Desarrollando conocimientos sobre alimentación saludable en jóvenes hospitalizados: una campaña de autorregulación

Background: Data from the World Health Organization shows obesity has more than doubled worldwide since 1980. Childhood obesity is mainly associated with external and modifiable factors, as eating habits, existing room for promoting healthy lifestyles. Additionally, learning can take place in contexts other than schools, as the hospital, potentiating the time of hospitalization. Self-regulated learning framework is suited to train the skills necessary for self-management processes and behavioral changes. The aim was to describe and evaluate a campaign designed to increase knowledge about healthy eating by hospitalized school-aged youth. Method: A quasi-experimental design was used. Participants were randomly distributed between the experimental and control groups, each one with 15 participants aged between six and 16 years-old. Information about healthy eating was not provided directly; participants had to reflect and work to build knowledge through activities inspired in the self-regulated learning framework. Results: Results showed that the experimental group when compared with their counterparts significantly improved their knowledge on healthy eating after taking part in the campaign. Conclusions: Campaigns that increase knowledge on healthy eating based on the promotion of self-regulated learning strategies could be incorporated in health promotion programs not only in pediatric units but also in other educational contexts.Antecedentes: el informe de la Organización Mundial de Salud indicó que la obesidad más que duplicó desde 1980. La obesidad infantil es mayoritariamente asociada a causas externas y modificables, como hábitos de alimentación, y puede ser combatida a través de estilos de vida saludables. Las intervenciones educativas pueden ocurrir en el hospital, potenciando el tiempo de hospitalización. El entrenamiento puede ser realizado en el marco de la autorregulación del aprendizaje. Nuestro objetivo es evaluar una campaña de promoción del conocimiento sobre alimentación saludable entre jóvenes hospitalizados en edad escolar. Método: se usó un diseño cuasi-experimental. Los participantes fueron distribuidos al azar entre los grupos experimental y control, cada uno con 15 participantes de entre 6 y 16 años. La información sobre alimentación saludable no fue ofrecida directamente, los participantes tuvieron que reflexionar y trabajar para construir conocimiento, a través de actividades inspiradas en el aprendizaje autorregulado. Resultados: los resultados muestran que después de la campaña, el grupo experimental, comparando con el grupo de control, mejoró significativamente su conocimiento sobre alimentación saludable. Conclusiones: campañas para incrementar el conocimiento sobre alimentación saludable basadas en el marco de la autorregulación del aprendizaje podrían ser incorporadas en programas de promoción de la salud

The Keck+Magellan Survey for Lyman Limit Absorption II: A Case Study on Metallicity Variations

We present an absorption line analysis of the Lyman limit system (LLS) at z=3.55 in our Magellan/MIKE spectrum of PKS2000-330. Our analysis of the Lyman limit and full HI Lyman series constrains the total HI column density of the LLS (N_HI = 10^[18.0 +/- 0.25] cm^{-2} for b_HI >= 20 km/s) and also the N_HI values of the velocity subsystems comprising the absorber. We measure ionic column densities for metal-line transitions associated with the subsystems and use these values to constrain the ionization state (>90% ionized) and relative abundances of the gas. We find an order of magnitude dispersion in the metallicities of the subsystems, marking the first detailed analysis of metallicity variations in an optically thick absorber. The results indicate that metals are not well mixed within the gas surrounding high $z$ galaxies. Assuming a single-phase photoionization model, we also derive an N_H-weighted metallicity, = -1.66 +/- 0.25, which matches the mean metallicity in the neutral ISM in high z damped Lya systems (DLAs). Because the line density of LLSs is ~10 times higher than the DLAs, we propose that the former dominate the metal mass-density at z~3 and that these metals reside in the galaxy/IGM interface. Considerations of a multi-phase model do not qualitatively change these conclusions. Finally, we comment on an anomalously large O^0/Si^+ ratio in the LLS that suggests an ionizing radiation field dominated by soft UV sources (e.g. a starburst galaxy). Additional abundance analysis is performed on the super-LLS systems at z=3.19.Comment: 20 pages, 7 figures (most in color). Accepted to Ap

Phase matters when there is power : Phasic modulation of corticospinal excitability occurs at high amplitude sensorimotor mu-oscillations

