Male infertility practice among Filipino urologists: A road less traveled

INTRODUCTION@#Advancement in male infertility were evident during the past several decades where ashift to evidence-based management is becoming apparent. However, there is still a knowledge gapamong training urologists in the said field where the Philippines is no exception. This is the first studythat would determine the current trend of practice in male infertility among Filipino urologists andrecommend solutions to this problem.@*MATERIALS AND METHODS@#A 42-item self-administered survey questionnaire was carried out using theSurvey Monkey. This Institutional Review Board (IRB)-approved online survey consisted of 3 parts:demographics, adherenceto the guidelines andclinical practice.The authors contacted thePhilippineUrological Association (PUA) via email and requested for confidential distribution of an online survey.The participants were given 4 weeks from the date of initial mailing until end of the survey process.STATA 15.0 was used for data analysis.@*RESULTS@#A total of 131 respondents participated in the survey. Only 13% responded that they are “veryinterested” in the specialty of male infertility. About 84% of respondents see less than 5 male infertilitycases per month with 67% of them reporting that male infertility constitutes less than 10% of theirpractice. For the treatment, 36% of them prescribe testosterone for empiric medical therapy of maleinfertility which is contraindicated in the treatment of male infertility and only 5% of respondents offerthe gold standard microsurgical varicocoelectomy in patients with varicocoele. Only 8% of respondentsare affiliated with IVF centers, which is troubling with regards to how men with poor reproductivepotential are treated especially in azoospermic men. Two percent of the respondents rated their exposureto male infertility during residency as “excellent” while only 3% of them rated their knowledge asexcellent. With this, responders suggest more exposure to the specialty, more postgraduate courses,lectures, and webinars, more training opportunities, a local guideline for Filipino urologists to follow,and more exposure to professional networks.@*CONCLUSION@#Practice of male infertility in the Philippines is inadequate in terms of knowledge andtreatment for these patients. Most respondents follow the male infertility guidelines available, but itdoes not translate into practice, highlighting their own preferences in diagnosis and treatment. Eventhough they consider it as a necessary part of Urology, lack of exposure to cases, surgical loads, andresearch makes it a challenge when faced with these cases in their clinics. A change in the residency,postgraduate, and national level are recommended to have the best clinical outcome and well-beingfor these patients.

Facial protection in the era of COVID-19: A narrative review.

We live in extraordinary times, where COVID-19 pandemic has brought the whole world to a screeching halt. Tensions and contradictions that surround the pandemic ridden world include the availability, and the lack thereof, various facial protection measures to mitigate the viral spread. Here, we comprehensively explore the different types of facial protection measures, including masks, needed both for the public and the healthcare workers (HCW). We discuss the anatomy, the critical issues of disinfection and reusability of masks, the alternative equipment available for the protection of the facial region from airborne diseases, such as face shields and powered air-purifying respirators (PAPR), and the skin health impact of prolonged wearing of facial protection by HCW. Clearly, facial protection, either in the form of masks or alternates, appears to have mitigated the pandemic as seen from the minimal COVID-19 spread in countries where public mask wearing is strictly enforced. On the contrary, the healthcare systems, that appear to have been unprepared for emergencies of this nature, should be appropriately geared to handle the imbalance of supply and demand of personal protective equipment including face masks. These are two crucial lessons we can learn from this tragic experience.

Voluntary Control of Task Selection Does Not Eliminate the Impact of Selection History on Attention.

The human visual system can only process a fraction of the information present in a typical visual scene, and selection is historically framed as the outcome of bottom-up and top-down control processes. In this study, we evaluated how a third factor, an individual's selection history, interacts with top-down control mechanisms during visual search. Participants in our task were assigned to one of two groups in which they developed a history of either shape or color selection in one task, while searching for a shape singleton in a second task. A voluntary task selection procedure allowed participants to choose which task they would perform on each trial, thereby maximizing their top-down preparation. We recorded EEG throughout and extracted lateralized ERP components that index target selection (NT) and distractor suppression (PD). Our results showed that selection history continued to guide attention during visual search, even when top-down control mechanisms were maximized with voluntary task selection. For participants with a history of color selection, the NT component elicited by a shape target was attenuated when accompanied by a color distractor, and the distractor itself elicited a larger PD component. In addition, task-switching results revealed that participants in the color group had larger, asymmetric switch costs implying increased competition between task sets. Our results support the notion that selection history is a significant factor in attention guidance, orienting the visual system reflexively to objects that contradict an individual's current goals-even when these goals are intrinsically selected and prepared ahead of time.

The brain-derived neurotrophic factor Val66Met genotype does not influence the grey or white matter structures underlying recognition memory.

