PERMANENT LOW NORMAL TESTOSTERONE LEVELS AND SEMINOLOGICAL DAMAGES IN MEN FROM 37 TO 45 YEARS OLD

In our practice, we are increasingly seeing men aged from 37 to 45 years' old who have permanent low normal testosterone levels. Aim: We set out to investigate whether there is an association between permanent low normal testosterone levels and negative change in seminal fluid parameters in young men. Patients and Methods: For the period from January 2013 to December 2015 at the Andrology office at Hospital "St. Sofia" we examined 73 men aged 37 to 45 years with normal or elevated body mass index, permanent low normal testosterone level, and negative change in seminal fluid parameters. In order to compare the results we obtained, at the very beginning of the study we selected a control group of 20 healthy men of the same age. Results: We obtained, although within reference ranges, significantly lower values for total testosterone in the 73 men with negative change in seminal fluid parameters, compared with those in the control group without seminal damages (p<0.001) We found a high correlation relationship between the level of testosterone and the results of the first (r = 0.614, p<0.001) and second spermograms (r = 0.662, p<0.001). Conclusions: 1. Our study shows that in a number of men at a young age, some decrease in normal testosteronе secretion occurs, with a concomitant negative change in seminal fluid parameters, which is remarkably different from the same parameters in their peers with a high normal testosterone level. 2. We identify permanent low normal testosterone, overweight and obesity as predictors, signaling a possible negative change in seminal fluid parameters. 3. We can say that if obesity plays some role in seminal damages, the mechanism in most cases is most likely related to the sustained permanent low normal testosterone level, as a result of increased adipose tissue

An Artificial Intelligence-Based Noninvasive Solution to Estimate Pulmonary Artery Pressure

Aims: Design to develop an artificial intelligence (AI) algorithm to accurately predict the pulmonary artery pressure (PAP) waveform using non-invasive signal inputs. Methods and results: We randomly sampled training, validation, and testing datasets from a waveform database containing 180 patients with pulmonary atrial catheters (PACs) placed for PAP waves collection. The waveform database consisted of six hemodynamic parameters from bedside monitoring machines, including PAP, artery blood pressure (ABP), central venous pressure (CVP), respiration waveform (RESP), photoplethysmogram (PPG), and electrocardiogram (ECG). We trained a Residual Convolutional Network using a training dataset containing 144 (80%) patients, tuned learning parameters using a validation set including 18 (10%) patients, and tested the performance of the method using 18 (10%) patients, respectively. After comparing all multi-stage algorithms on the testing cohort, the combination of the residual neural network model and wavelet scattering transform data preprocessing method attained the highest coefficient of determination R2 of 90.78% as well as the following other performance metrics and corresponding 95% confidence intervals (CIs): mean square error of 11.55 (10.22–13.5), mean absolute error of 2.42 (2.06–2.85), mean absolute percentage error of 0.91 (0.76–1.13), and explained variance score of 90.87 (85.32–93.31). Conclusion: The proposed analytical approach that combines data preprocessing, sampling method, and AI algorithm can precisely predict PAP waveform using three input signals obtained by noninvasive approaches

Review of cyanotoxicity studies based on cell cultures

Cyanotoxins (CTs) are a large and diverse group of toxins produced by the peculiar photosynthetic prokaryotes of the domain Cyanoprokaryota. Toxin-producing aquatic cyanoprokaryotes can develop in mass, causing “water blooms” or “cyanoblooms,” which may lead to environmental disaster—water poisoning, extinction of aquatic life, and even to human death. CT studies on single cells and cells in culture are an important stage of toxicological studies with increasing impact for their further use for scientific and clinical purposes, and for policies of environmental protection. The higher cost of animal use and continuous resistance to the use of animals for scientific and toxicological studies lead to a progressive increase of cell lines use. This review aims to present (1) the important results of the effects of CT on human and animal cell lines, (2) the methods and concentrations used to obtain these results, (3) the studied cell lines and their tissues of origin, and (4) the intracellular targets of CT. CTs reviewed are presented in alphabetical order as follows: aeruginosins, anatoxins, BMAA (β-N-methylamino-L-alanine), cylindrospermopsins, depsipeptides, lipopolysaccharides, lyngbyatoxins, microcystins, nodularins, cyanobacterial retinoids, and saxitoxins. The presence of all these data in a review allows in one look to advance the research on CT using cell cultures by facilitating the selection of the most appropriate methods, conditions, and cell lines for future toxicological, pharmacological, and physiological studies

