Sperm Concentration Remains Stable Among Fertile American Men: A Systematic Review and Meta-Analysis.

IMPORTANCE: Findings from several high-profile meta-analyses have raised concerns about an ongoing global decline in sperm concentration and male fertility. However, these studies exhibit considerable heterogeneity in key variables including study population, methodology, fertility status, and geographic region. OBJECTIVE: To perform a systematic review and meta-analysis exploring temporal trends in sperm concentration among fertile men and men unselected for fertility status in the United States. DATA SOURCES: A literature search performed in Scopus and PubMed databases for studies published between 1970-2023. Additional studies were included from citations of prior global meta-analyses and reviews evaluating temporal trends in sperm count. Study selection and synthesis: Studies were included if they presented original data on sperm concentration in U.S. men without known infertility from 1970 to 2023. Aggregate data were assessed across all study populations, with additional subgroup analyses stratified by fertility status and U.S. region. MAIN OUTCOMES: Weighted generalized linear models were generated to evaluate the association between mean sperm concentration and sample collection year. RESULTS: A total of 874 articles were screened, with 58 meeting the inclusion criteria. These represented 75 unique study populations totaling 11,787 men in the U.S. Across all study populations, no change in sperm concentration was observed between 1970-2018 in unadjusted models (ß=0.14million/mL/year, p=0.42). When adjusting for U.S. region, no statistically significant decline in sperm concentration was seen. When adjusting for both region and fertility status, a modest annual decline was observed to meet statistical significance (ß=-0.35million/ml/year, p=0.04). Of the 49 study populations reporting adequate data to determine mean total sperm count, there was a significant increase in total sperm count of 2.9 million/year between 1970 and 2018 (p=0.03). Subgroup analysis found no statistically significant change in mean sperm concentration among any U.S. census region or fertility status cohort. CONCLUSION AND RELEVANCE: In contrast to prior global studies, this analysis suggests no clinically significant decline in sperm concentration among confirmed fertile men and the general male U.S. population without known infertility. While these findings provide some reassurance against a widespread rapid decline, further studies are necessary to better understand this important topic.

Do Adolescents Adopt the Prosocial Behaviors of the Classmates They Like? A Social Network Analysis on Prosocial Contagion.

While the influence of high-status peers on maladaptive behaviors is well-documented, socialization processes of prosocial behavior through high-status peers remain understudied. This study examined whether adolescents' prosocial behavior was influenced by the prosocial behavior of the peers they liked and whether this effect was stronger when the peers they liked were also well-liked by their classmates. Three waves of data, six months apart, were collected among Chilean early adolescents who completed peer nominations and ratings at Time 1 (n = 294, Mage = 13.29, SD = 0.62; 55.1% male), Time 2 (n = 282), and Time 3 (n = 275). Longitudinal social network analyses showed that adolescents adopted the prosocial behavior of the classmates they liked - especially if these classmates were well-liked by peers in general. In addition, adolescents low in likeability were more susceptible to this influence than adolescents high in likeability. The influence resulted both in increases and - especially - decreases in prosocial behavior, depending on the level of prosociality of the liked peer. Findings suggest that likeability represents an important aspect of peer status that may be crucial for understanding the significance of peer influence with respect to prosocial behaviors during adolescence. Pre-Registration: https://osf.io/u4pxm .

Early Enteral Nutrition (within 48 h) for Patients with Sepsis or Septic Shock: A Systematic Review and Meta-Analysis.

OBJECTIVE: Medical nutrition therapy provides the opportunity to compensate for muscle wasting and immune response activation during stress and trauma. The objective of this systematic review is to assess the safety and effectiveness of early enteral nutrition (EEN) in adults with sepsis or septic shock. METHODS: The MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, and ICTRP tools were searched from inception until July 2023. Conference proceedings, the reference lists of included studies, and expert content were queried to identify additional publications. Two review authors completed the study selection, data extraction, and risk of bias assessment; disagreements were resolved through discussion. Inclusion criteria were randomized controlled trials (RCTs) and non-randomized studies (NRSs) comparing the administration of EEN with no or delayed enteral nutrition (DEE) in adult populations with sepsis or septic shock. RESULTS: Five RCTs (n = 442 participants) and ten NRSs (n = 3724 participants) were included. Low-certainty evidence from RCTs and NRSs suggests that patients receiving EEN could require fewer days of mechanical ventilation (MD -2.65; 95% CI, -4.44-0.86; and MD -2.94; 95% CI, -3.64--2.23, respectively) and may show lower SOFA scores during follow-up (MD -1.64 points; 95% CI, -2.60--0.68; and MD -1.08 points; 95% CI, -1.90--0.26, respectively), albeit with an increased frequency of diarrhea episodes (OR 2.23, 95% CI 1.115-4.34). Even though the patients with EEN show a lower in-hospital mortality rate both in RCTs (OR 0.69; 95% CI, 0.39-1.23) and NRSs (OR 0.89; 95% CI, 0.69-1.13), this difference does not achieve statistical significance. There were no apparent differences for other outcomes. CONCLUSIONS: Low-quality evidence suggests that EEN may be a safe and effective intervention for the management of critically ill patients with sepsis or septic shock.

