Seminal plasma anti-Müllerian hormone level correlates with semen parameters but does not predict success of testicular sperm extraction （TESE）

Aim： To assess seminal plasma anti-Müllerian hormone （AMH） level relationships in fertile and infertile males. Methods： Eighty-four male cases were studied and divided into four groups： fertile normozoospermia （n = 16）, oligoastheno- teratozoospermia （n = 15）, obstructive azoospermia （OA） （n = 13） and non-obstructive azoospermia （NOA） （n = 40）. Conventional semen analysis was done for all cases. Testicular biopsy was done with histopathology and fresh tissue examination for testicular sperm extraction （TESE） in NOA cases. NOA group was subdivided according to TESE results into unsuccessful TESE （n = 19） and successful TESE （n = 21）. Seminal plasma AMH was estimated by enzyme linked immunosorbent assay （ELISA） and serum follicular stimulating hormone （FSH） was estimated in NOA cases only by radioimmunoassay （RIA）. Results： Mean seminal AMH was significantly higher in fertile group than in oligoasthenoteratozoospermia with significance （41.5±10.9 pmol/L vs. 30.5±10.3 pmol/L, P 〈 0.05）. Seminal AMH was not detected in any OA patients. Seminal AMH wascorrelated positively with testicular volume （r = 0.329, P = 0.005）, sperm count （r = 0.483, P = 0.007）, sperm motility percent （r = 0.419, P = 0.021） and negatively with sperm abnormal forms percent （r = -0.413, p = 0.023）. Nonsignificant correlation was evident with age （r = -0.155, P = 0.414） and plasma FSH （ r = -0.014, P = 0.943）. In NOA cases, seminal AMH was detectable in 23/40 cases, 14 of them were successful TESE （57.5%） and was undetectable in 17/40 cases, 10 of them were unsuccessful TESE （58.2%）. Conclusion： Seminal plasma AMH is an absolute testicular marker being absent in all OA cases. However, seminal AMH has a poor predictability for successful testicular sperm retrieval in NOA cases.

外阴痛:病理生理因素和临床治疗新观点方面的综述(英文)

慢性外阴疼痛,简称为外阴痛,在普通妇女人群中的发病率约为16%。本文简要概述了外阴痛的病因学以及治疗现状。到目前为止,对自发性广泛性外阴痛(unprovoked generalized vulvodynia,UGVD)的研究较少,本文重点讨论了外阴痛的一个亚类,即诱发的阴道前庭痛(provoked vestibulodynia,PVD),其症状为压迫阴道前庭周围可产生严重的烧灼样痛或剧烈疼痛。以往的研究表明外周(如阴道前庭组织异常、骨盆肌张力增高)和中枢(如神经中枢冲动增多)因素都参与了PVD的发生和维持过程。此外,由于患者对疼痛的心理性反应各异,也影响了疼痛症状的表现和时程。尽管PVD的发生包含多种因素,但到目前为止,对其治疗的研究都是单一的,回顾性和不可控的。本综述着眼于对PVD的外周(如局部用药、外阴大腺切除术等)和中枢(如应用抗抑郁药、镇痛治疗等)治疗,同时还讨论了针对于痛觉传递过程中不同水平(外周和中枢)的多向治疗方案。鉴于PVD机制的复杂性,今后对PVD的治疗推荐应用生物心理社会学疗法。

Proactive psychological and psychiatric support of patients with chronic noncommunicable diseases in a randomised trial:a Ukrainian experience