The Impact and Progression of the COVID-19 Pandemic in Bulgaria in Its First Two Years

After initially having low levels of SARS-CoV-2 infections for much of the year, Bulgaria experienced a major epidemic surge at the end of 2020, which caused the highest recorded excess mortality in Europe, among the highest in the word (Excess Mortality Rate, or EMR &sim;0.25%). Two more major waves followed in 2021, followed by another one in early 2022. In this study, we analyze the temporal and spatial patterns of excess mortality at the national and local levels and across different demographic groups in Bulgaria and compare those to the European levels. Bulgaria has continued to exhibit the previous pattern of extremely high excess mortality, as measured both by crude mortality metrics (an EMR of &sim;1.05%, up to the end of March 2022) and by standardized ones&mdash;Potential Years of Life Lost (PYLL) and Aged-Standardized Years of life lost Rate (ASYR). Unlike Western Europe, the bulk of excess mortality in Bulgaria, as well as in several other countries in Eastern Europe, occurred in the second year of the pandemic, likely related to the differences in the levels of vaccination coverage between these regions. We also observe even more extreme levels of excess mortality at the regional level and in some subpopulations (e.g., total EMR values for males &ge; 2% and EMR values for males aged 40&ndash;64 &ge; 1% in certain areas). We discuss these observations in light of the estimates of infection fatality rate (IFR) and eventual population fatality rate (PFR) made early in the course of the pandemic

Laparoscopic surgery of diaphragmatic sliding hernia in an infant

Introduction: The diaphragmatic hernia (DH) is a condition in which there is an upwards dislocation of parts of the stomach or the whole stomach from the abdomen to the chest. Three types are identified: the sliding hernia, type I, with dislocation of the cardia into the posterior mediastinum; type II, with normally positioned cardia but misplaced gastric fundus and type III, with dislocation of both.Materials and methods: This is a case report of a two-year-old infant with DH type I. Although the patient was born from a normal pregnancy in his postpartum period he suffered intraamniotic pneumonia. When he was two-months old during an emergency hospitalization due to acute respiratory failure and pneumonia of unknown origin, he was further diagnosed with gastroesophageal reflux disease. Both findings raised the suspicion of possible DH and a confirmation was made a few months later after hospitalization again due to pneumonia. A computed tomography of the chest revealed a 30-40mm sliding DH. After a consult with a paediatric surgeon a 6-month diet and close observation were recommended. If the symptoms wouldn`t resolve further operation was endorsed.Results: At the age of two the patient was scheduled for an elective surgery. At first a fiberoptic bronchoscopy was performed after the request by the anaesthesiologists to exclude tracheal stenosis. Next, laparoscopy was done showing an enlarged hiatal opening and axial DH with a length of the sac of around 3cm. The distal part of the oesophagus was mobilized in the mediastinum. A postoperative pneumonia occurred but it responded well to antibiotic treatment. The condition of the patient was significantly improved by this operative intervention.Conclusions: The DH is most commonly seen in adult patients. Regardless of age its treatment is largely surgical. If delayed or done on emergency basis the mortality is high

Surgical treatment of a massive solitary fibrous tumor of the pleura associated with symptomatic hypoglycaemia

