Enhancing Primary School Teaching through Virtual Reality

In this day and age, the usage of computers as well as Internet combined with mobile devices is an integral part of our routine especially for adolescents and younger children. Thus, it puts forward a multitude of challenges and advances for educational institutions. The purpose of this article is to explore the current use of virtual reality in order to support teaching and learning along with presenting a teaching proposal concerning the utilisation of CoSpace Edu software on the subject of Religious Affairs

Toward a real time multi-tissue Adaptive Physics-Based Non-Rigid Registration framework for brain tumor resection

This paper presents an adaptive non-rigid registration method for aligning pre-operative MRI with intra-operative MRI (iMRI) to compensate for brain deformation during brain tumor resection. This method extends a successful existing Physics-Based Non-Rigid Registration (PBNRR) technique implemented in ITKv4.5. The new method relies on a parallel adaptive heterogeneous biomechanical Finite Element (FE) model for tissue/tumor removal depicted in the iMRI. In contrast the existing PBNRR in ITK relies on homogeneous static FE model designed for brain shift only (i.e., it is not designed to handle brain tumor resection). As a result, the new method (1) accurately captures the intra-operative deformations associated with the tissue removal due to tumor resection and (2) reduces the end-to-end execution time to within the time constraints imposed by the neurosurgical procedure. The evaluation of the new method is based on 14 clinical cases with: (i) brain shift only (seven cases), (ii) partial tumor resection (two cases), and (iii) complete tumor resection (five cases). The new adaptive method can reduce the alignment error up to seven and five times compared to a rigid and ITK\u27s PBNRR registration methods, respectively. On average, the alignment error of the new method is reduced by 9.23 and 5.63 mm compared to the alignment error from the rigid and PBNRR method implemented in ITK. Moreover, the total execution time for all the case studies is about 1 min or less in a Linux Dell workstation with 12 Intel Xeon 3.47 GHz CPU cores and 96 GB of RAM

Testosterone Serum Levels Are Related to Sperm DNA Fragmentation Index Reduction after FSH Administration in Males with Idiopathic Infertility

Purpose: Although a robust physiological rationale supports follicle stimulating hormone (FSH) use in male idiopathic infertility, useful biomarkers to evaluate its efficacy are not available. Thus, the primary aim of the study was to evaluate if testosterone serum levels are related to sperm DNA fragmentation (sDF) index change after FSH administration. The secondary aim was to confirm sDF index validity as a biomarker of FSH administration effectiveness in male idiopathic infertility. Methods: A retrospective, post-hoc re-analysis was performed on prospectively collected raw data of clinical trials in which idiopathic infertile men were treated with FSH and both testosterone serum levels and sDF were reported. Results: Three trials were included, accounting for 251 patients. The comprehensive analysis confirmed FSH's beneficial effect on spermatogenesis detected in each trial. Indeed, an overall significant sDF decrease (p < 0.001) of 20.2% of baseline value was detected. Although sDF resulted to be unrelated to testosterone serum levels at baseline, a significant correlation was highlighted after three months of FSH treatment (p = 0.002). Moreover, testosterone serum levels and patients' age significantly correlated with sDF (p = 0.006). Dividing the cohort into responders/not responders to FSH treatment according to sDF change, the FSH effectiveness in terms of sDF improvement was related to testosterone and male age (p = 0.003). Conclusion: Exogenous FSH administration in male idiopathic infertility is efficient in reducing sDF basal levels by about 20%. In terms of sDF reduction, 59.2% of the patients treated were FSH-responders. After three months of FSH administration, a significant inverse correlation between sDF and testosterone was detected, suggesting an association between the FSH-administration-related sDF improvement and testosterone serum levels increase. These observations lead to the hypothesis that FSH may promote communications or interactions between Sertoli cells and Leydig cells

Serum Anti-Müllerian Hormone Is Significantly Altered by Downregulation With Daily Gonadotropin-Releasing Hormone Agonist: A Prospective Cohort Study

