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Male infertility (MI) and male sexual dysfunction (MSD) can often coexist together due to various interplay factors such as psychosexual, sociocultural and relationship dynamics. The presence of each form of MSD can adversely impact male reproduction and treatment strategies will need to be individualized based on patients’ factors, local expertise, and geographical socioeconomic status. The Asia Pacific Society of Sexual Medicine (APSSM) and the Asian Society of Men’s Health and Aging (ASMHA) aim to provide a consensus statement and practical set of clinical recommendations based on current evidence to guide clinicians in the management of MI and MSD within the Asia-Pacific (AP) region. A comprehensive, narrative review of the literature was performed to identify the various forms of MSD and their association with MI. MEDLINE and EMBASE databases were searched for the following English language articles under the following terms: “low libido”, “erectile dysfunction”, “ejaculatory dysfunction”, “premature ejaculation”, “retrograde ejaculation”, “delayed ejaculation”, “anejaculation”, and “orgasmic dysfunction” between January 2001 to June 2022 with emphasis on published guidelines endorsed by various organizations. This APSSM consensus committee panel evaluated and provided evidence-based recommendations on MI and clinically relevant MSD areas using a modified Delphi method by the panel and specific emphasis on locoregional socioeconomic- cultural issues relevant to the AP region. While variations exist in treatment strategies for managing MI and MSD due to geographical expertise, locoregional resources, and sociocultural factors, the panel agreed that comprehensive fertility evaluation with a multidisciplinary management approach to each MSD domain is recommended. It is important to address individual MI issues with an emphasis on improving spermatogenesis and facilitating reproductive avenues while at the same time, managing various MSD conditions with evidence-based treatments. All therapeutic options should be discussed and implemented based on the patient’s individual needs, beliefs and preferences while incorporating locoregional expertise and available resources.

Abstract Purpose Percentage of positive cores involved on a systemic prostate biopsy has been established as a risk factor for adverse oncologic outcomes and is a National Comprehensive Cancer Network (NCCN) independent parameter for unfavorable intermediate-risk disease. Most data from a radiation standpoint was published in an era of conventional fractionation. We explore whether the higher biological dose delivered with SBRT can mitigate this risk factor. Methods A large single institutional database was interrogated to identify all patients diagnosed with localized prostate cancer (PCa) treated with 5-fraction SBRT without ADT. Pathology results were reviewed to determine detailed core involvement as well as Gleason score (GS). High-volume biopsy core involvement was defined as ≥ 50%. Weighted Gleason core involvement was reviewed, giving higher weight to higher-grade cancer. The PSA kinetics and oncologic outcomes were analyzed for association with core involvement. Results From 2009 to 2018, 1590 patients were identified who underwent SBRT for localized PCa. High-volume core involvement was a relatively rare event observed in 19% of our cohort, which was observed more in patients with small prostates (p

Background: The current study aimed to assess the prevalence of bullying victimization (BV) and its association with psychopathology and suicidality in a nationwide general population. Methods: The target population were all the people living in Taiwan, the study samples were obtained by the following processes. A computer-assisted telephone interview was performed to identify potential respondents using telephone numbers selected with the stratified proportional randomization method. Self-reported data were evaluated. Moreover, data obtained using the validated Brief Symptom Rating Scale (BSRS-5) and Concise Mental Health Checklist (CMHC) were used to evaluate psychopathological symptoms and overall suicidal risks, respectively. Results were further analyzed using the chi-square tests and logistic regression model. Results: In total, 1930 respondents from a national general population survey were included in the analysis. The weighted prevalence of lifetime BV in the general population was 13.5%. Based on the chi-square analysis, individuals exposed to BV were at high risk for psychopathology (a BSRS-5 score of ≥6 (x2 = 45.5, P ≤ .001) and high BSRS-5 scores for all five items). Bullying exposure was significantly associated with lifetime suicide ideation and suicide attempt (x2 = 85.7, P ≤ .001; x2 = 17.0, P ≤ .001, respectively). The help-seeking behavior of respondents exposed to bullying did not differ significantly (x2 = 4.6, P = .327). Conclusion: Bullying exposure is associated with recent psychopathology and lifetime suicidality. Multifactorial interactive processes contribute to long-term harmful health implications in adulthood. Nevertheless, further research on the relevant mechanisms associated with bullying and potential interventions that can decrease morbidity must be conducted.

The deployment of lithium metal batteries is forestalled by poor control over the deposition morphology of lithium. Here, the authors discover that high electrical resistance can be leveraged for controlling lithium morphology and enabling high-performing lithium metal batteries.