Introduction: Solitary fibrous tumor (SFT) is a rare mesenchymal tumor originating from the pleu­ra. SFT is sometimes linked to hypoglycaemia due to the production of Insulin-like growth factor 2 by the tumor. This is known as the Doege-Potter syndrome.Materials and methods: Presented is a case of a 39-year-old male first admitted to endocrinology for clarification of hypoglycaemia who was later transferred to thoracic surgery due to the finding of a large mass and pleural effusion in the thoracic cavity. Shortness of breath and a persisting cough were also present complaints. The patient underwent a computed tomography (CT) scan and was diag­nosed with a large tumor taking up ¾ of the chest cavity along with a massive hemorrhagic right pleu­ral effusion. The SFT exerted pressure on the structures of the mediastinum: heart and large blood vessels; all of which were shifted left. A CT assisted Tru-Cut biopsy was performed to determine the histology of the mass. It was concluded that the tumor was a benign SFT. Benign SFTs, in comparison to malignant SFTs, make up about 78% to 88% of all diagnosed SFTs. A Positron-emission tomogra­phy scan performed on the whole body came back negative for pathological cell activity. It was also determined that the right lung was shifted cranially by the formation but limited-in-size ventilated parenchyma remained.Results: To remove the tumor an embolization of the nutritive vessels and an en bloc resection of the tumor, pericardium and right lung was performed. The patient`s postoperative course was unevent­ful and his hypoglycaemic symptoms resolved just after the operation.Conclusions: SFTs are uncommon findings in pulmonary pathology, especially these associated with paraneoplastic hypoglycaemia. Surgical resection is the cornerstone of their treatment leading to im­mediate improvement of the symptoms and usually without recurrence

Meningiomatosis of the upper extremities accompanied by choroid plexus meningioma

Introduction: Meningiomatosis is an extremely rare condition characterized by the presence of mul­tiple meningiomas. Ectopic meningiomas are uncommon tumors arising usually in the head or neck and even more rarely they can occur in the lung, mediastinum or skin.Materials and methods: In this case a 60-year-old man was admitted to a Dermatology ward due to tumor-like lesions on the fingers of both hands. The lesions began appearing three years before the admission being only a cosmetic malaise. However at the time of admittance the patient suffered pain and difficulty in the movement of the small joints of the hand. Biopsy of three lesions was performed, revealing cells characteristic for meningiomas. At the same time, the patient developed a speech dis­order and right-side hemiparesis. After a consult with a neurosurgeon, the patient underwent a con­trast-enhanced computed tomography scan of the brain. It showed a hyperdense tumor formation in the left lateral ventricle that increased in density after application of intravenous contrast. No defor­mation or dislocation signs were observed.Results: The patient was planned for elective surgery and underwent a dehydration therapy. Three days later a left-sided parieto-occipital craniotomy was performed and through an intergyral ap­proach the occipital horn of left lateral ventricle was reached. After evacuation of cerebral spinal flu­id and retraction of occipital lobe, the microscope was positioned. The tumor was solid and adhered to the choroid plexus. After microdissection of the choroid plexuses` vessels a total tumor mass resec­tion was performed. The next day after surgery the neurological exam revealed no signs of pathology. Full recovery of the neurologic deficit at discharge was observed.Conclusions: In summary, due to its slow growth and lack of symptoms patients often look for other specialists rather than neurosurgeons. Only three cases similar to this case report have been report­ed in the literature

Implementation of a Feed-forward Artificial Neural Network in VHDL on FPGA

International audienceDescribing an Artificial Neural Network (ANN) using VHDL allows a further implementation of such a system on FPGA. Indeed, the principal point of using FPGA for ANNs is flexibility that gives it an advantage toward other systems like ASICS which are entirely dedicated to one unique architecture and allowance to parallel programming, which is inherent to ANN calculation system and one of their advantages. Usually FPGAs do not have unlimited logical resources integrated in a single package and this limitation forces requirement for optimizations for the design in order to have the best efficiency in terms of speed and resource consumption. This paper deals with the VHDL designing problems which can be encountered when trying to describe and implement such ANNs on FPGAs