Search Results (46)

Purpose: Non-obstructive azoospermia (NOA) presents major challenges in assisted reproductive technology (ART) due to the extremely low number of viable sperm within testicular tissue. In Micro-TESE procedures, embryologists manually search for sperm under DIC microscopy—a slow, labor-intensive process. We aim to streamline this process with an efficient computational detection tool. Methods: We present SD-CLIP (Sperm Detection using Classical Image Processing), a lightweight, real-time algorithm that simulates sperm structure detection from unstained DIC images. The model first identifies convex sperm head candidates based on shape and width using edge gradients, then confirms the presence of a tail via principal component analysis (PCA) of pixel clusters. Results: Compared to the MB-LBP + AKAZE method, SD-CLIP improved processing speed by 4× and achieved a 3.8× higher posterior probability ratio, making detected sperm candidates significantly more reliable. Evaluation was performed on both human Micro-TESE and mouse testis images, demonstrating robustness in low-sperm environments. Conclusions: SD-CLIP simulates a domain-specific image interpretation model that identifies sperm morphology with high specificity. It requires minimal computational resources, supports real-time integration, and could be extended to automated sperm extraction systems. This tool has clinical value for accelerating Micro-TESE and increasing success rates in ART for NOA patients. Full article

Purpose: The aim of this study was to investigate the effectiveness and reliability of point-of-care ultrasonography (POCUS) in the differential diagnosis of azoospermia. Materials and methods: Records of 175 patients who had previously been diagnosed with normal-volume, normal-PH azoospermia and who had undergone surgical sperm retrieval were reviewed retrospectively. Patients’ preoperative evaluations included a comprehensive history and physical examination and a routine scrotal POCUS performed during their initial consultation by a non-radiologist treating andrologist in a clinic setting. Positive scrotal imaging revealed ectasia of the rete testis and/or dilation of the epididymal ductules. Based on their preoperative assessments, patients were guided to undergo either testicular sperm aspiration (TESA)/microsurgical sperm aspiration (MESA) procedures for those with suspected obstructive azoospermia (OA) or microdissection testicular sperm extraction (micro-TESE) for those with suspected non-obstructive azoospermia (NOA). Results: Of the 175 patients, 58 patients had normal follicle-stimulating hormone (FSH) levels (≤12 IU/L) and normal testicular volume. Thirty of them had no secondary signs of obstruction in their scrotal POCUS and subsequently underwent micro-TESE. All were confirmed to have NOA. Twenty-eight patients demonstrated at least two secondary signs of obstruction on scrotal POCUS. Of these, 15 underwent TESA, and 13 underwent MESA procedures. Twenty-seven patients were confirmed to have OA, and one was confirmed as having NOA. Among this cohort of men, the sensitivity of scrotal POCUS in diagnosing OA was 100%, whereas the specificity was 96.8%. Positive and negative predictive values (PPVs and NPVs) were 96.4 and 100%, respectively. Conclusions: Scrotal POCUS is an effective clinical diagnostic tool for distinguishing obstructive and non-obstructive azoospermia. Being noninvasive, safe, and affordable makes it an ideal bedside clinical tool that can serve the skilled non-radiologist clinician reliably. Full article

This study aimed to analyze the level of disclosure of information representing sustainability practices from the stakeholders’ perspective and its relationship with the funding cost of cooperative financial organizations. The level of disclosure was measured using 46 information indicators representing sustainability practices from the stakeholders’ perspective, identified in the annual reports of cooperative financial organizations (CFOs) listed in the World Cooperative Monitor 2023, totaling 155 observations. The relationship between disclosure and the cost of financing was analyzed using a random effects estimator with cluster-robust standard errors. The results demonstrate a negative relationship between the disclosure of sustainability practices and the funding cost. When disaggregated by sustainability pillar, the results show that disclosure in the social, environmental, and cultural pillars is negatively associated with funding cost, while the economic pillar shows no statistically significant effect. This suggests that disclosing sustainability-related information from the stakeholders’ perspective reduces the cost of funding and enhances the legitimacy of CFO managers, setting them apart from traditional banks. This study examines the relationship between sustainability disclosure and funding cost in CFOs by adapting validated indicators and applying a robust econometric approach. Unlike existing literature focused on traditional banks, it empirically investigates how sustainability disclosure affects information asymmetry, funding costs, and managerial legitimacy within the cooperative financial sector. Full article

