This document summarizes information from a presentation on azoospermia and microsurgical testicular sperm extraction (Micro-TESE). It defines obstructive and non-obstructive azoospermia and compares conventional sperm retrieval techniques to Micro-TESE. Micro-TESE has higher sperm retrieval rates compared to conventional TESE, especially for men with non-obstructive azoospermia. It allows identification and preservation of the few seminiferous tubules that may contain sperm, minimizing damage to the testis.
lecture delivered by Dr Sujoy Dasgupta in a Webinar organized by the Infertility Committee of FOGSI (Federation of Obstetric and Gynaecological Societies of India) and BOGS (Bengal Obstetric and Gynaecological Societiy), held in February, 2021
ICSI as it is presently performed is far from an ideal solution because the selection of sperm is based on the judgement of an embryologist, who is looking for the most normal appearing sperm available.
Iran march 2011
ABRASCT:
SPERM RETRIEVAL TECHNIQUES FOR THE AZOOSPERMIC MALE
Sandro C. Esteves, MD, PhD
Spermatozoa can be retrieved from either the epididymis or the testis, depending on the type of azoospermia, using different surgical methods such as PESA, MESA, TESA, TESE and micro-TESE.
In obstructive azoospermia (OA), sperm production is normal and gametes can be easily retrieved from the epididymis or the testicle in most cases, irrespective of the technique. PESA or TESA are simple and efficient methods for retrieving epididymal or testicular spermatozoa in men with OA. According to our data on OA, the etiology of the obstruction and the use of fresh or frozen-thawed epididymal/testicular sperm do not seem to affect ICSI outcomes in terms of fertilization, pregnancy, or miscarriage rates.
In cases of nonobstructive azoospermia (NOA), the efficiency of TESA for retrieving spermatozoa is lower than TESE, except in the favorable cases of men with previous successful TESA or testicular histopathology showing hypospermatogenesis. The use of microsurgery during TESE may improve the efficacy of sperm extraction with significantly less tissue removed, which ultimately facilitates sperm processing. Testicular histology results, if available, may be useful to predict the chances to retrieve sperm in men with NOA. Our data demonstrate that micro-TESE performs better than conventional TESE or TESA in cases of maturation arrest and Sertoli cell-only histological patterns, where tubules containing active focus of spermatogenesis can be positively identified using microsurgery. Testicular spermatozoa can be obtained even in the worst case scenario except in the cases of Y chromosome infertility with complete AZFa and/or AZFbmicrodeletions.
In both OA and NOA, sperm retrieval technique itself seems to have no impact on ICSI success rates. The main goal of PESA/TESA/TESE sperm processing is the recovery of a clean sample containing motile sperm. Such specimens are more fragile, and often compromised in motility, as compared to the ones obtained from ejaculates. Laboratory techniques should be carried out with great caution not to jeopardize the sperm fertilizing potential. Surgically-retrieved spermatozoa can be intentionally cryopreserved for future use. Spare left-over specimens that would be discharged after ICSI can also be cryostored. Different strategies can be developed according to each group’s results. If freezing of surgically-retrieved specimens provides results similar to those with the use of fresh sperm, then the use of freezing specimens would be preferable. If not, fresh specimens are preferable.
The reproductive potential of infertile men undergoing ART is related to the type of azoospermia. According to our data, the chances of retrieving spermatozoa (odds ratio [OR] = 43.0; 95% confidence interval [CI]: 10.3-179.5) and of achieving a live birth by ICSI (OR=1.86; 95% CI:l 1.03-2.89) were significantly increased in couples whose male partner had obstructive rather than non-obstructive azoospermia. Children conceived using sperm retrieved from men with OA and NOA should be followed-up because it is still unclear if there is an increased risk of birth defects when ICSI is carried out with non-ejaculated sperm.
