Testosterone levels in patients with varicocele and azoospermia / 北京大学学报(医学版)

OBJECTIVE@#Androgen deficiency is common in aging males and may have unfavourable health consequences. Large-scale studies suggested low testosterone level might increse mortality and morbidity in ageing males. However, young men with low testosterone level might be neglected. Recent studies reported young men with infertility may have reduced testosterone level. To investigate the incidence of androgen deficiency in males with infertility and possible factors affecting the low testosterone level.@*METHODS@#Between January 2011 and December 2012, 407 men with infertility caused by varicocele (VC), obstructive azoospermia (OA) and nonobstructive azoospermia (NOA) in our center were included. The number of men in each group of OA, NOA and VC was 141, 97 and 169, respectively. All the eligible patients underwent a serum testosterone assessment by a single morning blood draw (between 8:00 to noon) to test for concentration of the total testosterone. All serum samples were determined by radioimmunoassay in our andrology laboratory. Androgen deficiency was defined as having a total testosterone level less than 300 ng/dL.@*RESULTS@#The mean age was (30.4±5.8) years. The mean testosterone level was (4.18±1.64) ng/dL (range 0.30 to 11.32 ng/dL). The overall incidence of androgen deficiency was 26.5% (108/407). The incidences of androgen deficiency in NOA, OA and VC groups were 40.2% (39/97), 19.1% (27/141) and 24.9% (42/169), respectively, which were significantly higher in the NOA than in the VC and OA groups (P < 0.001). The incidences had no difference between the VC and OA groups (P=0.229). Univariate analysis revealed the cause of infertility, FSH and the mean testis volume as possible affecting factors for androgen deficiency. However, on multivariate analysis the only cause of infertility was an independent predictor. The incidence of androgen deficiency was the highest in the NOA group [OR 0.492 (95% confidence interval 0.288-0.840)].@*CONCLUSION@#NOA and varicocele might be risk factors of androgen deficiency. Young men with NOA may have a higher possibility of low testosterone level. Testosterone level should be followed up after NOA and varicocele treatment. Androgen deficiency should be assessed in males with infertility in clinical practice.

Low-intensity extracorporeal shock wave therapy promotes recovery of sciatic nerve injury and the role of mechanical sensitive YAP/TAZ signaling pathway for nerve regeneration / 中华医学杂志(英文版)

BACKGROUND@#Histological and functional recovery after peripheral nerve injury (PNI) is of significant clinical value as delayed surgical repair and longer distances to innervate terminal organs may account for poor outcomes. Low-intensity extracorporeal shock wave therapy (LiESWT) has already been proven to be beneficial for injured tissue recovery on various pathological conditions. The objective of this study was to explore the potential effect and mechanism of LiESWT on PNI recovery.@*METHODS@#In this project, we explored LiESWT's role using an animal model of sciatic nerve injury (SNI). Shockwave was delivered to the region of the SNI site with a special probe at 3 Hz, 500 shocks each time, and 3 times a week for 3 weeks. Rat Schwann cells (SCs) and rat perineurial fibroblasts (PNFs) cells, the two main compositional cell types in peripheral nerve tissue, were cultured in vitro, and LiESWT was applied through the cultured dish to the adherent cells. Tissues and cell cultures were harvested at corresponding time points for a reverse transcription-polymerase chain reaction, Western blotting, and immunofluorescence staining. Multiple groups were compared by using one-way analysis of variance followed by the Tukey-Kramer test for post hoc comparisons.@*RESULTS@#LiESWT treatment promoted the functional recovery of lower extremities with SNI. More nerve fibers and myelin sheath were found after LiESWT treatment associated with local upregulation of mechanical sensitive yes-associated protein (YAP)/transcriptional co-activator with a PDZ-binding domain (TAZ) signaling pathway. In vitro results showed that SCs were more sensitive to LiESWT than PNFs. LiESWT promoted SCs activation with more expression of p75 (a SCs dedifferentiation marker) and Ki67 (a SCs proliferation marker). The SCs activation process was dependent on the intact YAP/TAZ signaling pathway as knockdown of TAZ by TAZ small interfering RNA significantly attenuated this process.@*CONCLUSION@#The LiESWT mechanical signal perception and YAP/TAZ upregulation in SCs might be one of the underlying mechanisms for SCs activation and injured nerve axon regeneration.

