Male infertility microsurgical training

Microsurgical training is imperative for urologists and clinical andrologists specializing in male infertility. Success in male infertility microsurgery is heavily dependent on the surgeon＇s microsurgical skills. Laboratory-based practice to enhance microsurgical skills improves the surgeon＇s confidence, and reduces stress and operating time, benefiting both the patient and the surgeon. This review provides guidelines for setting up a microsurgical laboratory to develop and enhance microsurgical skills using synthetic and animal models. The role of emerginE techniaues, such as robotic-assisted microsureerv, is also discussed.

Male circumcision： towards a World Health Organisation normative practice in resource limited settings

There is now grade 1 evidence that male circumcision （MC） reduces the risk of a man acquiring HIV. Modelling studies indicate MC could in the next 10 years save up to 2 million lives in those African countries with high HIV prevalence. Several African countries are now scaling up public health MC programmes. The most effective immediate public health MC programmes in Africa will need to target 18-20 years old men. In the longer term there is a need for infant circumcision programmes. In order to implement more widespread MC there is a need to make the surgical procedures as simple as possible so that safe operations can be performed by paramedical staff. The WHO Manual of Male Circumcision under local anaesthetic was written with these objectives in mind. Included in the manual are three adult techniques and four paediatric procedures. The adult procedures are the dorsal slit, the for- ceps guided and the sleeve resection methods. Paediatric methods included are the plastibell technique, the Mogen and Gomco shield method and a standard surgical dorsal slit procedure. Each method is described in a step by step manner with photographic and line drawing illustrations. In addition to the WHO manual of surgical technique a teaching course has been developed and using this course it has been possible in one week to train a circumcision surgeon who has had no or minimal previous surgical experience. Further scaling will require training of circumcision surgeons, monitoring performance, training the trainer workshops as well as advocacy at national, international and government meetings. In addition to proceeding with standardised methods work is in progress to assess novel techniques in adults such as stay on ring devices and policies are being formulated as to how to assess new devices. Also work is in progress to explore efficiencies in surgical processing by task sharing. Proper informed consent and safety remain paramount and great care has to be taken as programmes in Africa scale up. In continental China where the HIV epidemic is at a much earlier stage there may be a case for considering infant circumcision but great care will be needed to ensure that there is no harm.

First Asian ISSAM Meeting on the Aging Male, Kuala Lumpur,Malaysia, 1-3 March 2001-an overview

1 Aging in Asia-an avalanche starts to form With decreasing fertilityrate and increasing life expectan-cy, the world is aging- withhighest rates in Asia. The socio-economic, financial and medicalconsequences of the aging popu-

A randomized, controlled, multicenter contraceptive efficacy clinical trial of the intravas device, a nonocclusive surgical male sterilization

Because of unavoidable complications of vasectomy, this study was undertaken to assess the efficacy and safety of male sterilization with a nonobstructive intravas device （IVD） implanted into the vas lumen by a mini-surgical method compared with no-scalpel vasectomy （NSV）. IVDs were categorized into two types： IVD-B has a tail used for fixing to the vas deferens （fixed wing） whereas IVD-A does not. A multicenter prospective randomized controlled clinical trial was conducted in China. The study was comprised of 1459 male volunteers seeking vasectomy who were randomly assigned to the IVD-A （n = 487）, IVD-B （n = 485） or NSV （n = 487） groups and underwent operation. Follow-up included visits at the 3rd-6TM and 12~ postoperative months, The assessments of the subjects involved regular physical examinations （including general and andrological examinations） and semen analysis. The subjects＇ partners also underwent monitoring for pregnancy by monthly interviews regarding menstruation and if necessary, urine tests, There were no significant differences in pregnancy rates （0.65% for IVD-A, 0 for IVD-B and 0.21% for NSV） among the three groups （P 〉 0.05）. The cumulative rates of complications at the 12th postoperative month were zero, 0.9% and 1.7% in the three groups, respectively. In conclusion, IVD male sterilization exhibits a low risk of long-term adverse events and was found to be effective as a male sterilization method, similar to the NSV technique. IVD male sterilization is expected to be a novel contraceptive method.

