Ureaplasma urealyticum infection and apoptosis of spermatogenic cells

Aim: To study the relationship between ureaplasma urealyticum (UU) infection and apoptosis of human spennato-genie cells. Methods: Spermatogenic cells were observed under light microscope with Wright-Giemsa staining andby means of terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate (dUTP)-biotin nick-end labeling(TUNEL) technique. Results: Apoptotic rate of UU-infected males ( 15.5%±6.8% ) was significantly higherthan that of controls (5.2%±2.3 % ). Conclusion: Apoptosis of spermatogenic cells can be caused by UU in-fection, which provides further evidence for UU-induced male infertility.

Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia(2021 Edition)

Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.

Analysis of semen quality of 38 905 infertile male patients during 2008- 2016 in Wenzhou, China

This study analyzed the trend in semen quality of infertile male patients in Wenzhou,China,based on the data obtained from 38905 patients during 2008-2016 in The First Affiliated Hospital of Wenzhou Medical University(Wenzhou,China).The results showed that only 24.9%of the patients had normal semen quality.For the semen quality of infertile male patients,that of the workers and 40-year-olds was significantly worse than the other occupational and age groups.For all the infertile patients,low semen volume,asthenozoospermia,and teratozoospermia accounted for 8.4%,50.5%,and 54.1%,respectively.During 2008-2016,the annual mean percentage of fast forward motile spermatozoa,percentage of total forward motile spermatozoa,and percentage of spermatozoa with normal morphology decreased linearly with slopes of-2.11,-2.59,and-0.70,respectively.The proportion of patients with asthenozoospermia and multi-abnormal spermatozoa increased during 2008-2016 with slopes of 4.70 and 4.87,respectively,while for low semen volume,it decreased with a slope of-0.47 in the same time period.The proportion of patients with teratozoospermia increased from 2008 to 2011 and from 2011 to 2016 with slopes of 17.10 and 2.09,respectively.In general,the deteriorating trend of semen quality of infertile male patients in Wenzhou was obvious.Future efforts should be made to reveal the adverse influences on semen quality,such as occupational exposure,environmental quality,and living habits.Furthermore,more pervasive reproduction health education is necessary.

Prevalence of late-onset hypogonadism among middle-aged and elderly males in China:results from a national survey

This study aimed to propose an operational definition of late-onset hypogonadism(LOH)that incorporates both clinical symptoms and serum testosterone measurements to evaluate the prevalence of LOH in aging males in China.A population-based sample of 6296 men aged 40 years-79 years old was enrolled from six representative provinces in China.Serum total testosterone(TT),sex hormone-binding globulin(SHBG),and luteinizing hormone(LH)were measured and free testosterone(cFT)was calculated.The Aging Males’Symptoms(AMS)scale was used to evaluate the LOH symptoms.Finally,5078 men were included in this analysis.The TT levels did not decrease with age(P=0.59),and had no relationship with AMS symptoms(P=0.87 for AMS total score,P=0.74 for≥3 sexual symptoms).The cFT levels decreased significantly with age(P<0.01)and showed a negative association with the presence of≥3 sexual symptoms(P=0.03).The overall estimated prevalence of LOH was 7.8%(395/5078)if a cFT level<210 pmol l−1 combined with the presence of≥3 sexual symptoms was used as the criterion of LOH.Among them,26.1%(103/395)and 73.9%(292/395)had primary and secondary hypogonadism,respectively.After adjustment for confounding factors,primary and secondary hypogonadism was positively related to age and comorbidities.Body mass index was an independent risk factor for secondary hypogonadism.The results suggest that the AMS total score is not an appropriate indicator for decreased testosterone,and that the cFT level is more reliable than TT for LOH diagnosis.Secondary hypogonadism is the most common form of LOH.

MORN3：MEIG1的分子伴侣在小鼠生精细胞中的表达

哺乳动物精子发生由细胞发育和分化的精细过程组成。减数分裂基因1（MEG1）在调节精子发生过程中起着重要作用。为探讨MEIGl的作用机制，采用酵母双杂交筛选出可能与MEIG1发生作用的多个蛋白，OJMORN3蛋白。通过制备全长MORN3蛋白N端的特异性多克隆抗体，分别在体外和体内研究MORN3的表达和定位。免疫荧光染色转染CHO细胞显示，MORN3定位在整个包浆。体内实验证实25kDa的MORN3蛋白仅在小鼠睾丸组织中表达，且主要在出生后20天开始表达，即主要表达于精子发生的第三阶段生精细胞变态期。在从成年野生型小鼠分离的混合睾丸细胞的整个生精细胞变态期，MORN3均表达于顶体，在长形精子期该蛋白同时也在精子领表达。在Meig—J基因敲除小鼠中，MORN3总体表达水平和在顶体中的定位没有改变，但在精子领的表达显著降低。以上研究表明MORN3作为MEIGl蛋白的分子伴侣，可能是精子发生过程的另一个重要调节因子。

A novel AMH variant at the prehelix loop impairs the binding to AMHR2 and causes persistent Mullerian duct syndrome

Dear Editor,Persistent Mullerian duct syndrome(PMDS;Online Mendelian Inheritance in Man[OMIM]:#261550)is a rare autosomal recessive inherent difference in sex development in males with Mullerian duct derivatives,including the uterus,fallopian tubes,and upper part of the vagina.'Approximately 88%of PMDS patients were found to have biallelic variants in the anti-Mullerian hormone(AMH;OMIM:*600957)or AMH type 2 receptor(AMHR2;OMIM:*600956)genes,and the rest were referred as idiopathic.I The serum AMH levels are usually very low or undetectable in PMDS patients with AMH gene mutations but normal or elevated in those with AMHR2 gene mutations.Here,an adult Chinese patient with PMDS carrying biallelic variants of the AMH gene was reported to have unexpectedly normal serum AMH level.Please refer to Supplementary Information of Patient and Methods for methodologies.