Eosin Y-water test for sperm function examination / 中华男科学杂志

Based on the principles of the in vitro staining technique, hypotonic swelling test, and water test, the Eosin Y-water test method was developed to simultaneously detect the integrity of the sperm head and tail and sperm membrane structure and function. As a widely used method in clinical laboratories in China, the Eosin Y-water test is methodologically characterized by three advantages. Firstly, both the sperm head and tail can be detected at the same time, which allows easy and comprehensive assessment of membrane damage in different parts of sperm. Secondly, distilled water is used instead of the usual formula solution to simplify and standardize the test by eliminating any potential effects on the water molecules through the sperm membrane due to different osmotic pressure or different sugar proportions and electrolyte solutions. Thirdly, the test takes less time and thus can be repeated before and after treatment. This article focuses on the fundamental principles and modification of the Eosin Y-water test and its application in sperm function examination and routine semen analysis for male infertility, assessment of the quality of sperm retrieved by testicular fine needle aspiration, semen cryopreservation program development, and evaluation of sperm membrane integrity after microwave radiation.

Long-term benefit of male circumcision to the reduction of urinary tract infections and genitourinary cancers in China / 中华男科学杂志

Increasingly accumulated results from randomized controlled trials and other clinical studies have demonstrated that male circumcision reduces the risks of acquisition and transmission of HIV, HPV, HSV-2, and other sexually transmitted infections, and thus has a potential role in preventing cervical cancer, penile cancer and prostate cancer. The prevalence of male circumcision in China is currently less than 5%. The clinical evaluation studies and randomized controlled trials of the Shang Ring device showed excellent safety profiles, extremely high acceptability, and satisfaction among the participants and service providers in Africa and China. Given the recent recommendations by the World Health Organization and the Joint United Nations Program on HIV/AIDS (UNAIDS), voluntary medical male circumcision should be promoted in China at the national level as an important alternative intervention to reduce reproductive tract infections and prevent both males and females from reproductive tract cancers. More emphasis is required on the studies of the long-term health benefits of male circumcision in uro-andrology.

Clinical studies of shang ring male circumcision in China and Africa / 中华男科学杂志

HIV/STIs remain a major global public health problem. One of the global strategies for the prevention and control of HIV/STIs is to interrupt their transmission, which requires the public health methods based on scientific evidence and cost-effectiveness. The scale-up of male circumcision services in the priority countries of the HIV-prevention project in sub-Saharan Africa has been hampered by the scarcity of trained providers and relative technical difficulty of male circumcision techniques recommended by WHO and UNAIDS. Shang Ring is an innovative and disposable device for male circumcision, which has been safely used for over 600 000 males in China since 2006. Clinical studies of more than 3 000 cases of Shang Ring circumcision in China, Kenya, Zambia, and Uganda have demonstrated its safety, effectiveness, acceptability and ease of use. The most obvious advantages of Shang Ring include short procedure time (3-6 min), excellent postoperative cosmesis, low rate of complications, high acceptance by clients and providers, ease of use, and standardization for reliable performance. As an innovative technique, Shang Ring has a great potential for facilitating the safe and effective scale-up of circumcision services. This article comprehensively reviews the clinical studies of Shang Ring male circumcision in China and Africa.

Progress in the clinical studies of male circumcision using the Shang Ring / 中华男科学杂志

Male circumcision can reduce men's risk of HIV infection from heterosexual intercourse by 60% and is therefore recommended as an important strategy for HIV prevention in Africa by WHO and UNAIDS. However, rapid expansion of male circumcision efforts could be greatly facilitated by a safer, more effective and acceptable male circumcision surgical technique or device. Shang Ring is a simple technique developed in China. It allows a circumcision to be completed with minimal bleeding, without suturing, and in only 3-5 min and reported complications are few. A standardized adult male circumcision surgical protocol utilizing the Shang Ring device was developed in 2008 in China. Several surgical training courses using this protocol were successfully held in 2009 and 2010 in China. A recent pilot clinical study of the Shang Ring was conducted to evaluate its safety and efficiency in Kenya in 2009. The results and acceptability among study participants were excellent and confirmed many of the advantages seen in the earlier Chinese studies from Wuhu, Ningbo and Xi'an, suggesting that the Shang Ring is safe for further studies in Africa, thus, could facilitate more rapid roll-out of adult male circumcision through task shifting, surgical efficiencies and better acceptability. Further international investigations of the Shang Ring technique have now been planned for Kenya and Zambia in 2011. Moreover, adult male circumcision utilizing the Shang Ring device is now being considered as ope of the potential candidate techniques to be used in the scale-up of adult male circumcision services for HIV prevention in WHO priority countries in Africa. This review article summarizes Shang Ring related clinical studies, seminars and surgical workshops, publications and presentations conducted between February 2008 and December 2010 in China, the United States and Africa.