Exploring the type of social support available to aged male hypertensive clients in Ghana

Objective: To explores the social support available to aged hypertensive male clients in a municipality in Ghana.Methods: The inclusion criteria were as follows: age ≥60 years and are known hypertensive patients. Data were collected from 186 selected aged male hypertensive patients for 3 months. The questionnaire was self-developed and open-ended. The data were processed and analyzed using SPSS version 23. Some of the variables were subjected to statistical tests and ranks in the order of impor tance to respondents. The enrolled respondents were allowed to par ticipate in the study after their informed consent was obtained. It was evident that respondents do not obtain much support or help in taking care of their condition.Results: The result revealed that the repondents has no support to help take care of their condition as evident by the responses in the study. The scores on average mean for some variables are(AM = 2.25, SD = 0.381) more than the test value of 2.50. Some of these supports were on feeding support(M = 3.97, SD = 0.278, n = 186), health support(M = 2.87, SD = 0.167, n = 186), and cleaning support(M = 2.59, SD = 0.868, n = 186). Supports such as clothing, socialization, medication, washing, transportation, and financial support were lacking.Conclusions: Based on the finding that certain forms of support were lacking, the study concludes that steps undertaken by the government, community, religious bodies, and family toward improving these supports can be of immense help for aged male hypertensive patients living in the Ejura-Sekyedumase municipality.

Qualitative Study on Male Nursing Students'Cognition of Nine-Valent Preventive Vaccine

Objective:To investigate the cognition degree of male nursing students to HPV and nine-valent vaccine and the influencing factors of male willingness to receive nine-valent HPV vaccine.Methods:Qualitative research semi-structured interview was conducted on male nursing students,and phenomenological research method was used to record,ran scribe,encode and classify the interview data and extract the topic.The number of interviews was determined according to the information saturation.Results:Seven themes were summarized in this study,which were mainly divided into two aspects.The promotion of vaccination includes two aspects:self-benefit and benefit of others.The prevention of vaccination mainly includes low awareness rate,feminization of vaccine infbnnation,high cost and safety and effectiveness.Conclusion:Male nursing students have low cognition degree and inoculation intention to human papillomavirus and nine-valent vaccine,so it is necessary to further strengthen publicity and carry out college education to improve vaccination.

Surveys of serum reproductive hormone levels and the prevalence rates of late onset of hypogonadism in Chinese aging males

Objective:To investigate the change patterns of reproductive hormones in serum of aging males and the difference among male age brackets and the prevalence rates of late onset of hypogonadism(LOH) in males in Chinese middle and aging males. Methods:Subjects included 1,498 men aged 40 to 69 from a county,and the serum reproductive hormones of 434 subjects were measured and calculated.In addition,the prevalence rates of LOH were analyzed by cut-off point of total testosterone(TT) and free testosterone(cFT),and screening scales(a questionnaire of androgen deficiency in the aging males(ADAM) and a scale of aging males’ symptoms(AMS)).TT,cFT,bio-available testosterone (Bio-T),luteinizing hormone(LH),sex hormone binding globulin(SHBG),testosterone secretion index(TSI), free testosterone index(FTD,the positive rates of LOH screening,androgen deficiency rates and the clinical prevalence rates of LOH were measured or calculated. Results:The serum TT levels did not change significantly with male aging while serum LH and SHBG levels gradually increased,but cFT,Bio-T,TSI and FTI levels gradually decreased with male aging.There was very significant difference in other six parameters of reproductive hormones(P<0.01),except for serum TT among the four age brackets(P>0.05).There was no correlation between serum TT levels and aging,LH levels(P>0.05). However,there was significantly a positive correlation between serum LH,SHBG and age(P<0.01),while there were negative correlation between cFT,Bio-T,TSI,FTI and age,LH levels(P<0.01).Moreover,SHBG level was positively correlated with LH level(P<0.01). Utilizing the Questionnaire of ADAM and AMS to screen subjects aged 40 to 69 years,mean positive rates of LOH screening were 80.77%and 32.34%respectively.Mean androgen deficiency rates were 14.02%and 43.69% by using TT and cFT cut-off point.In addition,mean LOH clinical prevalence rates of subjects on positive questionnaire results were 37.85%and 15.42%. Conclusion:The serum TT levels did not change significantly with male aging while serum LH,SHBG,cFT, Bio-T,TSI and FTI levels had the gradient change with aging.On the basis of Chinese population,however,the positive rate of LOH screening,androgen deficiency rate and clinical prevalence rate of LOH were obviously higher than that those of the other foreign studies.