A single nucleotide polymorphism (SNP) in the gene coding for brain-derived neurotrophic factor (BDNF) has previously been associated with a reduction in recognition memory performance. While previous findings have highlighted that this SNP contributes to recognition memory, little is known about its influence on subprocesses of recognition, familiarity and recollection. Previous research has reported reduced hippocampal volume and decreased fractional anisotropy in carriers of the Met allele across a range of white matter tracts, including those networks that may support recognition memory. Here, in a sample of 61 healthy young adults, we used a source memory task to measure accuracy on each recognition subprocess, in order to determine whether the Val66Met SNP (rs6265) influences these equally. Additionally, we compared grey matter volume between these groups for structures that underpin familiarity and recollection separately. Finally, we used probabilistic tractography to reconstruct tracts that subserve each of these two recognition systems. Behaviourally, we found group differences on the familiarity measure, but not on recollection. However, we did not find any group difference on grey- or white-matter structures. Together, these results suggest a functional influence of the Val66Met SNP that is independent of coarse structural changes, and nuance previous research highlighting the relationship between BDNF, brain structure, and behaviour.

Soy isoflavones and exercise to improve physical capacity in postmenopausal women.

AIM: In postmenopause, ovarian decline along with sedentary lifestyle could contribute to the loss of lean body mass (LBM) and muscle strength. This study aimed to verify whether exercise and isoflavones could have additive effects on muscle quality, muscle mass index, relative strength and physical capacity in overweight sedentary postmenopausal women. METHOD: We recruited 70 overweight-to-obese (body mass index 32.2±4.8 kg/m(2)) postmenopausal women (59±5 years old) to participate in a 6-month clinical study combining isoflavones (70 mg/day) and exercise (resistance and aerobic training) treatments. Subjects were divided into four groups: (1) placebo (n =15), (2) isoflavones (n =15), (3) exercise and placebo (n =20), and (4) exercise and isoflavone (n =20). Principal outcome variables included maximal muscle strength (1RM) at the leg press and the bench press, muscle mass index, muscle quality in the legs and relative strength. RESULTS: After 6 months of training, exercise produced 49% and 23% increases, respectively, in leg press and bench press 1RM (p ≤0.01). Leg relative strength and muscle quality increased by more than 50% (both p <0.01), while muscle mass index increased by 7% (p <0.05) in both exercise groups only. CONCLUSION: Exercise training can improve muscle tissue strength, function and quality in sedentary postmenopausal women. Isoflavones, irrespective of exercise, did not produce changes in these variables. From a clinical perspective, these results suggest that overweight women could reduce the risks of mobility impairments, even in the absence of weight loss, by following a sound exercise intervention that includes both resistance and aerobic training at a high intensity.

Management of ipsilateral pilon and calcaneal fractures: a report of 2 cases.

Although uncommon, the management of ipsilateral pilon and calcaneal fractures is a challenging problem for foot and ankle surgeons. There are several issues that may affect the outcome. Aside from damage to the soft-tissue envelope, technical issues such as positioning of the patient, application of traction, and tourniquet time may complicate surgical intervention. The authors present their experience with 2 patients who sustained this fracture pattern and highlight the mechanism, management, and possible complications of these injuries.

1-Butyryl-glycerol: a novel angiogenesis factor secreted by differentiating adipocytes.

Differentiation of adipocytes is accompanied by secretion of molecules stimulating angiogenesis in vivo and endothelial cell growth and motility in vitro. We demonstrate that the angiogenic and motility-stimulating activities secreted by adipocytes are separable from the endothelial cell mitogenic activity by fractionation of adipocyte-conditioned medium. The major differentiation-dependent angiogenic molecule was purified and identified by GCMS as 1-butyryl-glycerol (monobutyrin). Monobutyrin levels increase at least 200-fold during adipocyte differentiation and represent a major fraction of the total angiogenic activity. Synthetic monobutyrin shows the same spectrum of biological activities as the adipocyte-derived factor: stimulation of angiogenesis in vivo and microvascular endothelial cell motility in vitro, with no effect on endothelial cell proliferation. Angiogenesis is stimulated at doses as low as 20 pg when tested in the chick chorioallantoic membrane assay. These results strongly suggest that monobutyrin is a key regulatory molecule in an angiogenic process linked to normal cellular and tissue development.

A muscle-derived substrate-bound factor that promotes neurite outgrowth from neurons of the central and peripheral nervous systems.