Adult male circumcision for military men: history and future / 中华男科学杂志

Adult male circumcision (MC) has been shown to reduce the transmission of HPV, HSV, and HIV significantly during vaginal intercourse. However, the benefits of adult MC for men in military service have been poorly documented. Soldiers in war time have additional challenges in maintaining good penile hygiene, rendering uncircumcised men vulnerable to inflammation and infection; these maladies not only negatively impact these individuals, but also undermine the overall military strength. Adult MC can provide some long-term benefits for these military service men. Many African countries have already taken a special interest in adult MC for their military forces, resulting in increased numbers of these surgeries among this special population of men. In this review, we discuss the history of adult MC in the military along with the current trends and economic significance.

WHO Laboratory Manual for the Examination and Processing of Human Semen: its applicability to andrology laboratories in China / 中华男科学杂志

The 5th edition of WHO Laboratory Manual for the Examination and Processing of Human Semen (2010) represents a comprehensive revision. This article aims to explore the applicability of this manual to andrology laboratories in China mainland in view of sperm count analysis, sperm motility analysis, sperm morphology analysis, sperm function analysis, anti-sperm antibody and seminal plasma biochemical marker analysis, and quality assurance and quality control of semen analysis. The authors deem that its recommendation to the analysis method and lower reference limit of sperm concentration may be a little arbitrary and lack of evidence-based support, that the revised grading sperm motility, the strict criteria and the very low cut-off value of 4% morphologically normal spermatozoa for the evaluation of sperm morphology are not applicable to andrology laboratories in China mainland, that the sperm function markers need to be supplemented, and that the determination methods of anti-sperm antibody and seminal plasma biochemical markers are incompatible with the status of Chinese andrology laboratories. However, its recommended methods for quality assurance and quality control of semen analysis have a significant directive role in China mainland. It is worth to point out that the WHO manual ignored the data obtained from Chinese which accounts for approximate 20% of the world population. Thus, given the importance of the WHO manual, its general applicability should be evaluated in China.

The need for high-quality training and surgical standards for adult male circumcision in China / 中华男科学杂志

Although HIV is a significant problem in Africa, HIV infection rates are rising rapidly in other regions such as Asia and South America. International health organizations have recognized the need to develop effective strategies to check the worldwide transmission of HIV. Studies have demonstrated the significant reduction of HIV, HPV, HSV-2 and other STD infection rates with male circumcision (MC). Although numerous MC techniques are available, there are no standardized protocols and surgical training programs. Studies have shown that the standardization of MC techniques coupled with training programs can significantly reduce complication rates. High complication rates have been a primary obstacle to the implementation of MC services. We recommend the establishment of surgical standards and training protocols prior to the promotion of MC services in China.

Male circumcision is an effective "surgical vaccine" for HIV prevention and reproductive health / 中华男科学杂志

Recent randomized controlled clinical trials in Africa have demonstrated that adult male circumcision (MC) efficiently decreases the rate of HIV, HPV and HSV-2 infections. Many studies have clearly shown that MC is a simple, safe, and cost-effective method for the prevention of sexually transmitted diseases and urinary tract infection, and for improving genital hygiene. While a 30% MC prevalence exists worldwide, only 5% or less of the Chinese males have undergone circumcision. In this review, we report recent trends in international MC and HIV prevention efforts, as well as the potential benefits and importance of promoting MC in China. We appeal to medical and public health authorities to pay close attention to the international experience in MC and HIV prevention.

A recommendable standard protocol of adult male circumcision with the Chinese Shang Ring: outcomes of 328 cases in China / 中华男科学杂志

<p><b>OBJECTIVE</b>Standardization of and training in adult male circumcision can significantly reduce its complication rate. Currently no such program exists for its standardization and training, making it difficult to guarantee the quality of male circumcision services. We therefore established a standardized surgical protocol for adult male circumcision in China using the Shang Ring, and applied it to a clinical study examining the performance of the Shang Ring in adult male circumcision.</p><p><b>METHODS</b>A total of 328 adult men aged 18-58 (mean 27.8) years, 25 with phimosis and 303 with redundant prepuce, underwent circumcision with the Shang Ring, and evaluation of the operation time, pain scores (using the visual analog scale), postoperative complications, time for wound healing, and their satisfaction with the postoperative appearance.</p><p><b>RESULTS</b>The operation time was 4.7 +/- 1.3 minutes. The pain scores were 0. 2 +/- 0.6 during the surgery, 1.6 +/- 1.0 twenty hours postoperatively, 1.7 +/- 1.1 twenty hours prior to the ring removal, and 2.7 +/- 1.4 during the ring removal. Complications included infection in 2 (0.6%), bleeding in 2 (0.6%), and wound dehiscence in 2 (0.6%) of the patients. None of the patients with wound dehiscence required postoperative suturing and all were managed conservatively instead. Sixteen of the patients (4.9%) experienced penile edema. The time for complete wound healing after circumcision was 20.3 +/- 6.7 days. The rate of the patients'satisfaction was 99.7% (327/328).</p><p><b>CONCLUSION</b>The standard protocol of adult male circumcision with the Shang Ring has the advantages of short operation time, slight pain, low rate of complications, and high satisfaction and acceptance of the patients. Strict standardization of the surgical protocol can maximize its clinical advantages for adult male circumcision.</p>