Association between MTHFR c.677C>T variant and erectile dysfunction among males attending fertility clinic

Genetic risk factors have been shown to contribute to the development of sexual dysfunction.However,the role of methylenetetrahydrofolate reductase(MTHFR)gene variants in the risk of erectile dysfunction(ED)remains unclear.In this study,we recruited 1254 participants who underwent ED assessed by the International Index of Erectile Function-5.The MTHFR c.677C>T variant was also measured by fluorescence polymerase chain reaction(PCR).No significant difference in the genotypic frequency of the MTHFR C677T polymorphism(CC,CT,and TT)was observed between men from the ED and non-ED groups.In addition,on binary logistic regression analysis,both crude and adjusted models showed that the risk of ED was not significantly associated with the C677T polymorphism.Interestingly,a significantly higher frequency of the 677TT polymorphism was found in severe and moderate ED(P=O.02).The positive correlation between the MTHFR 677TT polymorphism and severe ED was confirmed by logistic regression analysis,even after adjusting for potential confounders(odds ratio[OR]=2.46,95%confidence interval[CI]:1.15-5.50,P=0.02).These findings suggest a positive correlation between the MTHFR 677TT polymorphism and the risk of severe ED.Identification of MTHFR gene polymorphisms may provide complementary information for ED patients during routineclinicaldiagnosis.

Varicocele and male infertility： current concepts and Future perspectives

This Special Issue of Asian Journal of Andrology is fully dedicated to the thematic area of Varicocele, which has been one of the most controversial issues in the field of Urology, Andrology, and Reproductive Medicine. Recognized as a dinical entity for over a century, varicocele from Latin： varix （dilated vein） and from Greek： kele （tumor） still elicits heated debate among scientists and clinicians on an arguable negative effect on male fertility and gonadal function and has fueled thousands of scholarly articles since its first report in the 18^th century.

人源肿瘤异种移植模型在儿童肿瘤研究领域的应用进展

儿童恶性肿瘤严重威胁儿童的生命健康以及生长发育。由于其与成人肿瘤在病因、病程上有显著不同,且患者人数较少,目前缺乏有效的研究手段。人源肿瘤异种移植模型是一种利用患者肿瘤组织构建的免疫缺陷小鼠模型,可以较完整地保留患者的肿瘤微环境,并保持与原发肿瘤较高的一致性,因此在新药开发和机制研究中得到了广泛应用。本文综述了人源肿瘤异种移植模型在儿童肿瘤如白血病、脑瘤、肉瘤、神经母细胞瘤、肾母细胞瘤、视网膜母细胞瘤及肝癌中的研究和应用现状,并分析了其在儿童肿瘤研究中的核心优势与局限性,旨在为儿童肿瘤发病机制的深入解析及新型治疗药物的研发提供参考。

Chromosome heteromorphisms: do they entail a reproductive risk for male carriers?