Point electro-cauterization versus holmium laser cauterization in the treatment of post-ejaculation hematuria / 中华男科学杂志

Objective@#To investigate the advantages and disadvantages of point electro-cauterization (PEC) and holmium laser cauterization (HLC) in the treatment of post-ejaculation hematuria.@*METHODS@#From January 2015 to December 2018, 73 patients with post-ejaculation hematuria, aged 24－63 (36.8 ± 4.2) years, underwent PEC (n = 35) or HLC (n = 38) after failure to respond to 3 months of conservative treatment. We compared the hospital days, total hospitalization expenses, maximum urinary flow rate (Qmax), average urinary flow rate (Qavg), Hamilton Anxiety Rating Scale (HAMA) score, postoperative duration of hematuria, and recurrence rate at 3 and 6 months after surgery.@*RESULTS@#All the patients experienced first ejaculation but no post-ejaculation hematuria at 1 month after operation. The recurrence rates were lower in the PEC than in the HLC group at 3 months (5.71% vs 2.63%, P > 0.05) and 6 months postoperatively (8.57% vs 5.26%, P > 0.05). Compared with the baseline, the Qmax was decreased from (18.56 ± 2.53) ml/s to (13.68 ± 3.31) ml/s (P < 0.05) and the Qavg from (14.35 ± 2.26) ml/s to (9.69±1.84) ml/s in the PEC group at 1 month after surgery (P < 0.01), but neither showed any statistically significant difference in the HLC group. Mild to moderate anxiety was prevalent in the patients preoperatively, particularly in those without job or regular income and those with a long disease course or frequent onset, the severity of which was not correlated with age, education or marital status. The HAMA score was decreased from18.65 ± 4.33 before to 12.35 ± 3.63 after surgery in the PEC group (P < 0.01), and from 16.88 ± 2.11 to 6.87 ± 4.36 in the HLC group (P < 0.01). The mean hospital stay was significantly longer in the former than in the latter group (［5.2 + 1.3］ vs ［3.4 ± 0.5］ d, P < 0.01), while the total cost markedly lower (［6.35 ± 1.20］ vs ［12.72 ± 2.15］ thousand RMB ¥, P < 0.05).@*CONCLUSIONS@#Both PEC and HLC are safe and effective for the treatment of post-ejaculation hematuria, with no significant difference in the recurrence rate at 3 and 6 months after operation, but their long-term effect needs further follow-up studies. PEC may increase the risk of negative outcomes of the postoperative urinary flow rate, while HLC has the advantages of better relieving the patient's anxiety, sooner discharge from hospital and earlier recovery from postoperative hematuria, though with a higher total cost than the former.

Relation of miR-140 Expression Level with Therapeutic Effect of Decitabine and Its Mechanism / 中国实验血液学杂志

OBJECTIVE@#To investigate the relationship of miR-140 expression level with the therapeutic effect of decitabine, and to explore whether the molecular mechanism is dependent on the regulation of TLR4 expression.@*METHODS@#Forty-seven patients with acute myeloid leukaemia (AML) were enrolled in our study and divided into decitabine combination treatment group (22 cases) and traditional treatment group (25 cases). The clinical efficacy was compared between these two groups. Real-time PCR was used to determine the plasma level of miR-140 in AML patients. Decitabine, miR-140 mimic and miR140 inhibitor were used to treat AML HL-60 cells in vitro, the real-time PCR and Western blot were used to detect the expressions of miR-140, TLR4 and NF-κB at both mRNA and protein levels.@*RESULTS@#Compared with traditional treatment group, decitabine combination treatment group showed more significant clinical efficacy. Plasma miR-140 level in both 2 treatment groups both decreased, but the plasma miR-140 level was higher in decitabine combination treatment group as compared with traditional treatment group. Experiment in vitro showed that 0.3 μmol/L decitabine significantly inhibited the HL-60 cell proliferation accompanied by up-regulation of miR-140 expression and down-regulation of expression of TLR4 and NF-κB. These effects induced by decitabine were partly reversed by pretreating the cells with 200 nmol/L miR-140 inhibitor.@*CONCLUSION@#Decitabine-induced up-regulation of miR-140 expression may be related with its chemotherapeutic effects, and miR-140/TLR4/NF-κB pathway may partly mediate the pharmacologic action of decitabine.

Qilin Pills for idiopathic oligoasthenospermia: A multi-centered randomized double-blind controlled clinical trial / 中华男科学杂志

