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.

Novel no-flip Shang Ring circumcision for adult males: a clinical application study of 528 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the safety and clinical outcomes of the novel simplified no-flip surgical approach to Shang Ring male circumcision in adults.</p><p><b>METHODS</b>A total of 528 adult males, aged 18 - 58 (mean 35) years, 63 with phimosis and 465 with redundant prepuce, underwent no-flip Shang Ring circumcision with or without removal of the outer ring. The operation time and intraoperative blood loss were recorded and observations were made on such complications as postoperative bleeding, infection, edema, and wound dehiscence.</p><p><b>RESULTS</b>The operation time, intraoperative blood loss, and 2-hour postoperative pain score were (3.8 +/- 0.3) min, (0.6 +/- 0.1) ml, and 7.3 +/-0.3, respectively. Spontaneous ring detachment occurred at 21.6 +/- 2.1 days postoperatively in 12.7% of the patients (67/528) who had chosen not to remove the rings. Of those who preferred removal of the outer ring (87.3% [461/528]), none experienced any pain at the ring removal 7 days after the operation. Postoperative complications included infection in 3 cases (0.56%) and mild edema in 9 (1.70%), but no bleeding and wound dehiscence. Totally, 518 (98.1%) of the patients felt satisfied with the postoperative penile appearance.</p><p><b>CONCLUSION</b>No-flip Shang Ring circumcision, with no need for removal of the inner ring, is a safe and simple approach for adult males, which is superior to conventional Shang Ring circumcision for requirement of fewer surgical instruments, shorter operation time, lower incidence of complications, and better satisfaction with the penile appearance. However, these advantages are to be further demonstrated by more randomized controlled trials.</p>

Clinical observation on combination of compound xuanju capsule and clomiphene citrate in treating ovulatory dysfunctional infertility patients of Shen-yang deficiency / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the therapeutic efficacy of combination of Compound Xuanju Capsule (CXC) and clomiphene citrate (CC) for ovulatory dysfunctional infertility (001) patients of Shen-yang deficiency syndrome (SYDS).</p><p><b>METHODS</b>Totally 87 001 patients of SYDS were randomly assigned to 2 groups, the treatment group (44 cases, treated with CXC and CC) and the control group (43 cases, treated with CC alone). The post-treatment clinical symptoms, the cervical mucus, the endometrial thickness, the quality of follicles, the ovulation, and the pregnancy rate, and so on were observed.</p><p><b>RESULTS</b>In aspect of improving the patients' SYDS, the effective rate was 86.4% (38/44) in the treatment group and 25.6% (11/43) in the control group. It was better in the treatment group (P < 0.01). After treatment better effects on the cervical mucus, the endometrial thickness, and the pregnancy rate were obtained in the treatment group, showing statistical difference when compared with the control group (P < 0.05). There was no statistical difference in the rate of ovulation and mature follicular numbers between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>CXC combined CC could ameliorate hypoestrinemia-like effects on the endometrium, increase the endometrial thickness, and be favorable to the pregnancy in treating ODI patients of SYDS.</p>

Metformin improves epididymal sperm quality and antioxidant function of the testis in diet-induced obesity rats / 中华男科学杂志

<p><b>OBJECTIVE</b>To observe the effects of metformin on epididymal sperm quality and antioxidant function of the testis in diet-induced obesity rats.</p><p><b>METHODS</b>Thirty-two male SD rats were fed on high-fat food for 8 weeks to make obesity models, and another 8 were included as normal controls. Twenty-four of the model rats were equally randomized into a model control group to be fed continuously on high-fat food, a metformin group to be fed on normal food with metformin, and a normal food group. By the end of the 12th week, all the rats were killed for the determination of Lee's index, the organ coefficients of the testis and epididymis, epididymal sperm concentration, sperm motility, grade a + b sperm percentage, and the contents of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and malondialdehyde (MDA) in the testicular homogenate.</p><p><b>RESULTS</b>Lee's index was significantly increased in the model control group (P < 0.01) as compared with the other three. Lee's index was markedly higher in the normal control than in the metformin group (P < 0.05). The organ coefficients of the testis and epididymis were significantly decreased in the model control group (P < 0.01) as compared with the other three. Sperm concentration and motility and the percentage of a + b sperm were significantly decreased in the model control in comparison with the other three groups (P < 0.05 or P < 0.01). Sperm concentration was remarkably higher in the normal control than in the metformin and normal food groups (P < 0.05). The content of SOD (U/mg prot) was significantly lower in the model control (90.92 +/- 4.06) than in the normal control and metformin groups (101.69 +/- 8.49 and 102.04 +/- 10.67) (P < 0.05); that of GSH-Px (U) obviously higher in the normal control (28.32 +/- 2.28) than in the model control (23.49 +/- 1.08, P < 0.01), the metformin (25.73 +/- 2.14, P < 0.05) and the normal food group (25.77 +/- 2.19, P < 0.05), but evidently lower in the model control than in the metformin group (P < 0.05); and that of MDA (nmol/mg prot) significantly higher in the model control (2.68 +/- 0.76) than in the normal control (1.84 +/- 0.31, P < 0.01), the metformin (1.88 +/- 0.33, P < 0.01), and the normal food group (2.14 +/- 0.35, P < 0.05).</p><p><b>CONCLUSION</b>Metformin therapy and improved diet could improve sperm quality and promote the antioxidant ability of the testis in diet-induced obesity rats.</p>

