Does Testicular Sperm Improve Intracytoplasmic Sperm Injection Outcomes for Nonazoospermic Infertile Men with Elevated Sperm DNA Fragmentation? A Systematic Review and Meta-analysis.

CONTEXT: For nonazoospermic infertile men with elevated sperm DNA fragmentation (SDF), it is unclear whether the use of testicular sperm for intracytoplasmic sperm injection (ICSI) may offer advantages over ejaculated sperm. OBJECTIVE: To determine whether ICSI outcomes (fertilisation rate, pregnancy rate, miscarriage rate, and live birth rate) are better with testicular sperm than with ejaculated sperm for men with elevated SDF. EVIDENCE ACQUISITION: We searched the Cochrane Central, EMBASE, MEDLINE, Web of Science, and Scopus databases (1946-2023) in February 2023 for relevant human comparative studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. EVIDENCE SYNTHESIS: Out of 2032 records, nine studies (more than 536 participants, mean age range 33-40.5 yr for males and 30.1-37.9 yr for females) were included in the systematic review and meta-analysis. Pooled estimates demonstrated that the pregnancy rate was significantly higher with testicular than with ejaculated sperm according to a sperm chromatin structure assay (SCSA)/sperm chromatin integrity test (SCIT) (odds ratio [OR] 2.51; p = 0.001) and terminal deoxynucleotidyl transferase dUTP nick-end labelling (TUNEL) assays (OR 3.65; p = 0.005). The live birth rate was significantly higher according to SCSA/SCIT (OR 2.59; p = 0.005). There were no significant differences in the fertilisation rate or miscarriage rate. CONCLUSIONS: Although significant improvements in pregnancy and live birth rates were observed with testicular sperm, the strength of findings is limited by availability and quality of evidence, both of which undermine recommendations for clinical practice. Standardised randomised controlled trials are needed to definitively determine whether the use of testicular sperm improves ISCI outcomes for men with high SDF. Until such evidence exists, ICSI after testicular sperm extraction or aspiration should not be routinely performed. PATIENT SUMMARY: Our review showed that for infertile men with a high level of DNA damage in their sperm, use of sperm extracted from the testicles may give better results than ejaculated sperm for a particular IVF (in vitro fertilisation) technique. However, there is a lack of high-quality data.

Brown adipose tissue and regulation of human body weight.

BACKGROUND: Approximately 30% of the global population is affected by obesity. Traditional non-surgical measures for weight loss have limited efficacy and tolerability. Therefore, there is a need for novel, effective therapies. Brown adipose tissue (BAT) has been implicated in physiological energy expenditure, indicating that it could be targeted to achieve weight loss in humans. The use of 18 F-fluorodeoxyglucose (18 F-FDG) positron emission tomography-computed tomography-(PET-CT) imaging has enabled the discovery of functionally active BAT in the supraclavicular, subclavian, and thoracic spine regions of human adults. This review aims to discuss the reasons behind the renewed interest in BAT, assess whether it is metabolically important in humans, and evaluate its feasibility as a therapeutic target for treating obesity. SOURCES OF MATERIAL: PubMed Central, Europe PMC, Medline. FINDINGS: In vivo studies have shown that BAT activity is regulated by thyroid hormones and the sympathetic nervous system. Furthermore, BAT uniquely contains uncoupling protein 1 (UCP1) that is largely responsible for non-shivering thermogenesis. Cold exposure can increase BAT recruitment through the browning of white adipose tissue (WAT); however, this technique has practical limitations that may preclude its use. Currently available medicines for humans, such as the ß3-adrenergic receptor agonist mirabegron or the farnesoid X receptor agonist obeticholic acid, have generated excitement, although adverse effects are a concern. Capsinoids represent a tolerable alternative, which require further investigation. CONCLUSIONS: The use of currently available BAT-activating agents alone is unlikely to achieve significant weight loss in humans. A combination of BAT activation with physical exercise and modern, successful dietary strategies represents a more realistic option.

A profile of noise sensitivity on the health-related quality of life among young motorcyclists.

INTRODUCTION: Motorcycle riders with noise sensitivity (NS) may suffer from degraded health-related quality of life (HRQOL) because they are exposed to acute noise levels on a daily basis. MATERIALS AND METHODS: This study was aimed to identify the relationship between NS and HRQOL among young motorcycle riders (undergraduate university students) aged between 19 and 25 years (n = 301) through a cross-sectional questionnaire-based study, that is, Weinstein noise sensitivity scale and the World Health Organization Quality of Life. The effects of NS on HRQOL were assessed based on gender, the years of motorcycle driving experience, and noise sensitive among groups using one-way analysis of variances with an alpha value of 0.05. RESULTS: The results showed no significant difference in NS between males and females. On the other hand, motorcycle driving experience for <4 years displayed a higher tendency toward NS. Moreover, a significantly (P = 0.004) decreasing trend among low, moderate, and high NS with their respective HRQOL was observed, while a high NS showed significantly (P = 0.015) lower scores on the social domain of the quality of life. CONCLUSION: The overall premise of the study has statistical significance and shows that individuals with high NS tend to have degraded HRQOL compared to individuals with low NS. Furthermore, in-depth studies are required from the other demographical background of participants to investigate the motorcyclist's NS and HRQOL as an integral requirement for the rider's safety and health.

Ictal kissing: a release phenomenon in non-dominant temporal lobe epilepsy.

BACKGROUND: A variety of ictal automatisms with strong emotional elements have been described. Ictal kissing has not been well characterized and may provide useful clinical information and insight into the mechanisms of stereotyped ictal behaviour. METHODS: Three of 220 patients (1.4%) admitted for video EEG monitoring between 7/2006 and 6/2009 with ictal kissing were identified. Clinical, neurophysiological and imaging data were reviewed and correlated. RESULTS: All patients were right-handed women with a longstanding history and findings consistent with right temporal lobe epilepsy (TLE). Multiple habitual events were recorded for each patient, characterized by staring, oral automatisms and amnesia. In addition, partial preservation of responsiveness and speech were seen during seizures in all three patients. The first two patients showed kissing behaviour triggered by interactions during seizure testing. The last patient had six seizures overnight and developed spontaneous kissing behaviour in the ictal and post-ictal period of her later events, associated with hyperorality and sexual disinhibition. CONCLUSION: Our series supports the findings of two prior cases, of one male and one female, which reported IK behaviour associated with TLE and lateralizing to the non-dominant hemisphere. This behaviour has not been described in simple partial seizures or seen with electrical cortical stimulation suggesting that it represents a release phenomenon rather than activation of distinct symptomatogenic cortex. This is also supported by the fact that ictal kissing can occur within the spectrum of seizure-induced Kluver-Bucy syndrome and may extend into the post-ictal period.