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Purpose: Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations. Materials and Methods:Materials and Methods: A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 coun-tries were analyzed descriptively, with a Delphi process used for expert recommendations. Results:Results: Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoosper-mia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differ-entiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate. Conclusions:Conclusions: This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations.

Resumo A dificuldade de incorporar a variável ambiental nos processos de contratação é recorrente no mundo. Nesse contexto, as contratações públicas sustentáveis são um instrumento importante para reduzir o impacto ambiental das organizações. No Brasil, há incapacidade para incorporar instrumentos que permitam uma atividade pública mais eficaz e eficiente. Em contrapartida, as tecnologias digitais, como a blockchain, podem ser a solução para problemas complexos no setor público. Nos últimos anos, governos têm adotado a blockchain em diversas áreas, sendo que, no âmbito internacional, a tecnologia é utilizada em bancos de dados de alguns países. No sentido de facilitar a implantação dos critérios ambientais nos procedimentos de licitação, este estudo propõe um modelo conceitual de aplicação da blockchain para contratações públicas sustentáveis de obras rodoviárias. Com base na análise de conteúdo de 25 processos de licitação, foi realizado o mapeamento das principais atividades, o que permitiu propor uma solução integrada ao Portal Nacional de Contratações Públicas. A principal contribuição do estudo é apresentar as potenciais aplicações referentes aos aspectos ambientais para blockchain nas contratações públicas e demonstrar a viabilidade da implementação dessa tecnologia. Diante das novas perspectivas para otimizar a gestão dos processos licitatórios e prover a sustentabilidade ambiental na administração pública, entende-se que a blockchain pode auxiliar na promoção de uma estrutura de licitação confiável, descentralizada, transparente e ambientalmente sustentável.

Abstract The utility of brain magnetic resonance imaging (MRI) for predicting dementia is debated. We evaluated the added value of repeated brain MRI, including atrophy and cerebral small vessel disease markers, for dementia prediction. We conducted a landmark competing risk analysis in 1716 participants of the French population‐based Three‐City Study to predict the 5‐year risk of dementia using repeated measures of 41 predictors till year 4 of follow‐up. Brain MRI markers improved significantly the individual prediction of dementia after accounting for demographics, health measures, and repeated measures of cognition and functional dependency (area under the ROC curve [95% CI] improved from 0.80 [0.79 to 0.82] to 0.83 [0.81 to 0.84]). Nonetheless, accounting for the change over time through repeated MRIs had little impact on predictive abilities. These results highlight the importance of multimodal analysis to evaluate the added predictive abilities of repeated brain MRI for dementia and offer new insights into the predictive performances of various MRI markers. Highlights We evaluated whether repeated brain volumes and cSVD markers improve dementia prediction. The 5‐year prediction of dementia is slightly improved when considering brain MRI markers. Measures of hippocampus volume are the main MRI predictors of dementia. Adjusted on cognition, repeated MRI has poor added value over single MRI for dementia prediction. We utilized a longitudinal analysis that considers error‐and‐missing‐prone predictors, and competing death.

Purpose: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians.

Introduction: Rectal cancer is the third most common cancer in the world. Tumors are most commonly located in the rectosigmoid region. There are many actors in the etiology such as age, geographical features, family history, obesity, diet, and history of malignancy. Blood groups are one of the controversial etiologic factors in CRC. Blood group antigens, covered by Karl Landsteiner in 1901, have been the subject of numerous cancer studies since 1953, when Aird declared that blood group A was associated with stomach cancer. Aim: In the present study, we aimed to determine the effect of blood group characteristics, which play a role in the etiology of Rectal cancer. Method: We Prospectively reviewed the patients who were diagnosed with CRC and operated in our center or at other centers and were followed postoperatively at our centers. Age, gender, histologic TNM stage (tumor, lymph node involvement, and metastasis), tumor-bearing colonRectal segment, ABO blood group, and Rh antigen were examined from the patients’ records. Results: Total of 60 patients with histopathologically confirmed as rectal cancers formed the study population. The male to female ratio in rectal cancers was 1.7:1. The age group varied from 16 to 80 years with most common age group in rectum cancer were between age is 45-64 years constituted (29) 48%. However, we observed relationship in the present study between Rh antigen and lymph node metastasis, liver metastasis, or TNM stage. O Blood group and rh positive was associated with lymph node involvement, higher TNM stage, and also found that risk of liver metastasis. Conclusion: As in Rectal cancer, our findings show that the O (+) blood group is a risk factor in rectal cancers, which have multifactorial etiology. Further genetic studies are needed.