References
Esteves SC, Glina S. Recovery of spermatogenesis after microsurgical subinguinal varicocele repair in azoospermic men based on testicular histology. IntBraz J Urol. 2005; 31:541-8.
Verza S Jr, Esteves SC. Sperm defect severity rather than sperm source is associated with lower fertilization rates after intracytoplasmic sperm injection. IntBraz J Urol. 2008,34:49-56.
Esteves SC, Verza S, Prudencio C, Seol B. Sperm retrieval rates (SRR) in nonobstructive azoospermia (NOA) are related to testicular histopathology results but not to the etiology of azoospermia. FertilSteril. 2010; 94(Suppl.):S132.
Esteves SC, Verza S, Prudencio C, Seol B. Success of percutaneous sperm retrieval and i
In this presentation we talk about the current management of male infertility in Delhi India.
Dr Vijayant Gupta is male infertility expert in new Delhi India
We talk about
1. Non obstructive azoospermia
2. Obstructive azoospermia
3. Oligospermia
http://drvijayantgovinda.com/male-infertility-treatment-in-delhi-male-infertility-specialist/
http://drvijayantgovinda.com/male-infertility-treatment-in-delhi-male-infertility-specialist/azoospermia-treatment-in-delhi-nil-sperm-count/
lecture delivered by Dr Sujoy Dasgupta in a Webinar organized by the Infertility Committee of FOGSI (Federation of Obstetric and Gynaecological Societies of India) and BOGS (Bengal Obstetric and Gynaecological Societiy), held in February, 2021
ICSI as it is presently performed is far from an ideal solution because the selection of sperm is based on the judgement of an embryologist, who is looking for the most normal appearing sperm available.
Iran march 2011
ABRASCT:
SPERM RETRIEVAL TECHNIQUES FOR THE AZOOSPERMIC MALE
Sandro C. Esteves, MD, PhD
Spermatozoa can be retrieved from either the epididymis or the testis, depending on the type of azoospermia, using different surgical methods such as PESA, MESA, TESA, TESE and micro-TESE.
In obstructive azoospermia (OA), sperm production is normal and gametes can be easily retrieved from the epididymis or the testicle in most cases, irrespective of the technique. PESA or TESA are simple and efficient methods for retrieving epididymal or testicular spermatozoa in men with OA. According to our data on OA, the etiology of the obstruction and the use of fresh or frozen-thawed epididymal/testicular sperm do not seem to affect ICSI outcomes in terms of fertilization, pregnancy, or miscarriage rates.
In cases of nonobstructive azoospermia (NOA), the efficiency of TESA for retrieving spermatozoa is lower than TESE, except in the favorable cases of men with previous successful TESA or testicular histopathology showing hypospermatogenesis. The use of microsurgery during TESE may improve the efficacy of sperm extraction with significantly less tissue removed, which ultimately facilitates sperm processing. Testicular histology results, if available, may be useful to predict the chances to retrieve sperm in men with NOA. Our data demonstrate that micro-TESE performs better than conventional TESE or TESA in cases of maturation arrest and Sertoli cell-only histological patterns, where tubules containing active focus of spermatogenesis can be positively identified using microsurgery. Testicular spermatozoa can be obtained even in the worst case scenario except in the cases of Y chromosome infertility with complete AZFa and/or AZFbmicrodeletions.
In both OA and NOA, sperm retrieval technique itself seems to have no impact on ICSI success rates. The main goal of PESA/TESA/TESE sperm processing is the recovery of a clean sample containing motile sperm. Such specimens are more fragile, and often compromised in motility, as compared to the ones obtained from ejaculates. Laboratory techniques should be carried out with great caution not to jeopardize the sperm fertilizing potential. Surgically-retrieved spermatozoa can be intentionally cryopreserved for future use. Spare left-over specimens that would be discharged after ICSI can also be cryostored. Different strategies can be developed according to each group’s results. If freezing of surgically-retrieved specimens provides results similar to those with the use of fresh sperm, then the use of freezing specimens would be preferable. If not, fresh specimens are preferable.