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.

Assessment of bone marrow changes in postmenopausal women with varying bone densities: magnetic resonance spectroscopy and diffusion magnetic resonance imaging / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recent studies suggest that bone marrow adipose tissue might play a role in the pathogenesis of osteoporosis. There are inconsistent findings on the relationship among marrow fat content, bone mineral density and apparent diffusion coefficient (ADC). This study aimed to prospectively explore the efficacy of MR spectroscopy (MRS) and diffusion-weighted MR imaging (DWI) in detecting vertebral marrow changes in postmenopausal women with varying bone densities.</p><p><b>METHODS</b>Both MRS and DWI of the lumber spine were performed in 102 postmenopausal women (mean age, (67.3 +/- 6.5) years; range, 55 - 83 years), who underwent dual X-ray absorptiometry. Marrow fat content and ADC were compared and correlated among three groups: 24 with normal bone density, 31 with osteopenia and 47 with osteoporosis.</p><p><b>RESULTS</b>Vertebral marrow fat content was significantly increased in the osteoporotic group ((65.60 +/- 7.68)%, P < 0.001) and the osteopenic group ((57.68 +/- 6.45)%, P < 0.001), when compared with the normal bone density group ((51.67 +/- 3.27)%). ADC values were significantly decreased in the osteoporotic group ((0.39 +/- 0.03) x 10(-3)mm(2)/s, P < 0.001) and in the osteopenic group ((0.42 +/- 0.02) x 10(-3)mm(2)/s, P < 0.001), when compared with the normal bone density group ((0.47 +/- 0.03) x 10(-3)mm(2)/s). The marrow fat content negatively correlated with both bone density (r = -0.731, P < 0.001) and marrow ADC (r = -0.572, P < 0.001). The bone density positively correlated with the ADC values (r = 0.802, P < 0.001).</p><p><b>CONCLUSIONS</b>Postmenopausal women experience a corresponding increase in vertebral marrow fat content as the bone density decreases. Marrow fat content and ADC correlate to the bone density. MRS and DWI may indirectly assess the early bone marrow changes in postmenopausal women.</p>

Standardized male circumcision with Shang Ring reduces postoperative complications: a report of 351 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the effect of standardized male circumcision with Shang Ring in reducing postoperative complications.</p><p><b>METHODS</b>We performed standardized male circumcision with Shang Ring for 351 males aged 4-58 (mean 31) years, 46 with phimosis and 305 with redundant prepuce, and observed the complications, including postoperative bleeding, infection, edema, and wound dehiscence.</p><p><b>RESULTS</b>The main complications included infection (5 cases, 1.42%), mild edema (9 cases, 2.56%), moderate edema (5 cases, 1.42%), and wound dehiscence (6 cases, 1.71%), but no postoperative bleeding was observed.</p><p><b>CONCLUSION</b>Using the standard protocol of circumcision with Shang Ring, well-trained male circumcision providers can significantly reduce postoperative complications and enhance the patient's satisfaction. Normalized training of the circumcision providers is essential for the popularization of standardized male circumcision with Shang Ring.</p>

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.