Parenchymal obliteration by renal masses: Functional and oncologic implications.

OBJECTIVES: Most renal tumors merely displace nephrons while others can obliterate parenchyma in an invasive manner. Substantial parenchymal volume replacement (PVR) by renal cell carcinoma (RCC) may have oncologic implications; however, studies regarding PVR remain limited. Our objective was to evaluate the oncologic implications associated with PVR using improved methodology including more accurate and objective tools. PATIENTS/METHODS: A total of 1,222 patients with non-metastatic renal tumors managed with partial nephrectomy (PN) or radical nephrectomy (RN) at Cleveland Clinic (2011-2014) with necessary studies were retrospectively evaluated. Parenchymal volume analysis via semiautomated software was used to estimate split renal function and preoperative parenchymal volumes. Using the contralateral kidney as a control, %PVR was defined: (parenchymal volumecontralateral-parenchymal volumeipsilateral) normalized by parenchymal volumecontralateral x100%. PVR was determined preoperatively and not altered by management. Patients were grouped by degree of PVR: minimal (<5%, N = 566), modest (5%-25%, N = 414), and prominent (≥25%, N = 142). Kaplan-Meier was used to evaluate survival outcomes relative to degree of PVR. Multivariable Cox-regression models evaluated predictors of recurrence-free survival (RFS). RESULTS: Of 1,122 patients, 801 (71%) were selected for PN and 321 (29%) for RN. Overall, median tumor size was 3.1 cm and 6.8 cm for PN and RN, respectively, and median follow-up was 8.6 years. Median %PVR was 15% (IQR = 6%-29%) for patients selected for RN and negligible for those selected for PN. %PVR correlated inversely with preoperative ipsilateral GFR (r = -0.49, P < 0.01) and directly with advanced pathologic stage, high tumor grade, clear cell histology, and sarcomatoid features (all P < 0.01). PVR≥25% associated with shortened recurrence-free, cancer-specific, and overall survival (all P < 0.01). Male sex, ≥pT3a, tumor grade 4, positive surgical margins, and PVR≥25% independently associated with reduced RFS (all P < 0.02). CONCLUSIONS: Obliteration of normal parenchyma by RCC substantially impacts preoperative renal function and patient selection. Our data suggests that increased PVR is primarily driven by aggressive tumor characteristics and independently associates with reduced RFS, although further studies will be needed to substantiate our findings.

The role of academic performance, prosocial behaviour and friendships on adolescents' preferred studying partners: A longitudinal social network analysis.

BACKGROUND: Peers constitute an important developmental context for adolescent academic behaviour providing support and resources to either promote or discourage attitudes and behaviours that contribute to school success. When looking for academic help, students may prefer specific partners based on their social goals regarding academic performance. AIMS: Based on the social goals for wanting to achieve academically (e.g., studying to be with friends, increasing/maintaining their own social status), we examine the extent to which adolescents' selection of preferred academic partners (with whom they would like to study) is driven by peers' academic performance, prosocial behaviour and friendships. Moreover, as high-achieving students play an important role in academic settings, whether they are more likely to prefer to study with similar high-achieving peers and friends was examined. SAMPLE: A total of 537 seventh-grade students from 13 classes over three waves. METHODS: Longitudinal social network analyses (RSiena). RESULTS: Adolescents were more likely to select high achievers, friends and prosocial peers as preferred academic partners. Furthermore, high achievers were more likely to choose other high achievers and friends as preferred academic partners. CONCLUSIONS: Adolescents are likely to prefer as study partners someone they can learn from and who is more approachable, cooperative and friendly. Regarding high achievers, they would choose not only academic partners with similar academic interests and motivations to help them boost their academic achievement but also classmates with whom they like to spend time and share personal issues.

