The document summarizes various techniques for retrieving sperm from men with azoospermia for use in IVF-ICSI procedures. It discusses the differences between obstructive and non-obstructive azoospermia and various sperm retrieval methods such as MESA, TESE, and microdissection TESE. It also covers evidence for techniques like FNA mapping followed by directed TESE to potentially improve sperm retrieval rates in men with non-obstructive azoospermia.
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.
Fertility Restoration after Cancer: Current and Future Therapies By Paul J. ...The Turek Clinics
Urologist and male fertility doctor for vasectomy and vasectomy reversal, sperm retrieval, testicular mapping, varicocele repair and ejaculatory duct repair, Dr. Paul Turek, speaks about Fertility Restoration after Cancer: Current and Future Therapies. Dr. Turek is director of The Turek Clinic. Located in San Francisco, California, The Turek Clinic provides world-class patient care with an essential holistic approach. (WARNING: Images in slides not appropriate for all audiences due to subject matter.)
American Urological Association (AUA) Lecture given at the American Society of Andrology (ASA) 40th annual conference, April 18 – 21, 2015 in Salt Lake City, Utah.
There I go again, a Western guy giving a lecture to an Eastern crowd. What team do I play on, you ask? In fact, I am honored to give a keynote at the First Integrative Fertility Symposium in Vancouver. Ok, call me a “swingman,” but the Easterners have a lot up their medical sleeves too. Ask Western medicine how to help a guy relax, and they’ll say, “don’t work so hard and take this pill.” Ask an Easterner, and they might suggest acupuncture, mindfulness and meditation. Which approach is better: a patch or a fix? You decide. Read more on my blog at > http://bit.ly/1EMuRFF
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.
Fertility Restoration after Cancer: Current and Future Therapies By Paul J. ...The Turek Clinics
Urologist and male fertility doctor for vasectomy and vasectomy reversal, sperm retrieval, testicular mapping, varicocele repair and ejaculatory duct repair, Dr. Paul Turek, speaks about Fertility Restoration after Cancer: Current and Future Therapies. Dr. Turek is director of The Turek Clinic. Located in San Francisco, California, The Turek Clinic provides world-class patient care with an essential holistic approach. (WARNING: Images in slides not appropriate for all audiences due to subject matter.)
American Urological Association (AUA) Lecture given at the American Society of Andrology (ASA) 40th annual conference, April 18 – 21, 2015 in Salt Lake City, Utah.
There I go again, a Western guy giving a lecture to an Eastern crowd. What team do I play on, you ask? In fact, I am honored to give a keynote at the First Integrative Fertility Symposium in Vancouver. Ok, call me a “swingman,” but the Easterners have a lot up their medical sleeves too. Ask Western medicine how to help a guy relax, and they’ll say, “don’t work so hard and take this pill.” Ask an Easterner, and they might suggest acupuncture, mindfulness and meditation. Which approach is better: a patch or a fix? You decide. Read more on my blog at > http://bit.ly/1EMuRFF
Reproductive Genetics: Introduction to Genetic Testing Optionskanew396
GenomeSmart can help you navigate the different reproductive genetic testing options to allow you to make informed decisions for the health of yourself and your family.
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
Acquired Disorders of Spermatogenesis By Paul J. Turek MD, Emeritus Professor...The Turek Clinics
Lecture on Acquired Disorders of Spermatogenesis written and presented by Paul J. Turek MD, Emeritus Professor and Endowed Chair in Urology Education, Department of Urology, University of California San Francisco and current Director of the The Turek Clinic, in San Francisco, California.
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
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
Reproductive Genetics: Introduction to Genetic Testing Optionskanew396
GenomeSmart can help you navigate the different reproductive genetic testing options to allow you to make informed decisions for the health of yourself and your family.
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
Acquired Disorders of Spermatogenesis By Paul J. Turek MD, Emeritus Professor...The Turek Clinics
Lecture on Acquired Disorders of Spermatogenesis written and presented by Paul J. Turek MD, Emeritus Professor and Endowed Chair in Urology Education, Department of Urology, University of California San Francisco and current Director of the The Turek Clinic, in San Francisco, California.
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
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
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.
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.
1. Discuss normal vs. abnormal semen analysis
2. Evaluate different treatments of varicocele
3. Assess azoospermia and discuss micro dissection testicular sperm extraction
4. Diagnose Klinefelter syndrome and genetic abnormalities in men with infertility
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.
Dr Sujoy Dasgupta was invited to deliver a lecture on "Male Infertility, Antioxidants and Beyond" on 3 February in Yuvacon 2024 organized by the Bengal Obstetric and Gynaecological Society (BOGS). The session was supported by UNS.
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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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.