IntroductionImpaired testosterone secretion is a frequent sequela following hematopoietic stem cell transplantation (HSCT) in pediatrics, but long-term longitudinal trendlines of clinical and biochemical findings are still scanty.MethodsMonocentric, retrospective analysis. Male patients transplanted

Abstract Background In studies of time-to-events, it is common to collect information about events that occurred before the inclusion in a prospective cohort. When the studied risk factors are independent of time, including both pre- and post-inclusion events in the analyses, generally referred to as relying on an ambispective design, increases the statistical power but may lead to a selection bias. In the field of venous thromboembolism (VT), ABO blood groups have been the subject of extensive research due to their substantial effect on VT risk. However, few studies have investigated their effect on the risk of VT recurrence. Motivated by the study of the association of genetically determined ABO blood groups with VT recurrence, we propose a methodology to include pre-inclusion events in the analysis of ambispective studies while avoiding the selection bias due to mortality. Methods This work relies on two independent cohorts of VT patients, the French MARTHA study built on an ambispective design and the Dutch MEGA study built on a standard prospective design. For the analysis of the MARTHA study, a weighted Cox model was developed where weights were defined by the inverse of the survival probability at the time of data collection about the events. Thanks to the collection of information on the vital status of patients, we could estimate the survival probabilities using a delayed-entry Cox model on the death risk. Finally, results obtained in both studies were then meta-analysed. Results In the combined sample totalling 2,752 patients including 993 recurrences, the A1 blood group has an increased risk (Hazard Ratio (HR) of 1.18, p = 4.2 × 10–3) compared with the O1 group, homogeneously in MARTHA and in MEGA. The same trend (HR = 1.19, p = 0.06) was observed for the less frequent A2 group. Conclusion The proposed methodology increases the power of studies relying on an ambispective design which is frequent in epidemiologic studies about recurrent events. This approach allowed to clarify the association of ABO blood groups with the risk of VT recurrence. Besides, this methodology has an immediate field of application in the context of genome wide association studies.

Breast tuberculosis is a rare form of extra-pulmonary tuberculosis. It accounts for less than 0.1% of breast conditions in developed countries but reaches about 3-4% in developing high TB endemic regions. It usually occurs in multiparous and lactating women. The clinical, radiological and pathological presentation may often mimic breast abscess, idiopathic granulomatous mastitis or carcinoma. The most common presentation is that of a lump. Constitutional symptoms are not usually present. The most common site is the right upper outer quadrant of the breast. It also occurs in association with Immunosuppression disorders such as HIV. Here we present a case of a young, multiparous non- lactating woman with tubercular mastitis, confirmed by FNAC of the mass. The Tuberculin skin test was positive and the patient improved with anti-tubercular treatment.

Purpose: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. Materials and Methods: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological Association [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. Results: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/ uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.

Resumo O sistema de alimentação produz impactos ambientais que não são evidentes para o consumidor final, especialmente em relação às distâncias percorridas. O objetivo da pesquisa foi avaliar os teleacoplamentos urbanos e os impactos ambientais a partir do cálculo do consumo energético e das emissões ambientais dos produtos alimentícios orgânicos. Por meio de quantitativos, distâncias, perdas e análise dos teleacoplamentos, mediram-se as emissões de Gases de Efeito Estufa - GEE, a pegada energética e a pegada de carbono dos alimentos orgânicos comercializados na CEASA/PR, Curitiba. As emissões representaram baixo impacto ao meio ambiente, pois a maior quantidade de orgânicos transportada origina-se de locais de produção que se situam na Região de Curitiba. O estudo evidencia um padrão de consumo privilegiando o alimento produzido nas regiões adjacentes ao comércio, de modo saudável e seguro, que deve estar associado a maior consciência dos impactos ambientais decorrentes das distâncias percorridas.

Com as preocupações relacionadas ao consumo de recursos naturais, alterações no espaço urbano e a geração de resíduos pela construção civil, estratégias foram criadas e desenvolvidas para a promoção do desenvolvimento ambientalmente sustentado. Uma delas é o projeto para a desconstrução como alternativa para a minimização dos resíduos sólidos, o prolongamento da vida útil de materiais, a preservação da energia incorporada e a redução de áreas para aterros e do consumo de recursos naturais. Diante das mudanças no perfil de consumo e dos registros da preocupação com o enfrentamento de uma nova crise hídrica, este trabalho visa identificar as diretrizes de projeto para a desconstrução que contribuem para a preservação de recursos hídricos. Para o desenvolvimento deste estudo foi realizada revisão bibliográfica narrativa com a pesquisa documental nas bases Scopus e Google Acadêmico fazendo uso de palavras-chave relacionadas ao tema. Com as buscas, verificou-se que há fases em que o consumo de água na construção civil é negligenciado, com etapas pouco exploradas, e ausência de dados e informações disponíveis. Para atingir o objetivo proposto, as informações sobre o consumo de água no setor e as diretrizes da desconstrução foram compiladas e relacionadas. Os vínculos entre as diretrizes de projeto para a desconstrução e as informações sobre o uso da água nas fases do ciclo de vida de edificações foram demonstrados e analisados com fluxogramas. Com base nessa análise, foi verificado que a desconstrução contribui para a preservação ambiental por considerar a edificação de forma integral, em todas as fases de existência.