MicroRNAs (miRNAs), a class of small noncoding RNAs, play a crucial role in spermatogenesis. However, their specific expression patterns in azoospermic patients, particularly in relation to sperm presence and pregnancy outcomes, remain underexplored. We performed small RNA sequencing on forty testicular tissue samples from idiopathic azoospermic and cryptozoospermic patients who underwent testicular sperm extraction (TESE). Differentially expressed (DE) miRNAs were identified across groups with high, rare, or no spermatozoa presence, as well as between individuals with successful and unsuccessful pregnancies following assisted reproduction. Functional enrichment analyses were conducted to assess the biological relevance of miRNA alterations. Our findings revealed distinct miRNA expression patterns linked to sperm presence and pregnancy outcomes. Samples with high sperm presence exhibited reduced miRNA expression, while those with impaired spermatogenesis demonstrated upregulated miRNAs associated with cell survival and differentiation pathways. Several regulatory pathways were also disrupted in samples leading to unsuccessful pregnancies, including the estrogen signaling receptor (ESR) pathway, interleukin-4 and interleukin-13 signaling, and transcription networks. This study highlights miRNA-mediated regulatory differences in azoospermic patients, identifying potential biomarkers for sperm retrieval success and fertility outcomes. Future validation and multi-omics approaches are needed to confirm these findings and enhance male infertility diagnostics. Full article

Background and Objectives: This study aimed to compare the effects of choriogonadotropin alfa and anastrozole treatments on the success of sperm retrieval in patients with Klinefelter syndrome (KS) undergoing micro-TESE at our clinic. Materials and Methods: We conducted a retrospective review of a cohort including patients with non-mosaic KS who underwent micro-TESE for fertility treatment at the Reproductive Medicine Center of our university hospital. This study included 43 patients who had not received exogenous testosterone therapy prior to or during the procedure. Before surgical sperm retrieval, all patients received either choriogonadotropin alfa or anastrozole treatment based on their preference. Micro-TESE was performed on all patients after three months of treatment. Results: The overall SRR in the cohort post-micro-TESE was found to be 32.6%. There was a significant increase in post-treatment testosterone levels compared to pre-treatment levels. Upon dividing patients into two groups based on whether sperm was successfully retrieved, we observed significant improvements in testosterone levels in both groups following treatment. In the group presenting with successful sperm retrieval, 28.6% of patients had received choriogonadotropin alfa, while 71.4% had received anastrozole. No statistically significant difference was found between treatment groups in terms of micro-TESE success. Both choriogonadotropin alfa and anastrozole treatments resulted in significant improvements in testosterone levels following treatment compared to pre-operative levels. Furthermore, in the choriogonadotropin alfa group, there were significant decreases in follicle-stimulating hormone and luteinizing hormone levels, as well as a significant increase in estradiol levels after treatment. Post-treatment E2 levels were significantly lower in the anastrozole group than in the choriogonadotropin alfa group (p = 0.032), while the mean testicular volume was statistically significantly lower in the choriogonadotropin alfa group. Conclusions: This study suggests that anastrozole treatment before micro-TESE in patients with KS yields more successful results in terms of the SRR compared to choriogonadotropin alfa treatment. Full article