Are There Any Natural Remedies To Treat Syphilis.pdf
Obstetric Hemorrhage
1. How to Manage Truly and Virtually Azoospermic Men for IVF-ICSI? Paul J. Turek M.D. Emeritus Professor and Endowed Chair Department of Urology, University of California San Francisco Director, The Turek Clinic, San Francisco, CA
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3. 17. I read in one of the papers that couples can get pregnant with sex. Is that true? A patient, 1998
4. Obstructive Non-obstructive The Problem of Azoospermia 5% of infertile men History Physical Exam Hormones Semen Analysis Repair ICSI ICSI
5. Case #2 There once was a couple who wanted children. Partner is 37 y.o. “ never” pregnant 38 y.o. with no prior paternity. FSH, T normal. Testes: 20mL Testis biopsy: normal Why am I doing this ? I hope he doesn’t find out…..
6. Case 2 35 yo healthy man with 2 years of unprotected sex. Partner 38 years old and no prior pregnancies. His exam reveals atrophic testes bilaterally. Has a grade III left varicocele FSH 20 (1-8 normal); Testosterone 330 (>300) Normal volume azoospermia; Pellet: no sperm. Testis biopsy: Sertoli cell only
7. Infertility M.D. Provider (Male or Female) Genetic Counseling PROGENI Medical Evaluation Y microdeletions Karyotype CFTR/5T Post-Test Counseling Treatment Plan
8. When to do Genetic Testing? Sperm <5 million/mL No sperm/testis failure Idiopathic Obstruction, absent vas deferens Other syndromes Scenario Y Delet. Karyotype Cyst. Fibr X Whatever fits! X X X X Case #1 40% Case #2 30%
10. Azoospermia: The Centrifuged Pellet Jaffe et al. J Urol. 1998; 159: 1548-50 (NS, n=17/group) (600-1000 x g for 15 minutes) TYPE # Pts % Sperm Variability Obstructive 70 18.6% 41% Non obstructive 70 22.8% 12%
11. Intermittent Complete Azo-Asthenospemia: Chance of Sperm at IVF-ICSI (n=15) Zenke et al. ASRM 2003 History Physical exam Semen analysis, pellet FNA Map IVF-ICSI At ICSI: Motile ejaculated sperm? TESA/TESE Yes No
12. Does Sperm Origin Affect ICSI Fertilization Rates? (n=314 ICSI cycles in 264 couples at UCSF) Shen et al, ASRM 2003 High 2PN rates with ICSI are possible regardless of sperm source.
13. Does Motile vs. Nonmotile Sperm Make a Difference? Bachtell et al. Hum Reprod. 1999, 14:101 Biologically, it appears to….. Motility *Viability Fresh Thawed Fresh Thawed Testis, NOA 5% 0.2% 86% 46% Epididymis, OA 22% 7% 57% 24% Vas deferens, fertile 71% 38% 91% 51%
14. Does Motile vs. Nonmotile Sperm Make a Difference? Clinically….. Park YS et al. Fert Steril 2003, 526:30 (n=160 patients with obstruction) FRESH THAWED Motile Nonmotile Motile Nonmotile testis testis testis testis sperm sperm sperm sperm 2PN Fert Rate 77% 29% 70% 51% Pregnancy Rate 44% 20% 34% 27%
15. What About “Delayed Fresh” Sperm Retrieval? Morris et al. J Urol. 2007, 178:2087-91 Time After Sperm Retrieval % Motility Testis sperm motility
29. Cryptorchidism 52-74% Variocele 63% Epididymitis 67% Mumps 67% Torsion >50% Post-chemotherapy 55-75% Genetic AZF a, b 0% Genetic AZF c 75% Idiopathic 50-60% Chance of Finding Sperm by NOA Diagnosis Shefi and Turek, submitted Raman and Schlegel. J Urol.170:1287, 2003 Hopps et al. Hum Reprod. 180:1660, 2003 Damani et al. JCO. 15: 930, 2002
30. Can we predict if sperm are present in NOA? History of ejaculated sperm FSH, inhibin level Testis biopsy histology Testicular size . Tournaye et al. Hum. Reprod. 12: 80, 1997. Seo JT and Ko W-J. Int J. Androl. 24: 306, 2001 Raman and Schlegel. J Urol.170:1287, 2003
31. Testis Biopsy: Results Normal Hypo Maturation Arrest Sertoli cell Only Only inform us of the biopsied area. How about elsewhere?
32. Why is sperm prediction important? 1. Can minimize emotional and financial cost of IVF cycles. 2. Can minimize trauma/damage to testis during sperm harvesting.