Background Presently, approaches for the early treatment of pathological anxiety in patients with chronic non-communicable diseases are lacking, thus delaying the initiation of symptom management at the early onset of the illness. Proactive psychological and psychiatric support, to alleviate subclinical symptoms of anxiety and to improve the quality of life in patients with chronic non-communicable diseases, is a promising candidate for the role of such therapy.Aims To investigate and determine the effectiveness of proactive psychological and psychiatric support for alleviating subclinical symptoms of anxiety and improving quality of life, in patients with chronic non-communicable diseases.Methods The study design was a monocentric randomised controlled trial with parallel groups. The study, involving 193 inpatients with chronic non-communicable diseases, complied with the ethical and deontological norms in accordance with the principles set out in the Declaration of Helsinki. Instruments used in the study included the Hamilton Anxiety Scale (HAM-A) to assess subclinical symptoms, the Scale of Somatic Symptoms and the Chaban Quality of Life Scale. Block randomisation was used to randomise patients to a 2-month-long study group with a proactive counselling psychiatry model care or a control group with standard regulated treatment for chronic non-communicable diseases. The allocation ratio was 1.15:1 owing to the expectancy of a higher percentage of dropout in the intervention group.Results After 60 days of treatment (T2), there was a statistically significant difference in all clinical parameters between the study and control groups. The median HAM-A value differed between the groups by 4.87 points, with statistically significant lower results in the study group. The comparison of the study group’s scale values on day 1 and day 60 demonstrated statistically significant changes in all three indicators.Conclusions Our results support existing evidence for the effectiveness of proactive psychological and psychiatric support to reduce subclinical anxiety and somatisation symptoms and to improve the quality of life for patients with common chronic non-communicable diseases. However, continued research on the effectiveness of proactive psychological and psychiatric support for patients with chronic non-communicable diseases is needed.

Sexuality after childbirth: Gaps and needs

Childbirth is a stressful event for a majority of women and can have many consequences one of which is female sexual dysfunction. The main aim of pre- and postnatal health services is to fulfil physical and emotional needs of mothers and babies but not sexual function of women. Also, the fact that sexual satisfaction is part of general well being and mental health is generally neglected. Sexual function of women not only is affected by childbirth, but also is influenced by many other factors. One of these factors is culture and religion. Women's sexual life after childbirth has different meaning in different cultures. In many conservative societies with certain cultural and religious beliefs women are prohibited from having sex after childbirth. In these societies, women hear conflicting stories about risks and benefits of having sexual intercourse during postpartum period the majority of which may not be true. It has been reported that some women may be at greater risk of postpartum sexual dysfunction as neurobiological factors and genetics have been recently suggested to impact female sexual functioning. Considering the multidimensional nature of female sexual dysfunction, this problem cannot be resolved by a simple solution and not all postpartum women can be treated by the same protocol. Various treatment options, such as the use of medications, behavioural interventions and psychotherapy have been investigated in research studies and there is still controversy over the issue. Regarding the fact that sexually satisfied women are more mentally healthy, routine screening during prenatal, antenatal and postnatal visits are suggested to uncover hidden difficulties with sexual functioning of women and improve their quality of life.

Treatment of Vasculogenic Erectile Dysfunction with Piezowave2 Device. Application of Low Intensity Shockwaves Using Novel Linear Shockwave Tissue Coverage (LSTC-ED®) Technique. A Prospective, Multicentric, Placebo-Controlled Study

Low intensity shockwave (LiSW) treatment is known to improve revascularization. The method has been evaluated and is used to treat vasculogenic erectile dysfunction (ED). The present study aimed to demonstrate the efficacy of a linear focused piezoelectric shockwave device (Richard Wolf/ELvationPiezowave2) to treat patients with vasculogenic ED using a novel linear shockwave tissue coverage LSTC-ED® technique. A total of 75 patients were treated using the Piezowave2 device and the LSTC-ED® technique. Patients’ erectile function was evaluated using the modified IIEF-5 (International Index of Erectile Function) scale at the beginning of treatment and at 1 month post treatment;patients were additionally questioned using our own Treatment Satisfaction Questionnaire (TSQ). The study also included a group of 50 patients treated by placebo;the outcomes of both groups were compared. The average IIEF-5 score of patients in the treatment group increased from 14.4 at baseline to 18.6 at 1 month post treatment. According to the IIEF-5 scale, treatment was successful in 81.33% of patients (61/75). According to the Treatment Satisfaction Questionnaire (answers 1 to 3 of the TSQ), treatment was successful in 77.3% of patients (58/75). In the placebo group of 50 patients only 5 patients showed an improvement based on IIEF score, and 8 reported an improvement based on their answers to the TSQ. No significant adverse effects were observed during treatment or in the follow-up period. The Piezowave2 device and the LSTC-ED® technique proved to be suitable and effective to treat erectile dysfunction.