The reproductive potential of infertile men undergoing ART is related to the type of azoospermia. According to our data, the chances of retrieving spermatozoa (odds ratio [OR] = 43.0; 95% confidence interval [CI]: 10.3-179.5) and of achieving a live birth by ICSI (OR=1.86; 95% CI:l 1.03-2.89) were significantly increased in couples whose male partner had obstructive rather than non-obstructive azoospermia. Children conceived using sperm retrieved from men with OA and NOA should be followed-up because it is still unclear if there is an increased risk of birth defects when ICSI is carried out with non-ejaculated sperm.
References
Esteves SC, Glina S. Recovery of spermatogenesis after microsurgical subinguinal varicocele repair in azoospermic men based on testicular histology. IntBraz J Urol. 2005; 31:541-8.
Verza S Jr, Esteves SC. Sperm defect severity rather than sperm source is associated with lower fertilization rates after intracytoplasmic sperm injection. IntBraz J Urol. 2008,34:49-56.
Esteves SC, Verza S, Prudencio C, Seol B. Sperm retrieval rates (SRR) in nonobstructive azoospermia (NOA) are related to testicular histopathology results but not to the etiology of azoospermia. FertilSteril. 2010; 94(Suppl.):S132.
Esteves SC, Verza S, Prudencio C, Seol B. Success of percutaneous sperm retrieval and i
In this presentation we talk about the current management of male infertility in Delhi India.
Dr Vijayant Gupta is male infertility expert in new Delhi India
We talk about
1. Non obstructive azoospermia
2. Obstructive azoospermia
3. Oligospermia
http://drvijayantgovinda.com/male-infertility-treatment-in-delhi-male-infertility-specialist/
http://drvijayantgovinda.com/male-infertility-treatment-in-delhi-male-infertility-specialist/azoospermia-treatment-in-delhi-nil-sperm-count/
The 2nd Gulf Andrology Conference
Riyadh Military Hospital, Ministry of Defense
Riyadh, Saudi Arabia, March 3-4, 2012
Lectures: Current and Future Treatments for Azoospermia
Male factor,Healthy Diet & normalization weight,WEIGHT LOSS IS MAGIC,Life car...Lifecare Centre
India performs approx. 1 Lac cycles of I.V.F. per year,Earlier 1 in 10 couples (10%) had infertility now it has increased to 15%
AZOOSPERMIA
pre IVF evaluation for male
Néma tanúk vallomása a rák történetéről
Molnár Erika - Szegedi Egyetem, Embertani Tanszék
A rákos megbetegedések napjainkban világszerte a vezető haláloki tényezők közt szerepelnek, de máig vitatott, hogy kizárólag a modern kor emberét sújtó vagy a megelőző történeti korokban is pusztító kórról van-e szó.
Erre a kérdésre keressük a választ a régészet, a paleopatológia és a modern orvostudomány vizsgálati eszközeinek segítségével. A régészek által feltárt csontvázleleteken megfigyelhető kóros elváltozások néma tanúkként vallanak a rosszindulatú daganatok jelenlétéről az egykor élt emberek körében.
Budapest Science Meetup, 2014. szeptember 11.
Mic Micro-dissection Testicular Sperm Extraction
(Micro-TESE)
Dr. Vishal Dutt Gour,
MBBS, MS, MCh (Urology)
Director, SCI International Hospital
M-4,GK-1,New Delhi-48
Learning Objectives
Understand the difference between obstructive (OA)
and non-obstructive azoospermia (NOA)
Overview of sperm retrieval techniques for NOA (micro
-TESE) and how to handle testicular sperm for ICSI
Learn the success rates and prognostic factors of sperm
retrieval in NOA using micro-TESE
Reproductive potential of Azoospermic men undergoing
assisted conception
Azoospermia
•It is not a synonymous of sterility
Obstructive
•Normal sperm production
Mechanical blockage
Vasectomy, Post-infectious, Congenital
Non-obstructive
Sperm production deficient or absent
Cryptorchidism, Orchitis, Radiation, Chemotherapy, Trauma, Genetic,
Gonadotoxins, Idiopathic
INTRODUCTION
•Microsurgical Testicular Sperm Extraction or “Micro-
TESE” has been developed to detect sperm in the
testicles of men who have poor sperm production.