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>

Clinical application of a new device for minimally invasive circumcision / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To study the clinical effects of a disposable circumcision device in treatment of male patients of different ages with either phimosis or excess foreskin.</p><p><b>METHODS</b>One thousand two hundred patients between the age of 5 and 95 years underwent circumcision using this procedure in the 2-year period between October 2005 and September 2007. Of these cases, 904 had excess foreskin and 296 were cases of phimosis.</p><p><b>RESULTS</b>In 96.33% of the cases the incision healed, leaving a minimal amount of the inner foreskin with no scarring and producing good cosmetic results. There were no incidents of device dislocation or damage to the frenulum. The average operative time was 2.5 min for excess foreskin, and 3.5 min for phimosis. During the 7 days of wearing the device, mild to moderate edema occurred in 10.08% of cases with excess foreskin and in 2.58% of those with phimosis. Edema in the frenulum was seen in 1.67% of patients, and only 0.67% had an infection of the incision. A total of 86.25% of patients reported pain due to penile erection. After removal of the device, 0.58% of the cases had minimal bleeding around the incision, and 2.42% had wound dehiscence.</p><p><b>CONCLUSION</b>The new device can be applied to an overwhelming majority of patients with phimosis and excess foreskin. This technique is relatively simple to perform, and patients who underwent this surgery had very few complications. Antibiotics were not required and patients reported less pain than those who were circumcised using conventional methods. Circumcision with this device requires minimal tissue manipulation, and is quicker and safer than circumcision using conventional techniques.</p>

Relationship of nitric oxide and nitric oxide synthase with varicocele infertility / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the relationship of nitric oxide (NO) and nitric oxide synthase (NOS) with varicocele (VC) infertility.</p><p><b>METHODS</b>Fifty-three infertile men, 21 with varicocele and 32 with subvaricocele, were enrolled as Group 1, 29 infertile patients with oligoasthenozoospermia but without varicocele as Group 2 and 28 normal fertile controls as Group 3. The NO content and NOS activity in the seminal plasma and peripheral blood were measured by nitric acid reductase method, and the semen parameters of VC determined by computer-assisted semen analysis (CASA).</p><p><b>RESULTS</b>Significant differences were noted between Group 1 and the other two in the NO content and NOS activity in the seminal plasma (P < 0.05) but not in the peripheral blood (P > 0.05). In Group 1, the NO content and NOS activity were increased in both the seminal plasma and peripheral blood with the enhanced diameter of the varicose spermatic vein, with a significant difference only in the seminal plasma between the varicocele and subvaricocele patients (P < 0.05), and the same increase was observed with decreased sperm concentration (> or = 20 x 10(6)/ml and < or = 10 x 10(6)/ml) and motility (> or = 50% and < or = 25%), with significant differences (P < 0.05).</p><p><b>CONCLUSION</b>NO plays an important role in the VC-induced decrease of seminal quality. For the diagnosis of VC, the determination of the NO content and NOS activity in the seminal plasma is of more significance than that in the peripheral blood, and the earlier the determination, the greater its clinical value for both the diagnosis and treatment of VC.</p>

CAG repeats of DNA polymerase gamma in Chinese males and relationship of idiopathic male infertility to CAG repeats / 中华男科学杂志

<p><b>OBJECTIVE</b>To analyze the polymerase gamma(Polg) gene polymorphisms in Chinese idiopathic infertile males and evaluate the correlation of the polymorphisms with male infertility.</p><p><b>METHODS</b>We conducted a study of Polg CAG repeats in the sperm or blood DNA of 55 asthenospermia patients, 57 oligospermia patients, 34 azoospermia patients, and 104 controls with PCR and GeneScan. Phenotypic data were available in all the subjects, including semen parameters, and clinical profiles.</p><p><b>RESULTS</b>The frequency of 10/not 10 CAG genotype in asthenospermia patients was higher than in the other groups, but with no significance.</p><p><b>CONCLUSION</b>Our findings have shown for the first time that there exits an ethnic difference between Chinese and European males in the number of CAG repeats of Polg gene, and that 10/not 10 CAG genotype may affect sperm motility.</p>

Expression of man, a formin homology domain-containing gene in the mouse limb / 生理学报

Formin defines a family of structurally related proteins that have two formin homology domains (FH1 and FH2). Various mutations in the formin locus result in limb deformity, suggesting that these genes play indispensable roles in the limb development. Here we report the isolation of a novel cDNA, man, from the mouse limb, which contains two conserved FH1 and FH2 domains. Its expression is described and possible functional significance is discussed.