Objective@#To evaluate the clinical efficacy and safety of Qilin Pills in the treatment of oligoasthenospermia in infertile men.@*METHODS@#This multi-centered randomized double-blind controlled clinical trial included 216 infertile males with oligoasthenospermia, 108 in the trial group and the other 108 in the control, the former treated with Qilin Pills at the dose of 6 g tid while the latter with Wuziyanzong Pills at 6 g bid, both for 12 weeks. We examined the total sperm count, sperm motility and the count of progressively motile sperm of the patients before and at 4, 8 and 12 weeks after medication and evaluated the safety of the drug based on the adverse events and the laboratory results of blood and urine routine examinations and liver and kidney function tests.@*RESULTS@#Compared with the baseline, the patients in the trial group showed a significant time-dependent improvement after 4, 8 and 12 weeks of medication in sperm motility (21.75% vs 27.54%, 29.04% and 32.95%, P <0.05), total sperm count (156.27 ×106 vs 177.33, 188.18 and 205.44 ×106, P <0.05), and the count of progressively motile sperm (32.08 ×10⁶/ml vs 46.33, 50.98 and 61.10 ×10⁶/ml, P <0.05). The three parameters above were also improved in the controls, but more significantly in the trial group (P <0.05).@*CONCLUSIONS@#Qilin Pills can evidently improve the semen quality of oligoasthenospermia patients with no obvious adverse events.

Daily low-dose tadalafil for erectile dysfunction induced by pelvic fracture urethral disruption / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the effect of daily low-dose tadalafil on erectile dysfunction (ED) induced by pelvic fracture urethral disruption (PFUD).</p><p><b>METHODS</b>This study included 46 cases of PFUD-induced ED treated from Jan 2008 to Dec 2011. The patients were aged 33.9 +/- 7.2 years (range 25 -51 yr), and the interval between injury and treatment was 19.6 +/- 12.7 months (range 3 - 72 mo), all with normal erectile function before PFUD. Based on the nocturnal penile tumescence and rigidity (NPTR) recorded by erectometry without medication of phosphodiesterase type 5 inhibitor (PDE-5I), the patients were divided into an abnormal nocturnal erection group and a non-nocturnal erection group, and treated with tadalafil 10 mg once daily for 3 months. The therapeutic effect was evaluated by IIEF-5 scores and the rate of yes responses to questions 2 and 3 of the Sexual Encounter Profile (SEP).</p><p><b>RESULTS</b>Totally 38 (82.6%) of the patients accomplished the treatment and follow-up, 26 (68.4%) in the abnormal nocturnal erection group and 12 (31.6%) in the non-nocturnal erection group. After 3 months of daily tadalafil treatment at 10 mg, the IIEF-5 scores were significantly improved in the abnormal nocturnal erection group than in the non-nocturnal erection group (P < 0.05), and the rate of yes responses to SEP2 and SEP3 was remarkably higher in the former than in the latter (76.9% vs 41.7% and 65.4% vs 25.0%, P < 0.05).</p><p><b>CONCLUSIONS</b>Daily low-dose tadalafil can effectively improve the erectile function of PFUD-induced ED patients, particularly in those with nocturnal erection.</p>

UPOINT system: a new diagnostic/therapeutic algorithm for chronic prostatitis/chronic pelvic pain syndrome / 中华男科学杂志

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition in urological outpatients, and is often improperly treated for its multifactorial etiology and non-specific clinical phenotype. Doctor Shoskes proposed a clinical phenotype system for CP/CPPS--the UPOINT system, which is a new diagnostic/therapeutic algorithm addressing 6 CP/CPPS phenotypic domains, including the urinary, psychosocial, organ specific, infection, neurological/systemic and muscle tenderness domains. Under the guidance of UPOINT, doctors can give a multimodal therapy for patients with CP/CPPS according to its clinical phenotype, and several clinical studies have demonstrated obvious clinical benefit from the UPOINT-based therapy.

Hypogastric artery autograft treating hemorrhage with infection of external iliac artery secondary to renal transplantation / 中华创伤杂志(英文版)

Massive hemorrhage from infected anastomosed site between the graft artery and the external iliac artery is one of the most serious complications of renal transplantation. Clinically, it is a rare but fatal occasion. We reported here one case of hemorrhage with infection in the iliac artery anastomosed site treated successfully with hypogastric artery autograft interposition in March 2003.

Generation of high affinity humanized single-chain antibody against PreS1 of hepatitis B virus from immune phage displayed antibody library / 中华肝脏病杂志

<p><b>OBJECTIVE</b>Screening and characterizing high affinity completely humanized single-chain antibody (ScFv) against PreS1 of hepatitis B virus.</p><p><b>METHODS</b>A combinatorial library of phage-displayed human ScFv, genes of which were derived from peripheral blood lymphocytes immunized by PreS1 of Hepatitis B Virus in vitro, was constructed. The library contained 7 10(8) clones.</p><p><b>RESULTS</b>After 3 rounds panning, a high affinity (K=10(7) to 10(8) mol/L) ScFv specific to PreS1 was obtained. The V(H) belonged to human V(H4) family, and V(1) to V(4) by sequence analysis.</p><p><b>CONCLUSION</b>This study suggests that the method of antigen stimulation in vitro is an expeditious way for the source of human immune antibody. And the ScFv may provide a more satisfactory therapy.</p>