Cross-cultural invariance of the Spanish version of the COVID-19 Assessment Scorecard to measure the perception of government actions against COVID-19 in Latin America

Abstract Objectives The present study aimed to evaluate the measurement invariance of a general measure of the perception of governmental responses to COVID--19 (COVID-SCORE-10) in the general population of 13 Latin American countries. Methods A total of 5780 individuals from 13 Latin American and Caribbean countries selected by non-probabilistic snowball sampling participated. A confirmatory factor analysis was performed and the alignment method was used to evaluate invariance. Additionally, a graded response model was used for the assessment of item characteristics. Results The results indicate that there is approximate measurement invariance of the COVID-SCORE-10 among the participating countries. Furthermore, IRT results suggest that the COVID-SCORE-10 measures with good psychometric ability a broad spectrum of the construct assessed, especially around average levels. Comparison of COVID-SCORE-10 scores indicated that participants from Cuba, Uruguay and El Salvador had the most positive perceptions of government actions to address the pandemic. Thus, the underlying construct of perception of government actions was equivalent in all countries. Conclusion The results show the importance of initially establishing the fundamental measurement properties and MI before inferring the cross-cultural universality of the construct to be measured.

Assessing the duration of obstetric analgesia and the time elapsed between analgesia and delivery. Observational trial / Evaluación de la duración de la analgesia obstétrica y del tiempo entre la analgesia y el parto. Estudio observacional

Abstract Introduction: The duration of labor and the immediate puerperium are affected by obstetric and maternal-fetal factors. Interventions to provide obstetric analgesia may prolong the hospital stay. Objective: To characterize the procedure for obstetric analgesia and describe the time elapsed between analgesia and delivery and postpartum surveillance in healthy mothers. Methods: Observational, descriptive trial. The time elapsed between analgesia and delivery, and postpartum surveillance were measured in healthy pregnant women with vaginal delivery and a prescription of a neuraxial analgesia technique. Results: 226 patients were included. The mean time elapsed between analgesia an delivery was 4 hours (IQR 3-7). 50.7 % (n=114) received early analgesia (neuraxial technique with ≤ 4 centimeters of cervical dilatation), of which 48.2 % (n = 109) experienced a duration of analgesia until delivery longer than expected. The mean cervical dilatation at the time of the neuraxial approach was 4 centimeters (IQR 4-6) and the epidural technique was the most frequently used - 92.9 % (n = 210). The mean postpartum surveillance was 20 hours (IQR 15-27). Conclusions: Half of the patients included received early analgesia and around fifty percent of them took longer than expected in completing delivery. The postpartum surveillance time was consistent with the provisions of the Ministry of Health and with the current trend of a short postpartum surveillance aimed at early hospital discharge and the benefits thereof.

Resumen Introducción: La duración del trabajo de parto y del puerperio inmediato se afectan por factores obstétricos y maternofetales. Las intervenciones para brindar analgesia obstétrica pudieran prolongar el tiempo total de estancia hospitalaria. Objetivo: Caracterizar el procedimiento de analgesia obstétrica y describir los tiempos entre analgesia y parto y vigilancia posparto en maternas sanas. Métodos: Estudio descriptivo observacional. Se midieron los tiempos entre analgesia y parto y vigilancia posparto en gestantes sanas, cuya vía final del parto fuera vaginal con indicación y aplicación de alguna técnica de analgesia neuroaxial. Resultados: Se incluyeron 226 pacientes. La mediana del tiempo de analgesia hasta el parto fue de 4 horas (RIC 3-7); el 50,7 % (n = 114) recibió analgesia temprana (técnica neuroaxial a ≤ 4 centímetros de dilatación cervical), de las cuales el 48,2 % (n = 109) tuvo un tiempo de analgesia hasta el parto mayor al esperado. La mediana de dilatación cervical al momento del abordaje del neuroeje fue de 4 centímetros (RIC 4-6) y la técnica epidural fue la más frecuente, 92,9 % (n = 210). La mediana de tiempo de vigilancia posparto fue de 20 horas (RIC 15-27). Conclusiones: La mitad de las pacientes incluidas recibió analgesia temprana y cerca de la mitad tardó más de lo esperado en finalizar su gestación. El tiempo de vigilancia posparto fue acorde con lo establecido por el Ministerio de Salud y con la tendencia actual de una vigilancia posparto corta que apunte a un alta temprana y sus beneficios.