Objectives: To compare surgical outcomes and sperm retrieval rates (SRRs) between conventional microsurgical-assisted testicular sperm extraction (m-TeSE—Group A) and testicular sperm extraction performed with surgical loupes (l-TeSE—Group B) in adult males with non-obstructive azoospermia (NOA). Methods: A multicentric prospective randomized trial (ethics committee no. 202/2022) in accordance with the CONSORT guidelines was conducted from March 2022 to April 2024. Adult males with NOA without genetic alterations who signed the informed consent were enrolled. SRRs, intra- and postoperative complications (according to the Clavien–Dindo classification), and hormonal profile changes were considered as outcomes during the follow-up period. Results: A total of 42 NOA patients were enrolled. The median age was 35 years (IQR: 33–49). The preoperative median FSH was 16.5 mIU/mL (IQR: 11.6–22.5) and the total testosterone was 4.6 (3.5–5.6). Overall, the SRR was 22.6%, with sperm retrieved from 19 testes. Histopathological findings reported Sertoli cell-only syndrome (SCOS) in 46.4% (39 cases), hypospermatogenesis in 26.2%, and germ cell arrest in 26.2% of the patients. No intraoperative complications were recorded. The postoperative complications were minimal (Clavien–Dindo grade I), but no significant differences were recorded in-between the two surgical approaches. Considering the operative time of the testicular exploration alone, Group B seemed to be faster than the m-TeSE, with a median time saving of 8 min (p < 0.01). Conclusion: The use of surgical loupes was safe and comparable with m-TeSE in terms of the SRRs and complication rates. L-TeSE offered a reduction in the operative time compared with m-TeSE. Full article

Tumors located at the tracheal bifurcation constitute a heterogeneous group of neoplasms whose treatment poses significant challenges due to their anatomical location, the requirement for radical resection, the need to restore local anatomy, and the necessity of maintaining adequate oxygenation throughout the entire procedure. Advances in airway reconstruction surgical techniques, anesthesia, and complementary therapies have progressively expanded indications for radical treatment of these neoplasms, resulting in significant improvements in both short- and long-term outcomes in recent years. Full article

Access to safe drinking water is a fundamental human right, yet it remains a global challenge affecting nearly 2 billion people, particularly in Africa in regions such as Guinea-Bissau. This study investigated the microbiological and physicochemical quality of drinking water in four rural areas of the Oio region of Guinea-Bissau—Cangha N’Tchugal, Cajaque, Infaidi and Insanha—over a one-year period (October 2022–September 2023) to assess water safety and seasonal variations. During this period, eight water samples were collected and analysed from each site, split evenly between the dry and wet seasons. The results showed widespread faecal coliform contamination, with concentrations escalating during the wet season (2 to 39 CFU/100 mL), posing a health risk. Physicochemical analysis showed consistently acidic pH values (from 4.93 to 6.58) and seasonal variations in phosphate and iron concentrations, with a marked decrease in iron concentrations during the wet season. These results indicated that the water from the four sampling points was unfit for human consumption. In light of these findings, there is an urgent need for the regular monitoring of water sources used for drinking and for improved access to resources and basic sanitation in the future. Full article

Background/Objectives: Non-obstructive azoospermia (NOA) is a severe form of male infertility characterized by the absence of sperm in the ejaculate due to impaired spermatogenesis. Testicular sperm extraction (TESE) combined with intracytoplasmic sperm injection is the primary treatment, but success rates are unpredictable, causing significant emotional and financial burdens. Traditional clinical and hormonal predictors have shown inconsistent reliability. This review aims to evaluate current and emerging non-invasive preoperative predictors of successful sperm retrieval in men with NOA, highlighting promising biomarkers and their potential clinical applications. Methods: A comprehensive literature review was conducted, examining studies on clinical and hormonal factors, imaging techniques, molecular biology biomarkers, and genetic testing related to TESE outcomes in NOA patients. The potential role of artificial intelligence and machine learning in enhancing predictive models was also explored. Results: Traditional predictors such as patient age, body mass index, infertility duration, testicular volume, and serum hormone levels (follicle-stimulating hormone, luteinizing hormone, inhibin B) have limited predictive value for TESE success. Emerging non-invasive biomarkers—including anti-Müllerian hormone levels, inhibin B to anti-Müllerian hormone ratio, specific microRNAs, long non-coding RNAs, circular RNAs, and germ-cell-specific proteins like TEX101—show promise in predicting successful sperm retrieval. Advanced imaging techniques like high-frequency ultrasound and functional magnetic resonance imaging offer potential but require further validation. Integrating molecular biomarkers with artificial intelligence and machine learning algorithms may enhance predictive accuracy. Conclusions: Predicting TESE outcomes in men with NOA remains challenging using conventional clinical and hormonal parameters. Emerging non-invasive biomarkers offer significant potential to improve predictive models but require validation through large-scale studies. Incorporating artificial intelligence and machine learning could further refine predictive accuracy, aiding clinical decision-making and improving patient counseling and treatment strategies in NOA. Full article

