS TrustLondonUK Department of Biomedical Sciences Humanitas Universityand Humanitas Research HospitalMilanItaly Department of Orthopedic Surgery the University of Illinois at ChicagoChicagoILUSA

A novel rheumatoid arthritis(RA)synovial fluid protein,Syntenin-1,and its receptor,Syndecan-1(SDC-1),are colocalized on RA synovial tissue endothelial cells and fibroblast-like synoviocytes(FLS).Syntenin-1 exacerbates the inflammatory landscape of endothelial cells and RA FLS by upregulating transcription of IRF1/5/7/9,IL-1β,IL-6,and CCL2 through SDC-1 ligation and HIF1α,or mTOR activation.Mechanistically,Syntenin-1 orchestrates RA FLS and endothelial cell invasion via SDC-1 and/or mTOR signaling.In Syntenin-1 reprogrammed endothelial cells,the dynamic expression of metabolic intermediates coincides with escalated glycolysis along with unchanged oxidative factors,AMPK,PGC-1α,citrate,and inactive oxidative phosphorylation.Conversely,RA FLS rewired by Syntenin-1 displayed a modest glycolytic-ATP accompanied by a robust mitochondrial-ATP capacity.The enriched mitochondrial-ATP detected in Syntenin-1 reprogrammed RA FLS was coupled with mitochondrial fusion and fission recapitulated by escalated Mitofusin-2 and DRP1 expression.We found that VEGFR1/2 and Notch1 networks are responsible for the crosstalk between Syntenin-1 rewired endothelial cells and RA FLS,which are also represented in RA explants.Similar to RA explants,morphological and transcriptome studies authenticated the importance of VEGFR1/2,Notch1,RAPTOR,and HIF1αpathways in Syntenin-1 arthritic mice and their obstruction in SDC-1 deficient animals.Consistently,dysregulation of SDC-1,mTOR,and HIF1αnegated Syntenin-1 inflammatory phenotype in RA explants,while inhibition of HIF1αimpaired synovial angiogenic imprint amplified by Syntenin-1.In conclusion,since the current therapies are ineffective on Syntenin-1 and SDC-1 expression in RA synovial tissue and blood,targeting this pathway and its interconnected metabolic intermediates may provide a novel therapeutic strategy.

关键词： Syntenin-1 Syndecan-1 RA FLS RA explants immunometabolism

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Tye &Sardi’s Psychological, Psychosocial, and Psychosexual Aspects of Penile Circumcision*

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Advances in Sexual Medicine 2022年第3期12卷 65-83页

作者： Stefan A. Bailis Stephen Moreton john N. Krieger brian j. morris Cornerstone Therapy & Recovery Center St. Paul Minnesota USA CircFacts Warrington UK Department of Urology University of Washington School of Medicine Seattle USA School of Medical Sciences University of Sydney Sydney Australia

Tye and Sardi recently reviewed the evidence purporting to implicate male circumcision, especially when performed early in infancy, in psychological problems in men. Here we provide a critical evaluation to determine the veracity of their evidence and claims. Missing from their review were critiques pointing out fundamental flaws in key studies. We argue that psychological stress in some men may be caused by anti-circumcision propaganda telling them that they are victims of “genital mutilation”, a term adopted from dissimilar female practices in particular ethnic groups. Sexual dissatisfaction results. We critically discuss claims about foreskin “gliding”, the eccentric foreskin-related sexual practice of “docking”, and the use of lubricant in masturbation. We further find that a study claiming to show numerous differences in socio-affective processing in men circumcised as neonates stem from statistically flawed and one-sided data that has been misinterpreted, and in fact shows the opposite of the hypothesis that psychological problems in some men can be attributed to the pain of their circumcision as newborns. Importantly, since the brain regions responsible for empathy, namely subcortical gray matter and white matter in frontal and parietal regions, were similar in neonatally circumcised and uncircumcised men, the null hypothesis remains null. In conclusion, we find no compelling evidence to support newborn circumcision pain being responsible for psychological problems in neonatally circumcised men. Men who come to believe that they are victims of their infant circumcision are in actual fact likely victims of false claims perpetrated by activist community groups with trenchant opposition to circumcision.