Crisis carcinoide como una causa poco frecuente de choque distributivo / Carcinoid crisis as a rare cause of distributive shock

Los tumores neuroendocrinos son neoplasias que suelen tener un comportamiento clínico maligno, son provenientes de células entero cromafines y/o células productoras de gastrina. Según su origen anatómico, se clasifican en tumores del intestino anterior (comprometen estómago, duodeno, pulmones y páncreas), intestino medio (parte distal del duodeno) e intestino posterior (colon transverso hasta el recto). El síndrome carcinoide, presente en la mitad de los casos al momento del diagnóstico, se caracteriza por desencadenar episodios de diarrea, taquicardia, hipotensión, rubor (por el desarrollo de telangiectasias), y según la gravedad, valvulopatías cardiacas. Por otro lado, la crisis carcinoide, una complicación infrecuente, está relacionada con episodios de choque, que cuando ocurren son consecuencia de la liberación en la circulación sistémica de aminas vasoactivas, posterior a un evento desencadenante. A continuación, se presenta el caso de un paciente masculino con antecedente de un tumor neuroendocrino de intestino delgado, quien luego de ser llevado a embolización de metástasis hepáticas, presentó una crisis carcinoide, y finalmente un choque distributivo refractario a tratamientos convencionales, incluyendo octreotide y vasopresores, que culminó con la muerte del paciente. Se realiza la discusión del caso clínico y la presentación de la literatura disponible, donde se describe la epidemiología, patogénesis, diagnóstico, clínica y tratamiento de esta entidad

Neuroendocrine tumors are neoplasms that usually have a malignant clinical behavior. They arise from enterochromaffin-like and/or gastrin-producing cells. According to their anatomical location they can be classified as foregut tumors (af- fecting stomach, duodenum, lungs and pancreas), midgut tumors (affecting distal portion of the duodenum) and hindgut tumors (affecting transverse colon to rectum). Carcinoid syndrome, occurring in half of the cases at the time of diagnosis, is characterized by episodes of diarrhea, tachycardia, hypotension, flushing (due to telangiectasia), and heart valve disease depending on their severity. On the other hand, the carcinoid crisis, a rare complication that is related to episodes of shock, occur as a consequence of the release of vasoactive amines into the systemic circulation after a triggering event. Here we describe a case of a male patient with a history of neuroendocrine neoplasm, who after embolization of hepatic metastatic lesions presented a carcinoid crisis, ending with a vasodilatory shock, refractory to conventional treatment including octreotide and vasopressors, which resulted in the death of the patient. A discussion of the clinical report and a review of the available literature are presented, including the epidemiology, pathogenesis, diagnosis, clinical manifestations and treatment of this entity

Alteraciones anatómicas del conducto nasopalatino en pacientes dentados y desdentados en el sector anterosuperior utilizando tomografía computarizada de haz cónico / Anatomical alterations of the nasopalatine canal in dentate and edentulous patients at the front superior sector based on cone beam computed tomography

Introducción: el conducto nasopalatino (CNP) es un trayecto intraóseo largo y delgado presente en la línea media anterior del maxilar, conecta el paladar con el piso de la cavidad nasal. El objetivo del estudio fue comparar las medidas del conducto nasopalatino y su forma mediante tomografía de haz cónico en pacientes dentados y pacientes desdentados en el sector anterosuperior. Materiales y métodos: estudio descriptivo y comparativo, se tomaron del archivo del Departamento de Imagenología 150 tomografías de pacientes dentados anterosuperiores y 52 tomografías de pacientes desdentados anterosuperiores. Mediante Excel y su herramienta "aleatoria" se seleccionaron 30 tomografías de pacientes dentados y 30 tomografías de pacientes desdentados. Se midió en el plano sagital oblicuo la distancia anteroposterior del conducto nasopalatino a nivel de su tercio superior, medio e inferior. Para determinar su altura se tomó el plano axial del nivel de la bifurcación superior hasta la desembocadura palatina. La adquisición de imágenes se realizó través del software i-Dixel del equipo 3D Accuitomo 170 MORITA, sistema DICOM. Resultados: los pacientes dentados presentan alturas mayores en relación a los pacientes edéntulos. En diámetro transversal los pacientes edéntulos presentan mayor tamaño a nivel del canal del CNP. Las medidas a nivel inferior, medio y superior en las corticales del diámetro del CNP en pacientes dentados son menores en relación a los pacientes edéntulos. Conclusión: los pacientes de 40 a 70 años de ambos sexos con edentulismo anterosuperior presentaron variaciones estructurales topográficas que consisten en mayor anchura, menor longitud y mayor dimensión transversal, siendo conductos agrandados.