(1) Background: Nonobstructive azoospermia (NOA) etiologies affect the sperm retrieval rate (SRR) by microdissection testicular sperm extraction (micro-TESE) and the clinical outcomes following intracytoplasmic sperm injection (ICSI); (2) Methods: We investigated seven NOA etiologies. The SRR and clinical outcomes of 627 patients were analyzed between November 2017 and July 2022 in the Reproductive and Genetic Hospital of China International Trust and Investment Corporation-Xiangya (CITIC-Xiangya); (3) Results: The overall SRR was 39.4% (247/627). The SRR according to NOA etiologies were: Y chromosome azoospermia factor c microdeletions (26/46, 56.5%), Klinefelter syndrome (KS), 36/85, 42.4%), idiopathic (110/398, 27.6%), cryptorchidism (20/29, 69.0%), chromosome anomalies (7/13, 53.9%), orchitis (45/50, 90.0%), and cancer (3/6, 50.0%). The SRR were different for spermatogonia arrest (26/96, 27.1%), maturation arrest (76/177, 42.9%), and SCOS (30/80, 37.5%) according to histological examinations. The clinical pregnancy rate was similar among the NOA etiologies. The high-quality embryo rate differed between successful (54.7%) and unsuccessful (40.9%) pregnancies. Moreover, the successfully pregnant women (28.99 years) were younger than the unsuccessfully pregnant ones (30.92 years); (4) Conclusions: The SRR from patients with NOA was associated with the etiology and histological categories, while the clinical outcome was associated with the high-quality embryo rate and the female partner’s age. Full article

Azoospermia, the absence of sperm cells in semen, affects around 15% of infertile males. Sertoli cell-only syndrome (SCOS) is the most common pathological lesion in the background of non-obstructive azoospermia and is characterised by the complete absence of germinal epithelium, with Sertoli cells exclusively present in the seminiferous tubules. Studies have shown a correlation between successful spermatogenesis and male fertility with lipid composition of spermatozoa, semen, seminal plasma or testis. The aim of this research was to discover the correlation between the Johnsen scoring system and phospholipid expressions in testicular cryosections of SCOS patients. MALDI imaging mass spectrometry is used to determine spatial distributions of molecular species, such as phospholipids. Phosphatidylcholines (PCs), phosphatidylethanolamines (PEs) and sphingomyelins (SMs) are the most abundant phospholipids in mammalian cells and testis. SMs, the structural components of plasma membranes, are crucial for spermatogenesis and sperm function. Plasmalogens, are unique PCs in testis with strong antioxidative properties. This study, using imaging mass spectrometry, demonstrates the local distribution of phospholipids, particularly SMs, PCs, plasmalogens and PEs in human testicular samples with SCOS for the first time. This study found a strong relationship between the Johnsen scoring system and phospholipid expression levels in human testicular tissues. Future findings could enable routine diagnostic techniques during microTESE procedures for successful sperm extraction. Full article

This study investigated the interfacial reactions between n-type Bi₂(Te,Se)₃ thermoelectric material, characterized by a highly-oriented (110) plane, and pure Sn and Sn-3.0Ag-0.5Cu (wt.%) solders, respectively. At 250 °C, the liquid-state Sn/Bi₂(Te,Se)₃ reactions resulted in the formation of both SnTe and BiTe phases, with Bi-rich particles dispersed within the SnTe phase. The growth of the SnTe phase exhibited diffusion-controlled parabolic behavior over time. In contrast, the growth rate was considerably slower compared to that observed with p-type (Bi,Sb)₂Te₃. Solid-state Sn/Bi₂(Te,Se)₃ reactions conducted between 160 °C and 200 °C exhibited similar interfacial microstructures. The SnTe phase remained the primary reaction product, embedded with tiny Bi-rich particles, revealing a diffusion-controlled growth. However, the BiTe layer had no significant growth. Further investigation into growth kinetics of intermetallic compounds and microstructural evolution was conducted to elucidate the reaction mechanism. The slower growth rates in Bi₂(Te,Se)₃, compared to the reactions with (Bi,Sb)₂Te₃, could be attributed to the strong suppression effect of Se on SnTe growth. Additionally, the interfacial reactions of Bi₂(Te,Se)₃ with Sn-3.0Ag-0.5Cu were also examined, showing similar growth behavior to those observed with Sn solder. Notably, compared with Ag, Cu tends to diffuse towards the interfacial reaction phases, resulting in a high Cu solubility within the SnTe phase. Full article