Prior studies have suggested that oscillatory activity in cortical networks can modulate stimulus-evoked responses through time-varying fluctuations in neural excitation-inhibition dynamics. Studies combining transcranial magnetic stimulation (TMS) with electromyography (EMG) and electroencephalography (EEG) can provide direct measurements to examine how instantaneous fluctuations in cortical oscillations contribute to variability in TMS-induced corticospinal responses. However, the results of these studies have been conflicting, as some reports showed consistent phase effects of sensorimotor mu-rhythms with increased excitability at the negative mu peaks, while others failed to replicate these findings or reported unspecific mu-phase effects across subjects. Given the lack of consistent results, we systematically examined the modulatory effects of instantaneous and pre-stimulus sensorimotor mu-rhythms on corticospinal responses with offline EEG-based motor evoked potential (MEP) classification analyses across five identical visits. Instantaneous sensorimotor mu-phase or pre-stimulus mu-power alone did not significantly modulate MEP responses. Instantaneous mu-power analyses showed weak effects with larger MEPs during high-power trials at the overall group level analyses, but this trend was not reproducible across visits. However, TMS delivered at the negative peak of high magnitude mu-oscillations generated the largest MEPs across all visits, with significant differences compared to other peak-phase combinations. High power effects on MEPs were only observed at the trough phase of ongoing mu oscillations originating from the stimulated region, indicating site and phase specificity, respectively. More importantly, such phase-dependent power effects on corticospinal excitability were reproducible across multiple visits. We provide further evidence that fluctuations in corticospinal excitability indexed by MEP amplitudes are partially driven by dynamic interactions between the magnitude and the phase of ongoing sensorimotor mu oscillations at the time of TMS, and suggest promising insights for (re)designing neuromodulatory TMS protocols targeted to specific cortical oscillatory states

Sperm selection with hyaluronic acid improved live birth outcomes among older couples and was connected to sperm DNA quality, potentially affecting all treatment outcomes

STUDY QUESTION: What effects did treatment using hyaluronic acid (HA) binding/selection prior to ICSI have on clinical outcomes in the Hyaluronic Acid Binding sperm Selection (HABSelect) clinical trial? SUMMARY ANSWER: Older women randomized to the trial's experimental arm (selection of sperm bound to immobilized (solid-state) HA) had the same live birth rates as younger women, most likely a result of better avoidance of sperm with damaged DNA. WHAT IS KNOWN ALREADY: Recent randomized controlled trials (RCTs) investigating the efficacy of HA-based sperm selection prior to ICSI, including HABSelect, have consistently reported reductions in the numbers of miscarriages among couples randomized to the intervention, suggesting a pathological sperm-mediated factor mitigated by prior HA-binding/selection. The mechanism of that protection is unknown. STUDY DESIGN, SIZE, DURATION: The original HABSelect Phase 3 RCT ran from 2014 to 2017 and included 2752 couples from whom sperm samples used in control (ICSI) and intervention (Physiological IntraCytoplasmic Sperm Injection; PICSI) arms of the trial were stored frozen for later assessment of DNA quality (DNAq). The trial overlapped with its mechanistic arm, running from 2016 to 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS: As miscarriage reduction was a significant secondary outcome of the trial, samples (n = 1247) selected for the mechanistic analysis were deliberately enriched for miscarriage outcomes (n = 92 or 7.4%) from a total of 154 miscarriages (5.6%) among all (n = 2752) couples randomized by stratified random sampling. Values from fresh semen samples for sperm concentration (mml), percentage forward progressive motility and percentage HA-binding score (HBS) were obtained before being processed by differential density gradient centrifugation or (rarely) by swim-up on the day of treatment. Surplus sperm pellets were recovered, aliquoted and cryopreserved for later analysis of DNAq using slide-based Comet, TUNEL, acridine orange (AO) and the sperm chromatin dispersion (SCD) assays. Following their classification into normal and abnormal sample subcategories based on reference values for sperm concentration and motility, relationships with HBS and DNAq were examined by Spearman correlation, Student's t-tests, Mann Whitney U tests, and logistic regression (univariable and multivariable). Parsimonious selection enabled the development of models for exploring and explaining data trends. Potential differences in future cumulative pregnancy rates relating to embryo quality were also explored. MAIN RESULTS AND THE ROLE OF CHANCE: Results from the 1247 sperm samples assayed for HBS and/or DNAq, generated data that were considered in relation to standard physiological measures of (sperm) vitality and to treatment outcomes. All measures of HBS and DNAq discriminated normal from abnormal sperm samples (P < 0.001). SCD correlated negatively with the Comet (r = -0.165; P < 0.001) and TUNEL assays (r = -0.200; P < 0.001). HBS correlated negatively with AO (r = -0.211; P < 0.001), Comet (r = -0.127; P < 0.001) and TUNEL (r = -0.214; P < 0.001) and positively with SCD (r = 0.255; P < 0.001). A model for predicting live birth (and miscarriage) rates included treatment allocation (odds ratio: OR 2.167, 95% CI 1.084-4.464, P = 0.031), female age (OR 0.301, 95% CI 0.133-0.761, P = 0.013, per decade) and the AO assay (OR 0.79, 95% CI 0.60-1. 02.761, P = 0.073, per 10 points rise). A model predicting the expected rate of biochemical pregnancy included male age (OR 0.464, 95% CI 0.314-0.674, P < 0.001, per decade) and the SCD assay (OR 1.04, 95% CI 1.007-1.075, P = 0.018, per 10 point rise). A model for conversion from biochemical to clinical pregnancy did not retain any significant patient or assay variables. A model for post-injection fertilization rates included treatment allocation (OR 0.83, 95% CI 0.75-0.91, P < 0.001) and the Comet assay (OR 0.950, 95% CI 0.91-1.00, P = 0.041). LIMITATIONS, REASONS FOR CAUTION: HABSelect was a prospective RCT and the mechanistic study group was drawn from its recruitment cohort for retrospective analysis, without the full benefit of randomization. The clinical and mechanistic aspects of the study were mutually exclusive in that measures of DNAq were obtained from residual samples and not from HA-selected versus unselected sperm. Models for fitting mechanistic with baseline and other clinical data were developed to compensate for variable DNAq data quality. HABSelect used a solid-state version of PICSI and we did not assess the efficacy of any liquid-state alternatives. PICSI reduced fertilization rates and did not improve the outlook for cumulative pregnancy rates. WIDER IMPLICATIONS OF THE FINDINGS: Notwithstanding the interventional effect on fertilization rates and possibly blastocyst formation (neither of which influenced pregnancy rates), poor sperm DNAq, reflected by lower HBS, probably contributed to the depression of all gestational outcomes including live births, in the HABSelect trial. The interventional avoidance of defective sperm is the best explanation for the equalization in live birth rates among older couples randomized to the trial's PICSI arm. As patients going forward for assisted conception cycles globally in future are likely to be dominated by an older demographic, HA-based selection of sperm for ICSI could be considered as part of their treatment plan. STUDY FUNDING/COMPETING INTEREST(S): The study was supported by the National Institute for Health Research (NIHR) EME (Efficacy and Mechanism Evaluation)-11-14-34. National Research Ethics Service approval 11/06/2013: 13/YH/0162. S.L. is CEO of ExamenLab Ltd (company number NI605309). TRIAL REGISTRATION NUMBER: ISRCTN99214271