Dear Editor,Chromosome heteromorphisms are described as variations in size and morphology at specific regions that can be detected through classical banding methods.They are mitotically stable variants usually present in a heterozygous state(only one of the homologous chromosomes is heteromorphic).In humans,the most commonly detected heteromorphisms involve the heterochromatic regions of chromosomes 1,9,16,and Y(designated as lqh,9qh,16qh,and Yqh,respectively),and the short-arms,satellites,or stalks of the acrocentric chromosomes 13,14,15,21,and 22(e.g,for chromosome 13 designated as 13p.13ps,and 13pstk,respectively).Pericentric inversions involving the heterochromatic region of chromosomes l,9,and Y are also frequently observed.

Effects of long-term androgen replacement therapy on the physical and mental statuses of aging males with late-onset hypogonadism： a multicenter, randomized controlled trial in Japan （EARTH Study）

Androgen replacement therapy （ART） efficacy on late-onset hypogonadism （LOH） has been widely investigated in Western countries; however, it remains controversial whether ART can improve health and prolong active lifestyles. We prospectively assessed long-term ART effects on the physical and mental statuses of aging men with LOH in Japan. The primary endpoint was health-related quality of life assessed by questionnaires. Secondary endpoints included glycemic control, lipid parameters, blood pressure, waist circumference, body composition, muscular strength, International Prostate Symptom Scores （IPSS）, International Index of Erectile Function-5 （IIEF-5） scores, and serum prostate-specific antigen levels. Of the 1637 eligible volunteers, 334 patients 〉 40 years with LOH were randomly assigned to either the ART （n = 169） or control groups （n = 165）. Fifty-two weeks after the initial treatment, ART significantly affected the role physical subdomain of the short form-36 health survey （SF-36） scale （P= 0.0318）. ART was also associated with significant decreases in waist circumstance （P = 0.002） and serum triglyceride （TG） （P = 0.013） and with significant increases in whole-body and leg muscle mass volumes （P= 0.071 and 0.0108, respectively）, serum hemoglobin （P 〈 0.001）, IPSS voiding subscore （P = 0.0418）, and the second question on I IEF-5 （P = 0.0049）. There was no significant difference between the groups in terms of severe adverse events. In conclusion, in patients with LOH, long-term ART exerted beneficial effects on Role Physical subdomain of the SF-36 scale, serum TG, waist circumstance, muscle mass volume, voiding subscore of IPSS, and the second question of IIEF-5. We hope our study will contribute to the future development of this area.

Afterword to varicocele and male infertility： curreni concepts and future perspectives

We summarize and comment on the topics discussed by the contributors to this Special Issue of Asian Journal of Andrology. The scope of varicocele covers a wide spectrum, including proteomics and metabolomics, hormonal control, interventional therapy, and assisted reproductive technology （ART）. The selection of topics demonstrates the exciting breadth of this thematic area and the opportunity research holds for both increasing the understanding and improving the reproductive health of males with varicocele.

STUDIES ON MALE STERILE MATERIAL CONTROLLED BY THE RECESSIVE GENES OF WHEAT HAVING THE Aegilops squarrosa CYTOPLASM

In order to accelerate the progress in research of hybrid wheat, it is necessary to find out new source of male sterile cytoplasm. Aegilops squarrosa cytoplasm has been considered ideal material for producing new male sterile line of hybrid wheat. Although the male sterile mutants were induced by treatment with chemical mutagens, yet satisfactory male sterile materials controlled by recessive genes have so far not been obtained.

Asymptomatic postpubertal male with equally sized normal testicles with palpable left varicocele

Varicoceles are a common finding in the general public. The incidence appears to increase later in life with a contemporary study finding an increase in incidence of 10% per decade of life） While common in the general population, they are even more common among those presenting for a fertility evaluation, as high as 39% in some series and are often initially diagnosed during such examinations） Others present without symptoms or fertility issues and are found incidentally on a physical exam by a general practitioner.