Background: The nasopalatine canal (NPC) is a long and thin intraosseous passage present in the anterior midline of the maxilla that connects the palate with the floor of the nasal cavity. The objective of the study was to compare the measures of nasopalatine duct and its shape by cone beam tomography in dentate patients with respect to edentulous patients in the frontal anterior sector. Materials and methods: descriptive and comparative study, was taken from the files of the Imagenology Department 150 tomographies of anterosuperior dentate patients and 52 tomographies of edentulous in the frontal anterior sector. Unsing the Excel program and its tool "random", 30 tomographies of dentate patients were selected as well as the 30 tomographies of edentulous. Were measured in the oblique sagittal plane the anteroposterior distance of the nasopalatine canal at the level of its upper, middle and lower third. To determine its height, the axial plane was taken from the level of the upper bifurcation to the palatal opening. The acquisition of images was done through the i-Dixel software of the 3D Accuitomo 170 MORITA, DICOM system. Results: the dentate patients present higher heights in relation to the edentulous patients. In edentulous patients the diameter have a larger size at the NPC channel level. The measurements at the lower, middle and upper levels in the cortices of the diameter of the NPC in dentate patients are lower in relation to the edentulous patients. Conclusion: Patients of 40 to 70 years old, male and female, with frontal anterior edentulism presented structural topographic variations that consist of greater width, smaller longitudinal dimension and larger transversal dimension being enlarged canals.

What is popular? Distinguishing bullying and aggression as status correlates within specific peer normative contexts

Abstract This study tested social status correlates of aggression and bullying and how these are influenced by peer groups' normative beliefs about aggression and prosocial behavior among 1165 fourth, fifth and sixth graders in Chile. Associations between aggression and popularity (positive) and social preference (negative) were confirmed, whereas bullying was negatively associated with both dimensions. Normative beliefs about aggression and prosocial behavior were assessed at the group level, while social status was assessed at the classroom level through peer nominations. Hierarchical Linear Analyses showed that in groups with a higher value associated with aggression, classmates rated aggressive peers as less popular but also less disliked. The status correlates of bullying remained unaffected by peer normative beliefs. The discussion focuses on the social function of aggression as compared to the social sanction associated with bullying, and on the specificity of these associations at different layers of the social ecology. (AU)

“Siempre se vuelve”: análisis del discurso del acto de proclamación como candidata presidencial de Michelle Bachelet / “Always in return”: discourse analysis from Michelle Bachelet’s presidential candidate proclamation event

El presente artículo analiza el discurso realizado por Michelle Bachelet en el Centro Cívico y Artístico de la comuna de El Bosque en Santiago, para presentar su decisión de ser candidata presidencial para las elecciones del año 2013 en Chile. El objetivo de la investigación busca comprender las posiciones de enunciación y las tonalidades discursivas que utiliza la candidata en dicha proclamación, tomando en cuenta la modalidad de liderazgo político femenino que ejerce su figura. Desde el punto de vista metodológico, la herramienta utilizada es el análisis del discurso, considerando conceptos desarrollados por la tradición francesa, desde donde se rescatan los aportes de los trabajos de Foucault (posiciones de enunciación) (Foucault, 1970) y de la escuela rusa, a través de los argumentos desarrollados por Bajtin (tonalidades discursivas) (Voloshinov, 1997). Los resultados exhibieron que, en el discurso de Michelle Bachelet, predomina una posición de sujeto (líder) y tres tonalidades discursivas (familiar, experta y heroica). Las conclusiones apuntan a generar la conexión entre la posición de enunciación hallada y las tonalidades discursivas identificadas a través del análisis del discurso...

This article analyzes Michelle Bachelet’s speech which took place in La Granja’s Civic and Artistic Center in Santiago, Chile to present her decision to run as candidate for the 2013 elections in Chile. This research aims to understand statement positions and discursive tonalities that Bachelet -as candidate used in the mentioned proclamation. Considering the methodological perspective, the analysis tool used was the discourse analysis (DA), considering concepts developed by French tradition -focusing on Foucault’s work constributions (statement positions) (Foucault, 1970) and Russian current with Bajtin’s developed arguments (discursive tonalities (Voloshinov, 1997). Results showed that in Michelle Bachelet’s speech predominate an individual (leading) position and three discursive tonalities (familiar, expert and heroic). These conclusions point to generate connections between the found statement position and the discursive tonalities identified throughout the discourse analysis...