Acknowledgments to reviewers of World Journal of Obstetrics and Gynecology

Many reviewers have contributed their expertise and time to the peer review,a critical process to ensure the quality of World Journal of Obstetrics and Gynecology.The editors and authors of the articles submitted to the journal are grateful to the following reviewers for evaluating the articles(including those published in this issue and those rejected for this issue)during the last editing time period.

Impact of carbimazole combined with vitamin E on testicular injury induced by experimental hyperthyroidism in adult albino rats:oxidative/inflammatory/apoptotic pathways

Thyroid hormones play essential roles in spermatogenesis,but their effects on infertile males remain poorly understood.This study aimed to evaluate the impact of combining carbimazole(CBZ)with vitamin E(VE)on testicular injury induced by experimental hyperthyroidism in adult albino rats,focusing on oxidative,inflammatory,and apoptotic pathways.In this experimental study,64 adult male albino Wistar rats were divided into eight groups:Group I(control-untreated),Group II(CBZ-control),Group III(VE-control),Group IV(CBZ+VE-control),Group V(levothyroxine-induced testicular injury),Group VI(levothyroxine+CBZ-treated),Group VII(levothyroxine+VE-treated),and Group VIII(levothyroxine+CBZ+VE-treated).The study was conducted in the Faculty of Medicine,Suez Canal University(Ismailia,Egypt).After cervical decapitation,both testes and epididymis were examined histopathologically and immunohistochemically.Significant differences were observed among groups concerning malondialdehyde(MDA),glutathione(GSH),superoxide dismutase(SOD),and catalase(CAT;all P<0.001).Polymerase chain reaction analysis showed significant differences in tumor necrosis factor-α(TNF-α),interleukin-10(IL-10),Bcl-2-associated X protein(BAX),B-cell lymphoma 2 protein(Bcl2),p53,Caspase-3,Caspase-8,Caspase-9,and nuclear factor-kappa B(NF-κB)mRNA levels(all P<0.001).Hyperthyroid group treated with CBZ alone(Group VI)exhibited testicular side effects,affecting seminiferous tubules and spermatogenesis.However,the Group VIII showed improved spermatogenesis and a decrease in testicular side effects.The addition of VE to the treatment of hyperthyroid rats with CBZ reduced testicular side effects and seminiferous tubular affection when potentially improving spermatogenesis.Further research is needed to elucidate the underlying mechanisms fully.

Sexuality following trauma injury: A literature review

Restoration of the quality of life(QoL)of trauma injury survivors is the aim of trauma rehabilitation.It is generally acknowledged that sexuality is an important component of QoL;however,rehabilitation services frequently fall short of including sexuality as a matter of routine.The literature was reviewed to examine the experiences of trauma survivors from three groups:spinal cord injury(SCI),traumatic brain injury(TBI)and burns.The focus was on the impact of trauma on the QoL to identify future research directions and to advocate for the inclusion of sexuality as an integral part of rehabilitation.Databases searched were Proquest,Ovid,Cinahl,Medline,PsycInfo and Cochrane Central Register of controlled trials.A total of 36 eligible studies were included:SCI(n=25),TBI(n=6),burns(n=5).Four themes were identified across the three trauma groups that were labeled as physiological impact of trauma on sexuality,cognitive-genital dissociation(CGD),sexual disenfranchisement(SD)and sexual rediscovery(SR).Trauma injury has a significant impact on sexuality,which is not routinely addressed within rehabilitation services.Further sexuality research is required among all trauma groups to improve rehabilitation services and in turn QoL outcomes for all trauma survivors.

Mother and daughter became father and son： a case report

Dear Editor, Gender dysphoria （GD） is defined as a marked incongruence between one＇s experienced and one＇s assigned gender. It is characterized by a strong desire to get rid of one＇s primary and/or secondary sex characteristics and to have the primary and/or secondary sex characteristics of the other gender. Here, we present a case of a mother and daughter who were both diagnosed with GD.