Purpose: COVID pandemic significantly affected the delivery and maintenance of healthcare system, resulting in greater utilization of digital health interventions. Materials and Methods: This multi-national cross-sectional survey was administered to clinicians working in major Asia-Pacific cities during the mandatory social lockdown period in June 2020. Clinical demographics and professional data, delivery of Andrology-related healthcare services, and patient distress based on validated questionnaires such as Depression and Anxiety Stress Scales (DASS) and Decisional Engagement Scale (DES) were collected. Results: Telehealth medicine was instituted in all the centres with the majority of centres (92.9%) reported a 50% or more reduction in out-patient related services. The numbers of phone calls, emails correspondence and educational webinars have significantly increased. Despite the provision of reasons for changes in healthcare service and delay in surgery, more than half of the patients (57.1%) rated 2 on the DASS score for the item on patients over-react to situations, while a third of the patients (35.7%) scored a 2 for DASS item on patients being more demanding or unreasonable. The DES scores were more positive with most patients reported a score above 7 out of 10 in terms of items on accepting current arrangement (85.7%), confident in clinician decision-making about treatment (92.9%) and comfortable that the decision is consistent with their preferences (71.4%). Most patients (85.7%) indicated their preferences for more detailed information on healthcare provision. Conclusions: Our study showed telehealth services were integrated early and successfully during the COVID pandemic and patients were generally receptive with minimal psychosocial distress.

There has been much debate about whether returns on financial assets, such as stock returns or commodity returns, are predictable; however, few studies have investigated cryptocurrency return predictability. In this article we examine whether bitcoin returns are predictable by a large set of bitcoin price-based technical indicators. Specifically, we construct a classification tree-based model for return prediction using 124 technical indicators. We provide evidence that the proposed model has strong out-of-sample predictive power for narrow ranges of daily returns on bitcoin. This finding indicates that using big data and technical analysis can help predict bitcoin returns that are hardly driven by fundamentals. Keywords: Bitcoin return prediction, High-dimensional classification, Decision tree classification, CART, Cryptocurrency, Bitcoin, Technical indicators

Abstract: BACKGROUND: Premature ovarian failure (POF) is a typical condition of pathological ovarian ageing. Injuries and atrophies of blood vessels in the ovaries can lead to ovarian insufficiency, but the underlying mechanism remains unclear. AIMS: This study investigated the epigenetic mechanism by which thymopentin (TP-5) activated ovarian angiogenesis to achieve its effects on POF. MATERIALS AND METHODS: The qPCR, western blot and immunofluorescence staining were used to detecte the expression levels of gene. The hematoxylin and eosin stainingwas used to histopathological examination. The RNA-Seq sequencing was used to transcriptome detection. RESULTS: First, pathological examination revealed that TP-5 significantly increased ovary weight in the cyclophosphamide-induced POF mouse model. The proportion of atretic follicles was reduced, and the level of E2 in the peripheral blood was elevated. Meanwhile, immunofluorescence staining showed that TP-5 increased protein expression of CD31 and Tie1 in the ovarian tissues of mice with POF, suggesting that TP-5 could induce ovarian angiogenesis. RNA-Seq sequencing results suggested that TP-5 could induce the high level of Notch/Tie2 pathway expression that is associated with angiogenesis in ovarian tissues. qPCR and western blotting showed significantly increased expression of METTL3, a methyltransferase that catalyses the formation of N6-methyladenosine (m6A) in RNA. Meanwhile, the results of the dot blot suggested that the overall RNA methylation level was significantly higher in the ovarian tissues of mice in the TP-5 group than in the control group. Finally, RIP-PCR analysis showed that specific sites in the 3'-untranslated region (3'UTR) of the mRNA of key factors in the Notch/Tie2 pathway were hypermethylated in the ovaries of mice in the TP-5 treatment group. CONCLUSION: Therefore, this study demonstrated that TP-5 exerted its therapeutic effect on POF by stimulating angiogenesis. The mechanism of action is the promotion of the expression of RNA m6A methyltransferases by TP5, which increases the overall RNA m6A methylation level in mouse ovarian tissue. Specifically, the methylation ofspecific m6A sites in the 3'UTR of the RNA of key factors in the Notch/Tie2 pathway increased, which enhanced their stability and expression levels, leading to the induction of angiogenesis.

Summary: Dissolution of transition metals from high-voltage cathodes and their incorporation into the solid-electrolyte interphase (SEI) of carbonaceous anodes drastically reduces the lifetime of Li-ion batteries. The effects of dissolved transition metals on the performance of carbonaceous anodes are well characterized; however, the impact on Li-metal anode performance and the SEI is rarely considered. Here, we use cryogenic electron microscopy to reveal the impact of dissolved Ni on the SEI formation process on Li-metal. A link between Ni incorporation into the SEI and the failure of Li-metal batteries is established. We find that Ni is reduced into its metallic state and incorporates as small clusters into the SEI, locally changing the chemistry and nanostructure of the SEI. These chemical and nanostructure changes locally modify the Li-ion and electron transport properties of the SEI, accelerating electrolyte decomposition, increasing formation of “dead” Li, and ultimately causing failure.