The development and survival of spinal motor neurons depends upon muscle-derived trophic factors. Some circumstantial evidence suggested to us that the regulatory subunit of cyclic adenosine 3':5'-monophosphate-dependent protein kinase (cAMP-dPK)-type II might be involved in neuritic outgrowth from spinal neurons. In the present study, we tested a commercial preparation of cAMP-dPK for neurite-promoting activity. Commercial cAMP-dPK-type II from skeletal and cardiac muscles elicited a significant neurite outgrowth from cultured embryonic chicken neurons when the enzyme preparation was bound to polylysine-coated substrata; type I cAMP-dPK from skeletal muscle was ineffective. Neither cAMP-dPK-type I nor -type II had a significant effect on the survival of spinal neurons in culture. Type II cAMP-dPK also stimulated neurite outgrowth from chicken cerebral hemisphere neurons, dorsal root ganglionic neurons, ciliary ganglionic neurons, and rat sympathetic ganglionic neurons in culture. The neurite-promoting activity appears to reside in a contaminant of the preparation since neither the purified regulatory nor catalytic subunits of cAMP-dPK-type II had an effect on neurite outgrowth per se from cultured neurons and since neurite-promoting activity did not correlate with [3H]cAMP binding or cAMP-dependent kinase activity. The neurite-promoting protein was then partially purified from commercial cAMP-dPK-type II by gel filtration on Sephadex G-200 followed by ion-exchange chromatography on DE-52 cellulose. Sodium dodecyl sulfate gel electrophoresis of the active protein peak revealed a major protein band (MW 50 kDa) and several minor bands (e.g., MW 200 kDa, 52 kDa, 45 kDa). Also, immunoblot analysis and immunoprecipitation revealed that the partially purified neurite-promoting protein was distinct from laminin, heparan sulfate proteoglycan, nerve growth factor, neural cell adhesion molecule, and fibronectin. Furthermore, the neurite-promoting activity was not diminished by treatment with heparinase nor was it bound to heparin conjugated to Sepharose. Our results demonstrate that a protein unrelated to laminin or its associated macromolecules and which copurifies with the type II cAMP-dPK of striated muscle stimulates neurite outgrowth from neurons of the central and peripheral nervous systems.

Localization of transferrin within the developing vertebrate nervous system.

Transferrin is one of several serum proteins localized within neurons during development of the nervous system. The expression of transferrin receptors appears to precede the active accumulation of transferrin by neurons. The first cells immunoreactive for transferrin appear adjacent to the ventricles or to the central canal of the spinal cord. These cells then appear to migrate from this site. These neurons become progressively more immunoreactive for transferrin, attain a peak of reactivity and then lose their reaction to antitransferrin antibodies. Thus, a "window" of transferrin immunoreactivity is found. As neurons lose their reactivity to antitransferrin antibodies, glia and the walls of capillaries become positive. In the rat nervous system, the gradual decrease in intraneuronal transferrin is accompanied by an increase in mitochondrial malate dehydrogenase, an enzyme of the tricarboxylic acid cycle. Thus, the accumulation of transferrin appears to closely precede the ontogeny of oxidative metabolism in the brain. As transferrin appears transiently in all neurons, this protein may be involved in a number of other important developmental events such as the expression of dopamine D2 receptors and the period of "programmed" cell death in the spinal cord.

Immunocytochemical localization of transferrin and mitochondrial malate dehydrogenase in the developing nervous system of the rat.

Transferrin accumulates within neurons of the developing nervous system of humans, sheep, pigs and chickens. To assess the relationship of this accumulation with the ontogeny of oxidative metabolism, we studied the immunocytochemical localization of transferrin (Tf) and the mitochondrial form of malate dehydrogenase (mMDH) in developing neural tissues by the peroxidase-antiperoxidase method. Rabbit anti-rat Tf was obtained commercially and gave a single band of reaction product (MW = 80 kd) on Western blots. Antibodies to porcine heart mMDH were elicited in a rabbit. Western blot analysis showed that this anti-porcine mMDH antibody reacted with the mMDH from porcine, rat or avian tissue but not with the cytosolic MDH from pigs. Tf was first detected in rat brain neurons at about the 18th embryonic day and reached a peak at about the 6th postnatal day. All neurons were immunoreactive with large neurons throughout the brain showing a strong reaction for Tf. From this time onward, the level in brain neurons gradually decreased until adulthood. However, Tf immunoreactivity still remained strongly evident in capillary endothelial cells. The localization of Tf within rat spinal cord neurons peaked as early as the 1st postnatal day and remained elevated to the 6th postnatal day. By contrast, reactivity for Tf within dorsal root ganglia neurons was intense as early as the 18th embryonic day and diminished only gradually. Mitochondrial MDH, a marker for oxidative metabolism, appeared to reach a peak after the crest of intraneuronal Tf had been observed. For example, brain and spinal cord MDH immunoreactivity increased with intense staining in the cell bodies and fibers of neurons from the 6th to the 13th postnatal day; immunoreactivity gradually diminished into adulthood. The gradient of reactivity was low in some areas of the brain but more intense in areas containing large neuronal cell bodies such as the red nucleus. This occurred after the peak of intraneuronal Tf at day 6 and suggested a precursor-product relationship. By contrast, immunoreactivity for neuron-specific enolase, a glycolytic enzyme, showed a developmental pattern that differed from either Tf or MDH in that reactivity appeared later in development and was less intense. These data suggest that as cerebral metabolic rates begin to increase as early as 5-6 days after birth in the rat, an increase in mMDH occurs coincident with the onset of oxidative metabolism. Furthermore, this rise in intraneuronal mMDH follows the peak of intraneuronal Tf and suggests that Tf supplies the iron required for the synthesis of other mitochondrial ferroproteins.