Multisystem inflammatory syndrome is a severe complication of SARS-CoV-2 infection in children (MIS-C). To date, data on long-term sequelae mainly concern cardiac outcomes. All ≤ 18 year olds consecutively admitted to the Buzzi Children's Hospital with a diagnosis of MIS-C between October 1, 2020, and May 31, 2022, were followed up for up to 12 months by a dedicated multidisciplinary team. They underwent laboratory tests, multi-organ clinical and instrumental assessments, and psychosocial evaluation. 56/62 patients, 40 M, mean age 8.7 years (95% CI 7.7, 9.7), completed the follow-up. Cardiological, gastroenterological, pneumological, and neurological evaluations, including IQ and EEG, were normal. Alterations of HOMA-IR index and/or TyG index, observed in almost all patients during hospitalisation, persisted in about a third of the population at 12 months. At 6 and 12 months respectively, impairment of adaptive functions was observed in 38/56 patients (67.9%) and 25/56 (44.6%), emotional and behavioural problems in 10/56 (17.9%) and 9/56 (16.1%), and decline in QoL in 14/56 (25.0%) and 9/56 (16.1%). Psychosocial well-being impairment was significantly more frequent in the subgroup with persistent glycometabolic dysfunction at 12 months (75% vs. 40.9% p < 0.001). Conlusion: The mechanisms that might explain the long-term persistence of both metabolic alterations and neuro-behavioural outcomes and their possible relationship are far from being clarified. Our study points out to the potential long-term effects of pandemics and to the importance of a multidisciplinary follow-up to detect potential negative sequelae in different areas of health, both physical and psychosocial. What is known: • Multisystem inflammatory syndrome in children (MIS-C) is a severe complication of SARS-CoV-2 infection. • Few data exist on the medium- and long-term outcomes of MIS-C, mostly focused on cardiac involvement. Emerging evidence shows neurological and psychological sequelae at mid- and long-term follow-up. What is new: • This study reveals that MIS-C may lead to long-term glycometabolic dysfunctions joined to impairment in the realm of general well-being and decline in quality of life, in a subgroup of children. • This study highlights the importance of a long-term multidisciplinary follow-up of children hospitalised with MIS-C, in order to detect the potential long-term sequelae in different areas of health, both physical and psychosocial well-being. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the impact of different components of daily training load during the week preceding the match on the risk of sustaining a match injury in professional rugby union. A cohort of 72 players from a single professional French club participated. Global positioning system-derived data including total distance (TD) and high-speed distance in addition to ratings of perceived effort (RPE) for both on- and off-pitch (gym-based strength conditioning work) training were collected for each training session over 3 seasons (2017-2020). The association between the daily measures of external and internal training load over the week preceding the day of the match (MD) and the subsequent risk of injury in match-play was estimated using a mixed-effects logistic model adjusted for contextual and individual factors. A total of 184 injuries were sustained in 128 matches (incidence: 81.2 injuries per 1,000 player hours). Higher RPE values for the strength conditioning session on MD-5 (p < 0.001) and for the on-pitch session on MD-1 (p = 0.04) were associated with an increased risk of injury in matches. On MD-2, a higher TD covered and that run at high speed (>MAS) were, respectively, associated with a higher (p = 0.03) and lower risk (p = 0.02) of injury in matches played. This study in professional rugby union shows that different components of external and internal load had varying influences on injury risk and particularly in relation to the day on which these were performed in the week leading up to the next match. At MD-2, training load favoring intensity rather than volume could reduce the risk of match-play injury. [ABSTRACT FROM AUTHOR]

Clostridioides difficile is a major nosocomial pathogen that can cause severe, toxin-mediated diarrhea and pseudomembranous colitis. Recent work has shown that C. difficile exhibits heterogeneity in swimming motility and toxin production in vitro through phase variation by site-specific DNA recombination. The recombinase RecV reversibly inverts the flagellar switch sequence upstream of the flgB operon, leading to the ON/OFF expression of flagellum and toxin genes. How this phenomenon impacts C. difficile virulence in vivo remains unknown. We identified mutations in the right inverted repeat that reduced or prevented flagellar switch inversion by RecV. We introduced these mutations into C. difficile R20291 to create strains with the flagellar switch “locked” in either the ON or OFF orientation. These mutants exhibited a loss of flagellum and toxin phase variation during growth in vitro, yielding precisely modified mutants suitable for assessing virulence in vivo. In a hamster model of acute C. difficile infection, the phase-locked ON mutant caused greater toxin accumulation than the phase-locked OFF mutant but did not differ significantly in the ability to cause acute disease symptoms. In contrast, in a mouse model, preventing flagellum and toxin phase variation affected the ability of C. difficile to colonize the intestinal tract and to elicit weight loss, which is attributable to differences in toxin production during infection. These results show that the ability of C. difficile to phase vary flagella and toxins influences colonization and disease development and suggest that the phenotypic variants generated by flagellar switch inversion have distinct capacities for causing disease.