Evaluation of sperm mitochondrial membrane potential in varicocele patients using JC-1 fluorescent staining / 中华男科学杂志

<p><b>OBJECTIVE</b>To detect sperm mitochondrial membrane potential (MMP) of varicocele patients and investigate its clinical significance.</p><p><b>METHODS</b>Sixty-seven varicocele patients were divided into a VC1 (grade 1, n = 26), a VC2 (grade 2, n = 21) and a VC3 group (grade 3, n = 20). And 29 normal fertile volunteers were included in a control group ( m = 29). Conventional semen analyses were performed by computer-assisted semen analysis (CASA). Semen samples were washed, followed by JC-1 staining to evaluate the sperm MMP (JC-1+ %) by flow cytometry.</p><p><b>RESULTS</b>The sperm MMPs of the VC1, VC2 and VC3 groups were siginificantly lower ([56.29 +/- 16.32]%, P < 0.05; [45.04 +/- 13.21]%, P < 0.01; [31.63 +/- 12.91]%, P < 0.01) than that of the control ([76.21 +/- 13. 96]%). There was a significant positive correlation between the percentage of JC-1+ and that of grade (a + b) sperm (r =0.693, P=0.000).</p><p><b>CONCLUSION</b>The decreased MMP in the sperm of varicocele men might be one of the important causes of male infertility.</p>

Comparison of four methods for sperm counting / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the accuracy and precision of 4 methods including Hemacytometer, Makler chamber, Cell-VU chamber, and computer-aided semen analysis for determining sperm concentration.</p><p><b>METHODS</b>Latex bead solutions with concentrations known as (35 +/- 5) x 10(6)/ml and (18.0 +/- 2.5) x 10(6)/ml and semen samples (n = 54) were counted by the above 4 methods and the results were then compared.</p><p><b>RESULTS</b>Mean bead concentrations for Hemacytometer, Makler, Cell-VU chambers and CASA were (44.84 +/- 4.86), (52.36 +/- 7.78), (39.70 +/- 4.76), (28.53 +/- 2.06) x 10(6)/ml respectively for the standard solution containing (35 +/- 5) x 10(6)/ml, and (21.04 +/- 1.87), (24.54 +/- 3.67), (19.09 +/- 2.02), (14.62 +/- 0.95) x 10(6)/ml respectively for a standard solution containing (18 +/- 2.5) x 10(6)/ml. The results of Cell-VU chamber were consistently similar and close to the standard solutions, while those of Hemacytometer, Makler chambers were overestimated, and those of CASA were underestimated. The coefficients of variation for Hemacytometer, Makler, Cell-VU chambers and CASA were 10.81%, 14.86%, 12.80%, and 7.22% respectively for a higher standard solution, while 8.89%, 14.96%, 10.58%, and 6.50% respectively for a lower standard solution. CASA has the lowest CV%. When semen samples were counted, the results of Hemacytometer, Makler, Cell-VU chambers and CASA were (76.98 +/- 59.90), (63.89 +/- 53.84), (45.28 +/- 34.52), (41.96 +/- 31.93) x 10(6)/ml respectively. There wasn't any significant difference either between Cell-VU chamber and CASA (P = 0.71), or between Hemacytometer and Makler chamber (P = 0.14), while there was significant difference between Cell-VU chamber or CASA and Hemacytometer or Makler chamber (P < 0.05 or P <0.01).</p><p><b>CONCLUSION</b>When counting semen sample, there wasnt any significant difference between Cell-VU chamber and CASA. Each laboratory can select its own proper method for manual or computer-aided analysis.</p>

AIDS vaccines and immunotherapy of infertility / 中华男科学杂志

The development of prophylactic AIDS vaccines and immunotherapeutic approaches such as therapeutic AIDS vaccines would greatly benefit from acquired experience in reproductive immunology field relating to pregnancy and infertility. Certain immune and pathological aspects of HIV infection are closely related to problems faced by obstetricians, embryologists, gynecologists, and andrologists. This review attempts to bring together the recent advances in AIDS field with progress made in the physiology and pathology of reproduction in humans. The insight gained in reproductive biology research, particularly in the area of immunotherapy of recurrent spontaneous abortions, can help to develop better strategies for the treatment and prevention of HIV infection.

Andrology in the 21st century: keeping pace with the time / 中华男科学杂志

This editorial briefly reviewed the history of andrology, its rapid development in recent years, the conception of male health, international andrology studies, the achievements of Chinese andrologists and the existing problems. It is highly necessary for Chinese andrology community to strengthen the international academic communication, join the International Society of Andrology and attend its activities actively.