The Sustainable Development Goals, adopted by all United Nations Member States, emphasize sustainable cities and communities, aiming to strengthen development planning and foster positive links between urban and rural areas by 2030. As the newly leading platform for urbanization development, characteristic towns (‘Tese Xiaozhen’ in Chinese) contribute to the target of sustainable urbanisation, wherein town policies are especially important for leading the sound development of characteristic towns. However, the effect of these characteristic towns policies remains uncertain. Additionally, most related studies have utilized qualitative methodologies in policy evaluation, which may be inadequate to guide actual practice. Thus, in order to accurately acknowledge the effect of characteristic towns policies, a policy evaluation framework is established in this paper, utilising the multiple streams theory, text mining and the Policy Modelling Consistency Index model (PMC-Index model). Then, taking 225 policy documents promulgated in China from 2015 to 2022 as the research objects, policy evaluation indicators were selected by combining the multiple streams theory to improve the PMC-Index model and a text mining method. Thereafter, an empirical analysis was conducted to evaluate the consistency of 10 characteristic towns policies chosen. The results indicate that the mean value of the PMC indexes of the 10 examined policies is 7.13 in the total of 9 points, which means that the general performance of the characteristic town policies is satisfactory, yet the low scores in terms of effectiveness, content, and guarantee. In the end, some recommendations and suggestions are proposed for clarifying administrative attributes, optimizing the integration of urban and rural resources, and adjusting the policy hierarchy to a bottom-up approach. This study not only provides a policy evaluation framework to comprehensively understand the consistency of global urbanization policies but also offers a beneficial reference for promote urban–rural sustainable development. Full article

Male infertility has affected an increasingly large population over the past few decades, affecting over 186 million people globally. The advent of assisted reproductive technologies (ARTs) and artificial intelligence (AI) has changed the landscape of diagnosis and treatment of male infertility. Through an extensive literature review encompassing the PubMed, Google Scholar, and Scopus databases, various AI techniques such as machine learning (ML), artificial neural networks (ANNs), deep learning (DL), and natural language processing (NLP) were examined in the context of evaluating seminal quality, predicting fertility potential, and improving semen analysis. Research indicates that AI models can accurately estimate the quality of semen, diagnose problems with sperm, and provide guidance on reproductive health decisions. In addition, developments in smartphone-based semen analyzers and computer-assisted semen analysis (CASA) are indicative of initiatives to improve the price, portability, and accuracy of results. Future directions point to possible uses for AI in ultrasonography assessment, microsurgical testicular sperm extraction (microTESE), and home-based semen analysis. Overall, AI holds significant promise in revolutionizing the diagnosis and treatment of male infertility, offering standardized, objective, and efficient approaches to addressing this global health challenge. Full article

Magnetic activated cell sorting (MACS) is a well-known sperm selection technique, which is able to remove apoptotic spermatozoa from semen samples using the classic annexinV based method. Leukocytes and erythrocytes in semen samples or in testicular tissue processed for in vitro fertilization (IVF) could exert detrimental effects on sperm. In the current study, we rethought the aforementioned technique and used magnetic microbeads conjugated with anti-CD45/CD235a antibodies to eliminate contaminating leukocytes and erythrocytes from leukocytospermic semen samples and testicular tissue samples gained via testicular sperm extraction (TESE). With this technique, a 15.7- and a 30.8-fold reduction could be achieved in the ratio of leukocytes in semen and in the number of erythrocytes in TESE samples, respectively. Our results show that MACS is a method worth to reconsider, with more potential alternative applications. Investigations to find molecules labeling high-quality sperm population and the development of positive selection procedures based on these might be a direction of future research. Full article