•Because the testicular tubules are microscopic
structures, they cannot be distinguished by the naked
eye.
•There is a higher chance that he will find sperm in
“fuller,” more normal tubules than in scarred or fibrotic
tubules.
Microscope- why a good one is required
Approach
•Always plan to follow gradual stepwise approach to retrieve
sperm
•Percutaneous Semineferous Biopsy 3 to 4 sites using 18/20 G
Scalp Vein
•Deliver the testis and do a mapping to check
•Proceed with Micro TESA
•Micro-TESE can be performed as a diagnostic procedure
and if usable sperm are found, then they can be frozen
and the couple is recommended to proceed with ICSI.
•It can also be performed and timed with an egg
retrieval/IVF cycle so that the sperm are injected into the
eggs without freezing.
•Freezing the sperm from men with sperm production
problems can be difficult since these sperm are usually
few in number and don’t thaw well.
•Therefore the best chance of pregnancy is to use fresh sperm
obtained just prior to IVF.
•The chance of finding sperm with Micro-TESE is better than
60%. This is twice the chances of finding sperm by non-
microsurgical or needle biopsies taken by general urologists.
Micro-TESE is a great advance in male reproductive surgery, but
is only performed by a small number of male reproductive
surgeons.
Depending on the time of year, grocery store, and your personal preference, it may actually save you time and money to choose some frozen foods over fresh.
Sperm Retreival: Optimizing Sperm Retrieval and Pregnancy in Nonobstructive A...The Turek Clinics
Dr. Paul Turek’s Society for the Study of Male Reproduction (SSMR) presentation at the American Urology Association (AUA) annual conference in Orlando, FL on Tuesday, May 20, 2014.
Azoospermia is an challenging subject either on the diagnostic side or on the therapeutic issues. Types of testicular biopsy must be employed in selected patients as regard their background diagnosis e.g. obstructive, Klinefelter's,... etc.
Clinical management of men with nonobstructive azoospermia - Sperm Retrieval ...Sandro Esteves
Reproductive Andrology Workshop III
17-21 January 2016 - Kuwait City - KUWAIT
Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health
Lecture 4: Sperm Retrieval Methods in Nonobstructive Azoospermia
Novel concepts in male factor infertility: clinical and laboratory perspectivesSandro Esteves
Presentation Objectives:
1. Update on the WHO reference values for semen parameters, and understand the role of sperm DNA fragmentation testing to decision-making strategies;
2. Learn how to counsel azoospermic men seeking fertility, and the role of gonadotropin therapy in this infertility condition;
3. Understand the benefits of microsurgery to both sperm retrieval and varicocele treatment;
4. Appraise the role of medical and surgical interventions to infertile men undergoing ART.
Role of sperm index in embryo quality what to do - 17th iranian congressSandro Esteves
17th International Congress of the Iranian Association for Fertility and Reproductive Medicine
Tehran– March 2011
Abstract
ROLE OF SPERM INDEXES IN EMBRYO QUALITY: WHAT TO DO?
Sandro C. Esteves, MD, PhD
Spermatozoa are highly specializedcells with the purpose of not onlydelivering competent paternal DNA to the oocyte but also to provide a robust epigenetic contribution to embryogenesis. The identification of sperm fertility markers and the ability to selecthealthy spermatozoa for ART have a dual objective of choosing the best treatment strategy and optimizing ART outcomes. Currently, sperm indexes determination in the clinical setting is generally based on cell morphology and DNA content. Both sperm morphology and DNA integrity results, obtained from raw semen samples, have been shown to be of prognostic value for unassisted and assisted conception and useful in the selection of the best assisted conception modality.