Is AMH a promising predictive biomarker for mTESE success in iNOA patients?

The September ESHRE Journal Club discussion focused on a study by Pozzi et al. that addressed the current standards in diagnostic male reproductive health, and whether or not AMH testing should be included in the future; what the possible mechanisms behind the link of AMH and sperm retrieval may be; how DCA can help us to understand prediction tools and models in clinical practice; and to what extent a high AMH level should alter the course of treatment in iNOA patients. AMH, anti-M€ ullerian hormone; iNOA, idiopathic non-obstructive azoospermia; DCA, decision curve analysis; mTESE, micro-dissection testicular sperm extraction

Neuromodulatory effects and reproducibility of the most widely used repetitive transcranial magnetic stimulation protocols

Repetitive transcranial magnetic stimulation (rTMS) is widely used in both research and clinical settings to modulate human brain function and behavior through the engagement of the mechanisms of plasticity. Based upon experiments using single-pulse TMS as a probe, the physiologic mechanism of these effects is often assumed to be via changes in cortical excitability, with 10 Hz rTMS increasing and 1 Hz rTMS decreasing the excitability of the stimulated region. However, the reliability and reproducibility of these rTMS protocols on cortical excitability across and within individual subjects, particularly in comparison to robust sham stimulation, have not been systematically examined. In a cohort of 28 subjects (39 ± 16 years), we report the first comprehensive study to (1) assess the neuromodulatory effects of traditional 1 Hz and 10 Hz rTMS on corticospinal excitability against both a robust sham control, and two other widely used patterned rTMS protocols (intermittent theta burst stimulation, iTBS; and continuous theta burst stimulation, cTBS), and (2) determine the reproducibility of all rTMS protocols across identical repeat sessions. At the group level, neither 1 Hz nor 10 Hz rTMS significantly modulated corticospinal excitability. 1 Hz and 10 Hz rTMS were also not significantly different from sham and both TBS protocols. Reproducibility was poor for all rTMS protocols except for sham. Importantly, none of the real rTMS and TBS protocols demonstrated greater neuromodulatory effects or reproducibility after controlling for potential experimental factors including baseline corticospinal excitability, TMS coil deviation and the number of individual MEP trials. These results call into question the effectiveness and reproducibility of widely used rTMS techniques for modulating corticospinal excitability, and suggest the need for a fundamental rethinking regarding the potential mechanisms by which rTMS affects brain function and behavior in humans

Consensus and diversity in the management of varicocele for male infertility: Results of a global practice survey and comparison with guidelines and recommendations

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