EFFECT OF GOSSYPOL ON CONTENTS OF PROSTAGLANDINS IN REPRODUCTIVE ORGANS OF MALE RATS in vivo

Prostaglandins have been known to play an important role in reproduction, and the relationship between prostaglandins (PGs) and male reproduction is a promising developing field. We have reported the effect of gossypol on PGs levels in rat plasma,

单细胞测序联合孟德尔随机化分析鉴定前列腺癌预后相关基因及分析

目的:结合患者临床信息,通过单细胞测序联合多组学分析,识别前列腺癌发生发展中的关键基因,并利用转录组学进一步验证,鉴定出前列腺癌预后相关基因。方法:前列腺癌患者的单细胞测序数据来自GSE156632数据库中的4例患者,利用R语言进行细胞聚类和注释,随后挑选出上皮细胞进行差异分析,使用Hiplot网站对鉴定出的差异基因进行富集分析,随后利用UKB(UK Biobank)数据库下载基因对应的表达数量性状基因座(expression quantitative trait locus,eQTL)的单核苷酸多态性(single nucleotide polymorphism,SNP)位点,同时从TCGA(The Cancer Genome Atlas)和GEO(Gene Expression Omnibus)数据库下载了前列腺癌患者临床数据以及对应的基因表达数据。采用单因素COX回归分析观察孟德尔随机化后基因对患者预后的影响。结果:利用Seurat包对4例患者的单细胞数据进行质控和整合,在进行质控和细胞类型鉴定后,挑选出了上皮细胞亚群进行差异分析,共得到1566个基因,随后进行了富集分析,结果显示差异基因可能富集于Ras信号通路,细胞凋亡与氧化磷酸化等信号通路,随后使用1566基因进行了孟德尔随机化,得到了74个可能的因果基因,使用TCGA-PRAD和GSE116918对这74个基因进行了单因素COX回归分析,发现FAM3B,JUNB,TMEM59,KRT5这4个可能的相关基因,最后比较了孟德尔随机化和单因素COX回归的结果,发现KRT5可能是对前列腺癌最有影响的基因。结论:这些结果表明,FAM3B,JUNB,TMEM59,KRT5可能在前列腺癌进展中起到作用,KRT5可能成为前列腺癌的预后预测因子和治疗靶点。

术前MRI参数对腹腔镜根治性前列腺切除术术后早期尿控的预测

目的:收集术前核磁共振成像(MRI)所得图像测量的尿路结构相关参数,探究其与腹腔镜根治性前列腺切除术(LRP)术后早期尿控的关联性,为术后发生尿失禁的高危人群筛选提供理论依据。方法:经严格的筛选后共纳入自2015年1月至2021年2月在首都医科大学附属北京同仁医院确诊为前列腺癌并行LRP的49例患者,患者年龄50~78岁,随访时间1年。术前通过收集患者完整资料,提取可能与术后早期尿控情况相关的临床数据,同时测量MRI图像所示可能与尿控相关的解剖结构参数,并收集术后早期患者尿控恢复情况的相关数据—尿垫使用数量。采用SPSS23.0对数据进行基础统计学分析,经单因素相关分析筛选可能相关因素(P<0.1),再采用R4.0.3或SPSS23.0对纳入的因素与尿控结果进行多因素Logistic回归分析。结果:MRI图像测量所得前列腺前后径长度为(4.0±1.11)cm;前列腺左右径长度为(4.6±0.83)cm;前列腺上下径长度为2.4~6.4 cm;膜部尿道长度(MUL)为(13.16±3.52)mm;尿道横纹括约肌厚度范围为1.08~4.37 mm。多因素分析结果显示年龄与术后1个月尿控是否恢复存在相关性(P=0.035,OR=0.16)。尿道横纹肌厚度与术后3个月(P=0.011,OR=0.02)、术后9个月(P=0.014,OR=0.039)、术后12个月(P=0.014,OR=0.039)尿控是否恢复存在相关性。对于术后12个月仍存在尿失禁的患者,尿道横纹括约肌小于或等于1.6 mm,尿失禁较为严重[P=0.010,OR(95%置信区间)=(0.858,6.240)]。MUL与患者术后9个月(P=0.024,OR=0.508)及12个月(P=0.024,OR=0.508)尿控是否恢复呈正相关。前列腺体积、前列腺各径线、以及研究过程中纳入的可能与术后尿控情况存在相关性的因素在分析过程中显示无明显统计学意义。结论:尿道横纹肌厚度与患者早期尿控是否恢复呈正相关,且尿道横纹括约肌越薄,患者尿失禁程度越严重。MUL与早期尿控是否恢复呈正相关。年龄是LRP术后1个月尿控是否恢复的独立危险因素。需要进行长期随访的前瞻性研究进一步证实上述初步结果。