Research Question: What is the effect of gonadotropin-releasing hormone (GnRH)-agonist treatment on serum anti-Müllerian hormone (AMH)?Design: This prospective cohort study conducted in a tertiary university hospital comprised patients (n = 52) who self-administered daily triptorelin (0.1 mg/0.1 mL) subcutaneously for 14 days from menstrual cycle day 21 ± 3, between July 2015 and March 2016. Enrolled women were 18–43 years old, considered normal ovarian responders, with a planned GnRH agonist controlled ovarian stimulation protocol. The primary endpoint was to evaluate the effect of GnRH agonist on serum AMH levels after 7 and 14 days of treatment.Results: Under GnRH agonist treatment, serum AMH was significantly decreased vs. baseline on day 7 (mean change from baseline: −0.265 ng/mL; 95% confidence interval [CI], −0.395 to −0.135 ng/mL; p < 0.001). On day 14, serum AMH was significantly increased (mean change from baseline: 0.289 ng/mL; 95% CI, 0.140–0.439 ng/mL; p < 0.001). Although the median change in AMH from baseline was only −14.9% on day 7 and +17.4% on day 14, from day 7 to 14 AMH significantly increased by 0.55 ng/mL (43.8%; p < 0.001), which is of paramount clinical importance. A linear, mixed-effect model demonstrated that GnRH agonist treatment for 7 and 14 days had a highly significant effect on serum AMH concentration after adjustment for confounding factors (age, body mass index, baseline antral follicle count, and visit). AMH assay precision was excellent (four aliquots/sample); coefficient of variation was 1.2–1.4%.Conclusions: GnRH agonist treatment had a clinically significant effect on serum AMH, dependent on treatment duration. The clear V-shaped response of AMH level to daily GnRH agonist treatment has important clinical implications for assessing ovarian reserve and predicting ovarian response, thus AMH measurements under GnRH agonist downregulation should be interpreted with great caution

Treatment algorithms for high responders: What we can learn from randomized controlled trials, real-world data and models

A high ovarian response to conventional ovarian stimulation (OS) is characterized by an increased number of follicles and/or oocytes compared with a normal response (10-15 oocytes retrieved). Ac-cording to current definitions, a high response can be diagnosed before oocyte pick-up when >18-20 follicles >= 11-12 mm are observed on the day of ovulation triggering; high response can be diagnosed after oocyte pick-up when >18-20 oocytes have been retrieved. Women with a high response are also at high risk of early ovarian hyper-stimulation syndrome (OHSS)/or late OHSS after fresh embryo transfers. Women at risk of high response can be diagnosed before stimulation based on several indices, including ovarian reserve markers (anti-Mullerian hormone [AMH] and antral follicle count [AFC], with cutoff values indicative of a high response in patients with PCOS of >3.4 ng/mL for AMH and >24 for AFC). Owing to the high proportion of high responders who are at the risk of developing OHSS (up to 30%), this educational article provides a framework for the identification and management of patients who fall into this category. The risk of high response can be greatly reduced through appropriate management, such as individualized choice of the gonadotropin starting dose, dose adjustment based on hormonal and ultrasound monitoring during OS, the choice of down-regulation protocol and ovulation trigger, and the choice between fresh or elective frozen embryo transfer. Appropriate management strategies still need to be defined for women who are predicted to have a high response and those who have an unex-pected high response after starting treatment.(c) 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/)

Cumulative Live Birth Rates Following Stimulation With Corifollitropin Alfa Compared With hp-hMG in a GnRH Antagonist Protocol in Poor Ovarian Responders

Background: Bologna criteria poor ovarian responders have a very low prognosis. Although, it has been proposed that LH supplementation could be beneficial in women with previous hypo-response to FSH. There are no studies comparing the cumulative live birth rates (LBRs) between corifollitropin alfa (CFA) and highly purified human menopausal gonadotrophin (hp-hMG).Objective: To compare cumulative LBRs in Bologna poor ovarian responders undergoing ovarian stimulation with CFA followed by hp-hMG vs. hp-hMG alone in a GnRH antagonist protocol.Design: This is a retrospective cohort study. We included in total 917 poor responders fulfilling the Bologna criteria for poor ovarian response (POR) at a university-affiliated tertiary center from January 2011 until March 2017. Patients were administered either fixed daily doses of 300–450 IU of hp-hMG (group A) or a single dose of 150 μg of CFA followed by daily injections of ≥300 IU of hp-hMG from Day 8 of stimulation until the day of ovulation trigger (group B), in a fixed GnRH antagonist protocol.Results: LBRs after fresh embryo transfer (ET) were similar in group A 71/510 (14%) and B 42/407 (10%). Cumulative LBR per cycle was significantly higher in group A (16.9%) compared to group B (11.8%); (P = 0.03). However, logistic regression analysis showed no association between the type of gonadotropin administered and cumulative LBR. Only age was significantly associated with cumulative LBR (OR = 0.93, P = 0.007).Conclusion: Cumulative LBRs are similar in Bologna poor responders stimulated with CFA followed by hp-hMG compared to hp-hMG monotreatment in an antagonist protocol

Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

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

Controversy and consensus on the management of elevated sperm DNA fragmentation in male infertility: A global survey, current guidelines, and expert recommendations

Purpose Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. Results A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4–6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. Conclusions This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians

L'effet de l'hormone de croissance sur l'épaisseur endométriale et la fertilité, dans le traitement de femmes ayant un panhypopituitarisme

Le rôle de l'hormone de croissance (HC) dans la reproduction féminine est devenu un sujet d'intérêt au cours de la dernière décennie. L'utilisation de l' HC pour l'induction d'ovulation chez les femmes ayant un hypogonadisme hypogonadotrope reste controversée. Le rôle de l' HC dans l'endomètre humain est encore largement inconnu. Au mieux de nos connaissances, cette étude représente le premier rapport de cas, montrant d'évidence que l' HC pourrait jouer un rôle pas seulement pour l'induction d'ovulation, mais aussi pour le développement de l'épaisseur endométriale chez les femmes ayant un hypopituitarisme. En plus, dans cette thèse, on analyse le rôle de l' HC à la médecine de la reproduction depuis le début de son utilisation, les options pour le traitement d'infertilité de patientes souffrant de l' insuffisance hypophysaire, ainsi que deux sujets provoquants : 1) comment procéder en cas d'endomètre fin 2) l' HC dans le processus d'implantation

Θεραπεία της καθυστερημένης πώρωσης καταγμάτων με τεριπαρατίδη

Καθώς το προσδόκιμο ζωής αυξάνεται παγκοσμίως, ταυτόχρονα αυξάνεται και η συχνότητα καταγμάτων. Ωστόσο, 5 - 10% όλων των καταγμάτων δεν επουλώνονται άμεσα, οδηγώντας σε καθυστερημένη πώρωση και ψευδάρθρωση, προβλήματα που παραμένουν μια μεγάλη πρόκληση για τους ορθοπαιδικούς χειρουργούς. Επιπλέον, συχνά προκαλούν σημαντικά λειτουργικά και κοινωνικοοικονομικά προβλήματα για τους ασθενείς. Μέχρι πρόσφατα, οι θεραπευτικές επιλογές για περιπτώσεις καθυστερημένης πώρωσης και ψευδάρθρωσης επικεντρώθηκαν στην αναθεώρηση της χειρουργικής επέμβασης και στη βελτίωση της τοπικής θεραπείας. Παρά την πρόοδο των θεραπευτικών μεθόδων, η πλειονότητα των τρόπων αντιμετώπισης σχετίζεται με αυξημένη διάρκεια παραμονής στο νοσοκομείο, απώλεια αίματος, πόνο, δυσκαμψία και άλλες επιπλοκές. Επομένως, υπάρχει ανάγκη για μια άλλη μέθοδο θεραπείας που θα μπορούσε να επιλύσει αυτήν την κατάσταση με ελάχιστες ανεπιθύμητες ενέργειες. Τα υπάρχοντα στοιχεία δείχνουν ότι η τεριπαρατίδη μπορεί να είναι μια πιθανή νέα θεραπεία για την καθυστερημένη πώρωση των καταγμάτων. Η χρήση της είναι αποτελεσματική και ασφαλής, ωστόσο τα βιβλιογραφικά δεδομένα βασίζονται κυρίως σε μικρές μελέτες ή αναφορές περιστατικών. Απαιτούνται περαιτέρω προοπτικές, τυχαιοποιημένες, ελεγχόμενες κλινικές μελέτες για τη διερεύνηση της ασφάλειας και της αποτελεσματικότητας της τεριπαρατίδης για τη θεραπεία της καθυστερημένης πώρωσης των καταγμάτων.As life expectancy increases worldwide, so does the incidence of fractures. However, 5 - 10% of all fractures do not heal immediately, leading to delayed union and non-union, problems that remain a major challenge for orthopedic surgeons. In addition, these disturbances often cause significant functional and socioeconomic problems for patients. Until recently, treatment options for delayed union and non-union have focused on revision surgery and improving local treatment. Despite advances in management, most treatment methods are associated with increased hospital stay, blood loss, pain, stiffness, and other complications. Therefore, there is a need for another treatment method that could resolve this condition with minimal side effects. Existing evidence suggests that teriparatide may be a potential new treatment for delayed fracture healing. Its use is effective and safe; however the literature data are mainly based on small studies or case reports. Further prospective, randomized, controlled clinical trials are needed to investigate the safety and efficacy of teriparatide in the treatment of delayed fracture healing