关键词： Sexual Function Psychology Male Sexual Health Anti-Circumcision

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Fetal Head Compression: Its Possible Role in Neurologic Injury

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Open journal of Obstetrics and Gynecology 2024年第1期14卷 124-143页

作者： Barry S. Schifrin brian j. Koos Wayne R. Cohen Department of Obstetrics and Gynecology The Western University of Health Sciences Pomona USA The David Geffen School of Medicine at UCLA Los Angeles USA The University of Arizona College of Medicine Tucson USA

It is widely assumed that fetal ischemic brain injury during labor derives almost exclusively from severe, systemic hypoxemia with marked neonatal depression and acidemia. Severe asphyxia, however, is one of several causes of perinatal neurological injury and may not be the most common;most neonates diagnosed with hypoxic-ischemic encephalopathy do not have evidence of severe asphyxia. Sepsis, direct brain trauma, and drug or toxin exposure account for some cases, while mechanical forces of labor and delivery that increase fetal intracranial pressure sufficiently to impair brain perfusion may also contribute. Because of bony compliance and mobile suture lines, the fetal skull changes shape and redistributes cerebrospinal fluid during labor according to constraints imposed by contractions, and bony and soft tissue elements of the birth canal as the head descends. These accommodations, including the increase in intracranial pressure, are adaptive and necessary for efficient descent of the head while safeguarding cerebral blood flow. Autonomic reflexes mediated through central receptors normally provide ample protection of the brain from the considerable pressure exerted on the skull. On occasion, those forces, which are transmitted intracranially, may overcome the various adaptive anatomical, cardiovascular, metabolic, and neurological mechanisms that maintain cerebral perfusion and oxygen availability, resulting in ischemic brain injury. Accepting the notion of a potentially adverse impact of fetal head compression suggests that avoidance of excessive uterine activity and of relentless pushing without steady progress in descent may offer protection for the fetal brain during parturition. Excessive head compression should be considered in the differential diagnosis of ischemic encephalopathy.

关键词： Fetal Brain Injury Fetal Head Compression Ischemic Encephalopathy Neonatal Encephalopathy

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Male Circumcision Does Not Reduce Sexual Function, Sensitivity or Satisfaction

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Advances in Sexual Medicine 2015年第3期5卷 53-60页

作者： brian j. morris john N. Krieger School of Medical Sciences University of Sydney Sydney Australia Section of Urology VA Puget Sound Health Care System School of Medicine University of Washington Seattle USA

We disagree with Boyle’s recent article questioning our systematic review in journal of Sexual Medicine in 2013 (Volume 10, pages 2644-2657). In particular, he disputed the quality ranking we assigned to 7 of the 36 articles that met our inclusion criteria. These had been ranked for quality by the Scottish Intercollegiate Guidelines Network (SIGN) grading system. We found that, “the highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation or satisfaction.” This conclusion was supported by two randomized controlled trials, regarded as high-quality (1++) evidence and the majority of surveys and studies involving physiological measurements comparing uncircumcised and circumcised men. Here we explain why the 2 randomized controlled trials merit a 1++ ranking and why 4 reports that Boyle believes merit a higher ranking only meet the criteria set down for low quality (2?) evidence according to the SIGN system. We therefore stand by our conclusions. These are supported by a meta-analysis of sexual dysfunctions and by a recent detailed systematic review of the histological correlates of male sexual sensation.

关键词： Circumcision Erectile Function Sexual Satisfaction Premature Ejaculation Penile Sensitivity

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Aerosol jet printing of surface acoustic wave microfluidic devices

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Microsystems & Nanoengineering 2024年第1期10卷 231-242页

作者： joseph Rich brian Cole Teng Li Brandon Lu Hanyu Fu Brittany N.Smith jianping Xia Shujie Yang Ruoyu Zhong james L.Doherty Kanji Kaneko Hiroaki Suzuki Zhenhua Tian Aaron D.Franklin Tony jun Huang Department of Biomedical Engineering Duke UniversityDurhamNC 27708USA Department of Electrical and Computer Engineering Duke UniversityDurhamNC 27708USA Department of Mechanical Engineering Virginia Polytechnic Institute and State UniversityBlacksburgVA 24061USA Thomas Lord Department of Mechanical Engineering and Materials Science Duke UniversityDurhamNC 27708USA Deptartment of Precision Mechanics Faculty of Science and EngineeringChuo UniversityTokyo 112-8551Japan Department of Chemistry Duke UniversityDurhamNC 27708USA

The addition of surface acoustic wave(SAW)technologies to microfluidics has greatly advanced lab-on-a-chip applications due to their unique and powerful attributes,including high-precision manipulation,versatility,integrability,biocompatibility,contactless nature,and rapid actuation.However,the development of SAW microfluidic devices is limited by complex and time-consuming micro/nanofabrication techniques and access to cleanroom facilities for multistep photolithography and vacuum-based processing.To simplify the fabrication of SAW microfluidic devices with customizable dimensions and functions,we utilized the additive manufacturing technique of aerosol jet printing.We successfully fabricated customized SAW microfluidic devices of varying materials,including silver nanowires,graphene,and poly(3,4-ethylenedioxythiophene)polystyrene sulfonate(PEDOT:PSS).To characterize and compare the acoustic actuation performance of these aerosol jet printed SAW microfluidic devices with their cleanroom-fabricated counterparts,the wave displacements and resonant frequencies of the different fabricated devices were directly measured through scanning laser Doppler vibrometry.Finally,to exhibit the capability of the aerosol jet printed devices for lab-on-a-chip applications,we successfully conducted acoustic streaming and particle concentration experiments.Overall,we demonstrated a novel solution-based,direct-write,single-step,cleanroom-free additive manufacturing technique to rapidly develop SAW microfluidic devices that shows viability for applications in the fields of biology,chemistry,engineering,and medicine.