PDCD4和miR-107在阴茎癌组织中的表达及与患者预后的关系

目的:探究程序性细胞死亡因子4(PDCD4)及微小RNA-107(miR-107)在阴茎癌组织中的表达水平及与患者预后的关系。方法:选取2018年01月至2020年06月经本院确诊阴茎癌并行手术治疗患者32例,术中分别取患者阴茎癌组织(研究组)及癌旁正常阴茎组织(对照组)各32对,应用实时定量PCR(quantitative reverse transcription-PCR)检测两组PDCD4和miR-107的表达水平并分析其与临床病理参数及预后的关系,并采用Kaplan-Meier进行生存曲线分析及Logistic回归分析影响阴茎癌患者预后的因素。结果:研究组PDCD4表达量明显低于对照组,miR-107表达量明显高于对照组(P均<0.05);PDCD4和miR-107的表达与阴茎癌患者淋巴结转移、组织分级相关(P均<0.05),与年龄、吸烟史、饮酒史、肿瘤部位无关(P均>0.05);应用Kaplan-Meier法对生存率进行分析,miR-107低表达组生存率显著高于miR-107高表达组,PDCD4低表达组生存率低于PDCD4高表达组(P均<0.05)。多因素分析结果显示,TNM分期高、淋巴结转移、PDCD4低表达和miR-107高表达均是影响阴茎癌患者预后的独立危险因素(均P<0.05)。结论:阴茎癌患者miR-107呈异常高表达,PDCD4呈低表达,二者均是影响阴茎癌的独立危险因素且有望作为预测阴茎癌患者预后的重要指标。

自我接纳在勃起功能障碍患者病耻感与抑郁症状间的中介作用

目的:探讨自我接纳在勃起功能障碍(ED)患者病耻感与抑郁症状间的中介作用。方法:采用便利抽样法选取2022年1—12月于赣州市人民医院就诊的76例ED患者为研究对象,选取80例健康者作为健康组。使用一般资料调查表、自我接纳问卷(SAQ)、社会影响量表(SIS)和患者健康问卷(PHQ-9)调查评估研究对象自我接纳程度、病耻感程度、抑郁症状程度。并用采用分层回归法分析、检验患者自我接纳、病耻感与抑郁症状程度之间的关系和中介效应。结果:本次调查的ED患者SAQ总分(37.04±6.50)分,SIS总分(56.04±6.56)分,PHQ-9总分(8.53±2.98)分;ED组SAQ总分显著低于健康组,SIS总分和PHQ-9总分均显著高于健康组,差异均有统计学意义(P<0.05)。Pearson检验显示,ED患者自我接纳程度与病耻感程度、抑郁症状严重程度均为负相关(P<0.05),病耻感程度与抑郁症状严重程度为正相关(P<0.05);中介效应检验显示,ED患者的自我接纳在患者病耻感与抑郁症状严重程度间起部分中介作用,占总效应的14.95%。结论:ED患者病耻感通过自我接纳的中介作用影响抑郁症状严重程度。