These assays, however,provide an assessment of the distribution of cells in a given ejaculatethat may not be representative of the sperm population used in the ART treatment cycle. In fact, severe teratozoospermia,using Kruger’s strict criteria on pre-ART semen analysis, does notcorrelate to fertilization and embryo formation (including blastocyst development) in ICSI cycles. Nonetheless, if a more holistic approach to sperm morphology is taken, two prognostic groups can still be identified in cases of severeteratozoospermia (<4% normal) because certain morphology patterns and sperm abnormalities are known to affect ICSI outcomes. The first group includes mostly genetically determined sperm pattern defects, such asglobozoospermia, short tail syndrome and small-headed spermatozoa (in most cases combined with very small acrosomes). All of these types represent untreatable conditions that have been associated with abnormal sperm function andpoor ART outcomes. The second group includes unspecifiedor non-genetically determined sperm defects or patternscaused by environmental factors, medication, infection and related infertility conditions, including varicocele. Treatment of these conditions has been shown to optimize sperm morphology indexes with a positive impact on ART outcomes. Although the technician microscopically selects morphologically normal individual sperm during ICSI, form normalcy does not necessarily imply normal DNA content. As such, sperm DNA testing has been advocated to be an independent and reliable marker of fertility potential since sperm chromatin andDNA integrity is essential to ensure that the fertilizing sperm cansupport normal embryonic development of the zygote.At present, conflicting reports exist on the role of sperm DNA fragmentation index for embryo development, and it is apparent that DNA fragmentation does not significantly impair zygote and cleaving embryo morphology because major activation of the embryonic genome only beginafter the 4-cell stage. These observations do no underscore the importance of finding ways to increase sperm DNA integrity, since it has been suggested that DNA fragmentation is associated with late paternal effects that may lead to early miscarriages or diseases in the offspring. The etiology of sperm DNA damage is multi-factorial and may be due to primary (ageing, cryptorchidism, genetic defects, idiopathic) and or secondary (drugs, environmental, tobacco smoking, genital tract inflammation, infection,testicular hyperthermia and varicoceles) factors. Specific or non-specific treatments, including antioxidant supplements, are generally associated with reduced levels of sperm DNA damage and/or improved fertility potential.
Taken in conjunction, it is apparent that there is no unique sperm factor able to predict embryo development, but several candidate biomarkers are involved in this complex process.As a result, a wide variety of techniques have been proposed, including externalization of phosphotidylserine (magnetic-activated cell sorting),cell
Clinical management of men with nonobstructive azoospermia - Chances of Harve...Sandro Esteves
Reproductive Andrology Workshop III
17-21 January 2016 - Kuwait City - KUWAIT
Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health
Lecture 2: Chances of Harvesting Sperm in Nonobstructive Azoospermia
Air quality: is it that important? And if so, how to measure and control it?Sandro Esteves
Quality and Risk Management in the IVF Laboratory; Redlara Brasil, Belo Horizonte, 14-15 September 2016
Content:
1.Air quality: is it that important?