关键词： printing wave fluid

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Critical Evaluation of a Survey Claiming “Long-Term Adverse Outcomes from Neonatal Circumcision”

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Advances in Sexual Medicine 2019年第4期9卷 67-109页

作者： Stefan A. Bailis Stephen Moreton brian j. morris Cornerstone Therapy & Recovery Center St. Paul USA CircFacts Warrington UK School of Medical Sciences and Bosch Institute University of Sydney Sydney Australia

We critically evaluate an online “Global survey of circumcision harm” that gauged beliefs of men who thought that their neonatal circumcision had harmed them. Sequential evaluation of the survey data and claims reveal numerous serious flaws that are at odds with strong scientific evidence. Moreover, the one-sided study design and “loaded” survey title meant the findings were not representative of the general population of circumcised males. None of the participants’ claimed physical problems were confirmed by a health practitioner. Belief in this seriously flawed survey has potential to cause psychological harm to vulnerable men influenced by anti-circumcision claims, and as such has serious detrimental implications for male sexual health. The survey appears driven less by empiricism and more by psychological forces, as we show in de-tail. The overwhelming body of high quality medical scientific evidence finds no adverse effect of male circumcision on sexual function and pleasure, but strong evidence for a wide array of lifetime benefits in protection against infections, dermatological problems, and genital cancers. Consistent with the United Nations Convention on the Rights of the Child, children are entitled to low risk procedures that are beneficial to their health. In conclusion, the survey and its uncritical presentation do a disservice to evidence-based medicine, sexual health, mental health, public health, human rights, and pediatric policy development. It should therefore be dismissed as unreliable.

关键词： Sexual Function Psychology Male Health Anti-Circumcision

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Expertise and Ideology in Statistical Evaluation of Circumcision for Protection against HIV Infection

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World journal of AIDS 2017年第3期7卷 179-203页

作者： brian j. morris Gia Barboza Richard G. Wamai john N. Krieger School of Medical Sciences and Bosch Institute University of Sydney Sydney Australia Department of Cultures Societies and Global Studies School of Criminology and Criminal Justice Northeastern University Boston MA USA Department of African-American Studies Northeastern University Boston MA USA School of Medicine University of Washington Seattle WA USA Section of Urology VA Puget Sound Health Care System Seattle WA USA

Aim: To critically evaluate data and arguments by Van Howe defending his stance opposing male circumcision (MC), in particular his meta-regression analyses evaluating the ability of MC to reduce HIV infection risk in heterosexual populations within and outside Africa. Methods: We performed metaregression analysis of log odds of HIV infection between uncircumcised and circumcised men using a single covariate (MC prevalence) in the meta-regression model involving the metareg package in STATA 13 for 103 populations worldwide and for populations within Africa. The meta-regression of log odds and MC prevalence was fitted to a line, as were empirical Bayes estimates resulting from post-estimation. Results: Our critical evaluation of Van Howe’s arguments attempting to undermine the scientific evidence in support of the benefits of MC in protection of men against HIV during heterosexual intercourse, as well as other infections and conditions, together with his use of statistics to support his beliefs, revealed serious flaws, obfuscation and missing data. We therefore performed our own meta-regression analysis using a trivariate model. Doing so revealed that for MC prevalences of 50%, 75% and 100% for general populations within Africa, odds ratios for HIV risk in uncircumcised vs. circumcised men were 1.35, 1.58 and 1.85, respectively. Our meta-regression analysis of data for all countries yielded similar findings. For a general population outside Africa with 100% MC prevalence, OR was 1.5. Van Howe failed to acknowledge that since MC prevalence in US whites (91%) and blacks (76%) exceeds 75% his results support MC having a protective effect in those population groups. Conclusions: The protective effect of MC against HIV infection during heterosexual intercourse applies to populations both within and outside Africa. The debate engineered by MC opponents, and led by Van Howe, now appears to have run its course. The scientific evidence has prevailed.

关键词： Male Circumcision Human Immunodeficiency Virus HIV Prevalence Prevention Meta-Regression Global Health

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