Objective: To study how student self-assessment compared with the faculty's assessment on our family medicine clerkship and to explore the effect of demographic factors on the ratings. Methods: Students and their faculty preceptors assessed the students' achievement of clerkship objectives at mid clerkship. We performed Mann-Whitney U tests to compare student ratings and faculty ratings for each clerkship objective. We performed linear regression analyses to investigate the effect of medical school year and student sex on student ratings and the effect of sex concordance or sex difference of the faculty-student pair on faculty ratings. Results: Two hundred one students completed the family medicine clerkship between July 2015 and June 2016. Faculty ratings were higher than student ratings for all 12 clerkship objectives (P

The coronavirus disease-2019 (COVID-19) pandemic has caused an unprecedented healthcare crisis with various governmental healthcare policies enforced to redirect medical prioritization and minimize the spread of COVID19 infection. Recognizing that the COVID-19 crisis will be protracted, it is important that clinicians and the healthcare industry continue to adapt existing resources and review contingency plan amidst this uncertain and difficult times. The Asia Pacific Society of Sexual Medicine supports ongoing precautionary healthcare measures implemented by various institutions and governmental policies to contain and eliminate COVID19 infection. Clinicians are encouraged to modify and adapt various strategies that will continue to provide, support, and treat sexual health–related conditions in a safe and efficient manner.Chung E, Jiann BP, Nagao L, et al. Provision of Sexual Medicine Services During the Coronavirus Disease-2019 Pandemic: An Asia Pacific Society of Sexual Medicine Position Statement. J Sex Med 2020;8:325–326.

RESUMO Objetivo: Estabelecer se há superioridade entre os critérios para predizer desfecho clínico desfavorável na lesão renal aguda e nefropatia induzidas por contraste. Métodos: Estudo retrospectivo conduzido em hospital terciário com 157 pacientes submetidos à infusão de contraste radiológico para fins propedêuticos. Resultados: Cumpriram os critérios para inclusão 147 pacientes. Aqueles que cumpriram os critérios de lesão renal aguda induzida por contraste (59) também cumpriram os critérios para nefropatia induzida por contraste (76); 44,3% dos pacientes cumpriram os critérios para o estadiamento pelo sistema KDIGO; 6,4% dos pacientes necessitaram utilizar terapia de substituição renal, e 10,7% dos pacientes morreram. Conclusão: O diagnóstico de nefropatia induzida por contraste foi o critério mais sensível para determinar a necessidade de terapia de substituição renal e óbito, enquanto o KDIGO demonstrou a maior especificidade; na população avaliada, não houve correlação entre o volume de contraste e a progressão para lesão renal induzida por contraste, nefropatia induzida por contraste, diálise de suporte ou óbito.

Abstract This standardized patient case and its accompanying sequence of activities are intended to build skill among first-year medical students in recognizing patient clues and eliciting contextual information. Additional activities include a large-group introduction prior to the standardized patient encounter, a stimulated review of the standardized patient encounter, and a small-group reflection and discussion. The standardized patient case embeds three contextual themes (beliefs about treatment, stressful environment, and fear of what symptoms mean) that are each assigned a specific behavioral cue or clue. Standardized patients are trained to drop these clues and then to give further information only if the student interviewer follows up on the clue. Each theme is constructed to yield potentially meaningful differences in physician decision-making if the clue is or is not followed up on. Students and standardized patients then review the video independently and mark moments in the video that they feel represented clues and whether or not the clue was followed up on. Once the moments have been marked, the students view the video a second time to compare their own markings with those of the standardized patient. Lastly, the students meet in small groups with a faculty facilitator to share one exemplar moment and discuss with the group. Students indicated that the stimulated recall video review of their standardized patient encounter was the most effective activity for triggering reflection, followed by the small-group discussion and the review of the merged standardized patient bookmarks. Students felt that the activities were effective overall in promoting reflection on the relevance of context in the medical encounter.

Abstract This resource is a complete curriculum on the Task-Oriented Processes in Care (TOPIC) model, featuring all of the educational materials developed for use in student and resident teaching on the model, including slides, handouts, videos, case scenarios, and checklists for a TOPIC clinical performance examination. The TOPIC model conceptualizes the work of generalist physicians as processes and tasks during five prototypic visits: new problem visits, checkup visits, chronic illness visits, psychosocial visits, and behavioral change visits. During these visits, clinicians complete four major processes: information processing, patient-physician relationship development, integration of information and relationship, and lifelong learning. Each type of visit includes specific tasks that reflect the purpose of that type of visit. For example, at a chronic illness visit, physicians gather information to assess severity and control of the disease, determine adherence with treatment plan and presence of medication side effects, seek evidence of target-organ damage, and scan for other risk factors for complications. These tasks are different than those for the four other types of visits. Extensive data from performance-based assessments demonstrate that clerkship students and family medicine residents can perform the TOPIC tasks in simulated encounters. Assessment of the curriculum demonstrates that TOPIC is an effective teaching model that spans the continuum of medical education, from students to residents. Since the TOPIC model is a metacognitive framework that focuses on process and not on content or facts, some learners do not immediately appreciate the value of explicitly learning a cognitive strategy for approaching their work. We know that experts use these types of strategies and that novices develop them in the decade it takes to become an expert. TOPIC tries to shorten this developmental period by making the metacognitive thinking explicit, but some learners prefer the more familiar didactic presentations of medical knowledge about specific conditions. This model is robust and can be taught through many educational mediums by a variety of faculty members. The clerkship teaching has been done by different teachers using different seminar processes over the past decade, yet students still learn to perform the tasks in the end-of-clerkship clinical performance examination.