2. How to control?
3. How to measure?
Public lecture - Stem Cell and Male InfertilitySandro Esteves
Reproductive Andrology Workshop III
17-21 January 2016 - Kuwait City - KUWAIT
Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health
Public Lecture - Stem Cell and Male Infertility
Clinical management of men with nonobstructive azoospermia - Role of IVF Labo...Sandro Esteves
Reproductive Andrology Workshop III
17-21 January 2016 - Kuwait City - KUWAIT
Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health
Lecture 5: Role of IVF Laboratory in Nonobstructive Azoospermia
Clinical management of men with nonobstructive azoospermia - Steps Before Spe...Sandro Esteves
Reproductive Andrology Workshop III
17-21 January 2016 - Kuwait City - KUWAIT
Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health
Lecture 3: Steps Before Sperm Retrieval in Nonobstructive Azoospermia
Clinical management of men with nonobstructive azoospermia - Azoospermia Diff...Sandro Esteves
Reproductive Andrology Workshop III
17-21 January 2016 - Kuwait City - KUWAIT
Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health
Lecture 1: Azoospermia Differential Diagnosis
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
Micro-TESE as the latest option for the worst azoospermia scenarios
1. Sandro Esteves, MD, PhD
Director, ANDROFERT
Center for Male Reproduction
Campinas, BRAZIL
2. Learning Objectives
Learn the definitions and difference between
obstructive (OA) and non-obstructive
azoospermia (NOA)
Overview of conventional sperm retrieval
techniques and results for azoospermic men
Understand the rationale of using micro-TESE
for the worst azoospermia scenarios
Micro-TESE: technique and results
Esteves, 2
3.
4. Azoospermia: Definitions
• Complete absence of spermatozoa
Azoospermia in the ejaculate after centrifugation
• 1-3% male population
Prevalence • 10% infertile males
• Obstructive
Types • Nonobstructive
Esteves, Miyaoka & Agarwal.
An update on the initial assessment of the infertile male. CLINICS 2011; 66:1-10.
5. Obstructive Azoospermia
Features Sperm Retrieval
Normal Sperm
Production Simple and Effective
Mechanical Blockage
Main Causes: Sites:
● Epididymis
● Vasectomy, Post-infectious
● Testis
● Congenital (CBAVD)
● Vas deferens
● Iatrogenic, Trauma
Esteves, 5
7. 100% 100% 97.9%
95.3%
CBAVD (N=30) Vasectomy Post-infectious Total (N=142)
(N=64) (N=48)
Esteves SC, Verza S, Prudencio C, Seol B. Success of percutaneous sperm retrieval
and intracytoplasmic sperm injection (ICSI) in obstructive azoospermic (OA) men
according to the cause of obstruction. Fertil Steril. 2010;94 (Suppl):S233.
8. Intracytoplasmic Sperm Injection Outcomes Using
Ejaculated vs. Surgically-retrieved Sperm from em
with Obstructive Azoospermia
Ejaculate Epididymis/Testicle
70 73
P >0.05
48 46 51
43
20
12
Fertilization rate %TQE Pregnancy (%) Miscarriage (%)
(%)
Verza Jr S & Esteves SC. Sperm defect severity rather than sperm source is associated
with lower fertilization rates after intracytoplasmic sperm injection.
Int Braz J Urol 2008; 34:49-56.
10. Non-obstructive
Untreatable Azoospermia
condition
Small testes/elevated FSH/”sterile”
Absent or poor production for sperm
in ejaculate
Heterogeneity of sperm production:
600-800 seminiferous tubules/testis;
Single focus of production adequate to
retrieve spermatozoa for ICSI
Goal: To identify and retrieve sperm
for ICSI
Geographic location unpredictable
Esteves, 10
11. Can We Predict Sperm Retrieval
Success in NOA?
Important because:
1. Can minimize emotional and financial cost of IVF
cycles.
2. Can minimize trauma/damage to testis during sperm
harvesting.