33. 0 20% 40% 60% 80% 100% Sensitivity and Sampling Technique in NOA Testes Likelihood of finding sperm 1 biopsy 3 FNA MAP Weiss et al. Harefuah 132: 614, 1997 Kim et al. J. Urol, 157: 144, 1997 30% 36% 50%
34. Approaches to the NOA Patient a) Who has sperm? b) Where is it? 1. Simultaneous diagnostic and therapeutic biopsies with "Up front" cryopreservation of sperm. 2. Realtime Multi-biopsy or deep (Micro) biopsy TESE with/without diagnostic biopsy. 3. Diagnostic Systematic FNA "mapping" of testes with subsequent "directed" TESE. Van Peperstraten A. et al. Cochrane Database Syst Rev 2006; 3:CD002807.
36. How Can We Find Sperm? Microdissection TESE in OR Sperm Found? IVF/ICSI Yes No Donor Sperm Adoption +/- Pregn Microdissection Office FNA Map Sperm Found? Yes No IVF/ICSI "Directed" TESE Donor Sperm Adoption FNA Mapping
37. The Microdissection TESE Concept: Testis seminiferous tubules containing sperm are “thicker” than those that don’t. Schlegel PN. Hum Reprod 14: 131, 1999 Points: Systematic examination of testis lobules under 25x microscopy, general anesthesia
39. The Microdissection TESE Amer M, et al. Hum Reprod 15: 653, 2000 Approach Success (%) Tissue TESE biopsy 30/100 (30%) 54 mg Microdissection 45/100 (45%) 4.6mg Concept: 100 men with “identical” bilateral histology. One side TESE, the other microdissection
40. Microdissection TESE Amer et al 2000 100 45% 30% Okada et al 2002 98 45% 17% Okubu et al 2002 17 48% 24% Tsujimura et al 2002 93 43% 35% Ramon et al 2003 321 62% 58% Study #Pts %MicroTESE %TESE Success Success 49% 33%
41. The Microdissection TESE Concerns: 1) Operating microscope needed 2) General anesthesia 3) Expertise with experience 4) Long term effects (especially if bilateral) 5) A repeatable procedure?
42. Prostate Biopsies 1 2 3 4 5 6 X X X X X X X X X Testis The Idea Testis FNA Mapping
45. 1. Local anesthesia 2. Testis “wrap” 3. Mark out sites (template) 4. Aspirate and smear 5. Apply pressure Percutaneous Fine Needle Aspiration (FNA)
48. FNA Mapping-TESE Turek et al 2000 96 45% 95% (8) Lewin et al 1999 85 59% 59% (15) Hekimgil et al 2002 60 60% 60% (6) Cohen et al 2003 35 49% ----- Study #Pts % Sperm %TESE Success Success 53% Turek et al. J. Urol. 163: 1709, 2000 Hekimgil et al. BJU Inter. 87: 834, 2001 Cohen et al. Fertil Steril. 80: P344, 2003 Lewin et al. Hum Reprod. 14: 1785, 1999
49. FNA Mapping-Directed TESE Concerns: 1) No operating microscope needed 2) Local anesthesia 3) FNA expertise 4) Long term effects 5) A repeatable procedure?
50. What about the toughest (needle-haystack) cases? Replace “Directed” TESE with “Directed Micro-TESE”
52. Testis sperm aspiration (TESA) Testis sperm extraction (TESE) Testis microdissection (MicroTESE) Not all sperm retrieval procedures are the same 20% of NOA men Least Invasive Most invasive
54. Does “Mapping” Help in Redo NOA cases? TESA/TESE Attempts (n=51) (n=12) (n=3) % Patients Successful 90% 91% 100%
55. 1. Where are sperm generally found? 2. Are there any "hot spots" or "sperm rich" areas? 3. Is there any side to side correlation? 4. Are certain histologies more likely to have sperm? What have we learned? Testis FNA Mapping
56. 1 2 3 Sperm Frequency Maps Where are sperm found?
57. How “Patchy” or “Focal” is Sperm Production? Bx-FNA Discrepancy 27% FNA + Bx - Intratestis Variability - + 25% of testes Intertestis Variability - + 19% of testes Turek et al. J. Urol. 163: 1709, 2000
58. The FNA Map: An Archival Tool 1. What germ cells are present in the testis? 2. What other pathology is present? 3. Important for patient phenotyping. Meng MV et al. Hum Reprod. 16: 529, 2001 Nudell DM et al. Hum Reprod. 15, 1289, 2000 Fox M et al. Mol Reprod Dev. In press 4. Can it replace the standard biopsy? Meng et al. Am. J. Surg. Path. 25: 71, 2001
60. NMR Spectroscopy of the Testis Ex Vivo study of Testis Biopsies from Normal and Infertile Men Aronson, Kurhanewicz, Turek
61. MR Spectroscopy: Determining the Metabolic Fingerprint of the Normal and Abnormal Testis A non-invasive way to determine presence and location of spermatogenesis? Aaronson et al, 2007
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63. A tough nut to crack No standard approach exists Be kind to your embryologists Be kind to your patients X X X X X X X X X How to Manage Truly and Virtually Azoospermic Men for IVF-ICSI?