Esteves, 11
12. Predictive Value of Noninvasive Tests
for Sperm Retrieval in NOA
FSH Testosterone
Testicular Volume
Verza Jr. & Esteves. Fertil Steril 2011; 96: S53
Esteves, 12
13. Predictive Value of Invasive Tests for
Sperm Retrieval in NOA
Testicular Histopathology
Esteves, 13
14. Predictive Value of Histopathology
Results in Sperm Retrieval for men
with NOA
Sensitivity Specificity Accuracy
(95% CI) (95% CI) (%)
HYPO 93 (66-100) 70 (54-82)
81.9
MA 64 (31-89) 59 (44-73)
SCO 20 (08-37) 20 (07-41)
Verza Jr. & Esteves. Fertil Steril 2011; 96: S53
Esteves, 14
16. Conventional Sperm Retrieval
Techniques in NOA
Controlled studies Needle Open Biopsy
for NOA men Aspiration
Friedler et al., 4/37 (11%) 16/37 (43%)
Human Reprod 12:1488, 1997
Ezeh et al. 5/35 (14%) 22/35 (63%)
Human Reprod 13:3075, 1998
Esteves, 16
17. Conventional TESE (open biopsy) in NOA
Number of patients 25
20
15
10
5
0
1 2 3 4 7 8 9 10 14
Number of testicular fragments excised
Ostad et al., Urology 52:692, 1998.
Esteves, 17
18. Testicular Microdissection
Micro-TESE
• Method to identify site(s) of
production
– Based on the diameter of
seminiferous tubules
• Microsurgical approach
– Identify site of production
– Preserve vasculature of testis
– Small quantity of tissue excised
Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with
minimal tissue excision. Hum Reprod. 1999;14:131-135.
23. Micro-TESE vs TESE
Success Rates in Controlled Series
Schlegel 1999
Amer et al. 2000
Okada et al. 2002
Okubu et al. 2002 53%
41%
Tsujimura et al. 2002
Ramon et al. 2003 TESE Micro-TESE
Esteves et al. 2011
OR = 1.63 (95% CI: 1.32 – 2.01)
24. Microsurgical versus conventional single-biopsy testicular sperm
extraction in nonobstructive azoospermia: a prospective
controlled study
Verza Jr S, Esteves SC. Fertil Steril 2011; 96 (3): S53
TESE Micro-TESE
Esteves, 24
25. Microsurgical vs Single-Biopsy TESE
in Nonobstructive Azoospermia
Controlled series of 60 patients
Sperm Retrieval Success Rates
Micro-TESE single-biopsy TESE
93%
Method Histology categories
P=0.0005 64% 64% pairwise
comparisons
45%
P<0.0001
25%
20%
9% 6%
Overall Hypospermatogenesis Maturation Arrest Sertoli-cell Only
Microsurgical versus conventional single-biopsy testicular sperm extraction in
nonobstructive azoospermia: a prospective controlled study
Esteves, 25 Verza Jr S, Esteves SC. Fertil Steril 2011; 96 (3): S53
26. Microsurgical vs Single-Biopsy TESE
in Nonobstructive Azoospermia
Sperm retrieval method and Odds Ratio Relative Risk
histopathology category [95% Confidence [95%
Interval] Confidence
Interval]
Micro-TESE vs. TESE 3.97 [1.86-8.49] 1.64 [1.18-2.28]
HYPO vs. MA 5.15 [1.16-22.97] 1.61 [0.97-2.68]
HYPO vs. SCO 29.75 [6.96-127.27] 5.25 [2.53-10.91]
MA vs. SCO 5.77 [1.41-23.62] 3.26 [1.38-7.68]
Microsurgical versus conventional single-biopsy testicular sperm extraction in
nonobstructive azoospermia: a prospective controlled study
Verza Jr S, Esteves SC. Fertil Steril 2011; 96 (3): S53
Esteves, 26
39. Objective Identification of
Sperm-producing Tubules
1. Minimize trauma/damage to the testis:
minimal tissue excision.
2. Decrease operative time.
3. Facilitate laboratory tissue processing
and sperm search.
4. Improve success.
Esteves, 39
40. Conclusions
Nonobstructive azoospermia:
Most severe form of male infertility
Not synonymous of sterility
Current testing not predictive of successful SR.
Heterogenic pattern of sperm production in NOA:
Geographic location unpredictable
Microsurgical-guided Testicular Sperm Extraction:
Significantly higher SRR and chance of fatherhod
for men with NOA
Esteves, 40