Primary Retroperitoneal Lymph Node Dissection for Clinical Stage II A/B Seminomas: A Systematic Review and Meta-Analysis

ABSTRACT Introduction Chemotherapy and radiation therapy are considered standard treatments for stage II seminoma patients; however, these therapies are associated with long-term toxicities. Recently, retroperitoneal lymph node dissection has emerged as an alternative strategy, and the first three phase II trials were published in 2023 with promising results. The present study conducted a systematic review and meta-analysis to evaluate this surgery as an alternative treatment for stage IIA/B seminoma patients. Purpose Seminomas are the most common testicular tumors, often affecting young adult males. Standard treatments for stage II seminomas include chemotherapy and radiation therapy, but these therapies are associated with long-term toxicities. Thus, identifying alternative strategies is paramount. Herein, we conducted a systematic review and meta-analysis to appraise the efficacy and safety of retroperitoneal lymph node dissection (RPLND) for treating this condition. Methods We systematically searched the PubMed, Embase, and Cochrane databases for studies evaluating RPLND as a primary treatment for stage II A/B seminomas. Using a random-effects model, single proportion and means and pooled 2-year recurrence-free survival rates with hazard rates and 95% CI were calculated. Results Seven studies were included, comprising 331 males with stage II seminomas. In the pooled analysis, the recurrence rate was 17.69% (95% CI 12.31-24.75), and the 2-year RFS rate was 81% (95% CI 0.77-0.86). The complication rate was 9.16% (95% CI 6.16-13.42), the Clavien-Dindo > 2 complication rate was 8.83% (95% CI 5.76-13.31), and the retrograde ejaculation rate was 7.01% (95% CI 3.54-13.40). The median operative time was 174.68 min (95% CI 122.17-249.76 min), median blood loss was 105.91 mL (95% CI 46.89-239.22 mL), and patients with no evidence of lymph node involvement ranged from 0-16%. Conclusions Primary RPLNDs for treating stage IIA/B seminomas have favorable RFS rates, with low complication and recurrence rates. These findings provide evidence that this surgery is a viable alternative therapy for these patients.

Cáncer de mama en el hombre. Reporte de caso / Breast cancer in men. Case repor

Introducción: El cáncer de mama masculino es una patología infrecuente que re-presenta menos del 1% de la patología mamaria maligna, con una edad media de diagnóstico de 67 años. Tiene un peor pronóstico que el cáncer de mama femenino debido a su alto origen genético y baja sospecha, desencadenando diagnósticos inadecuados y tardíos, y disminuyendo la supervivencia a mediano y largo plazo.Objetivo: Describir el caso clínico de un paciente masculino con diagnóstico de cáncer de mama, abordando la presentación clínica, los métodos diagnósticos, el tratamiento oncoespecífico, y la evolución clínica y quirúrgica. Presentación del caso: Se presenta un paciente masculino de 52 años, con evi-dencia de lesión exofítica en mama derecha más ganglio axilar ipsilateral, con diag-nóstico confirmado de patología de cáncer de mama estadio clínico cT4bN1Mx. Se plantea un manejo multidisciplinario: quimioterapia neoadyuvante y mastecto-mía radical derecha. Finalmente recibe tratamiento oncoespecífico y radioterapia con evolución favorable.Discusión: El cáncer de mama masculino tiene una baja incidencia respecto a la mujer, por lo que su sospecha diagnóstica se ve limitada. En etapas iniciales el diagnóstico es inespecífico debido a las pocas manifestaciones clínicas, pero deberá respaldarse en métodos imagenológicos, análisis anatomopatológico e in-munohistoquímico para guiar el tratamiento oncoespecífico.Conclusión: El cáncer de mama masculino posee una sospecha diagnóstica limi-tada que requiere un manejo multidisciplinario específico. La correcta estadifica-ción de la patología depende del seguimiento clínico y un análisis inmunohistoquí-mico oportuno, para un tratamiento adecuado con mejores resultados clínicos y altas tasas de supervivencia.

Introduction: Male breast cancer is an infrequent pathology; it represents less than 1% of malignant breast pathology, with an average age of diagnosis of 67 years. It has a worse prognosis than female breast cancer, due to its high genetic origin and low suspicion, which leads to inadequate and late diagnosis, becoming evident in advanced stages, decreasing survival in the medium and long term.Objective: To describe the clinical case of a patient diagnosed with breast cancer, addressing the clinical presentation, diagnostic methods, oncospecific treatment, as well as the corresponding clinical and surgical evolution.Case presentation: We present a 52-year-old male patient, with evidence of exophytic lesion in right breast plus ipsilateral axillary node, with diagnosis confir-med by pathology report of breast cancer, clinical stage: cT4bN1Mx. A multidisci-plinary management is proposed, initially the patient receives neoadjuvant chemo-therapy, then undergoes a surgical procedure: radical right mastectomy. Finally, she receives oncospecific treatment in the specialties of clinical oncology and radiothe-rapy, with favorable evolution.Discussion: Male breast cancer has a low incidence compared to women, so its diagnostic suspicion is limited. In initial stages the diagnosis is unspecific due to the few clinical manifestations, but should be supported by imaging methods and confirmatory methods, an anatomopathological and immunohistochemical analy-sis, to guide oncospecific treatment. Conclusions: Male breast cancer, is an infrequent pathology with limited diagnos-tic suspicion, which requires specific multidisciplinary management. It is important to have a continuous medical follow-up of the patient, to achieve at the time of diagnosis a correct clinical and immunohistochemical staging, which allows to fo-cus on the appropriate management and treatment, with better clinical outcomes and better survival rates.

El laboratorio de fertilidad masculina, su evolución en los últimos 20 años / The male fertility laboratory, its evolution over the last 20 years / O laboratório de fertilidade masculina, sua evolução ao longo dos últimos 20 anos

Resumen La mayor accesibilidad a los tratamientos de reproducción asistida (RA) y los avances de la criobiología produjeron cambios en los laboratorios de andrología. El objetivo de este trabajo fue analizar la demanda y evolución de las variables seminales en las últimas dos décadas, caracterizar el laboratorio andrológico actual, evaluar el impacto de la incorporación del aseguramiento de la calidad y la inclusión de los sistemas computarizados (CASA). Se utilizaron datos de las medias mensuales del control de calidad interno (n=22 528) y encuestas a profesionales de laboratorios andrológicos (n=65) y a médicos especialistas en fertilidad (n=33). La demanda global se redujo significativamente con el aumento de las solicitudes de primera vez. El volumen y recuento, variables dependientes de andrógenos, disminuyeron con los años. El criterio estricto en morfología disminuyó el porcentaje de normales; la mitad de los médicos encuestados recibieron resultados entre 0 y 10% y el 40% consideró que ponía en riesgo el valor clínico de la variable. El sistema CASA permitió objetivar la cinética espermática e incrementar el porcentaje de progresivos rápidos, pero pocos laboratorios lo incorporaron. El 66% de los médicos resuelven el factor andrológico severo por tratamientos clínicos y el 95% utiliza técnicas de RA. El análisis de semen es ejecutado fundamentalmente por bioquímicos especializados, con baja adhesión a la automatización y acreditación del laboratorio, pero con participación en programas de evaluación externa de calidad. La demanda disminuyó como consecuencia del aumento del tratamiento por RA. La reducción del porcentaje de formas normales compromete su utilidad clínica.

Abstract Increasing availability to assisted reproduction (AR) treatments in Argentina and advances in cryobiology resulted in changes in andrology laboratories. The aim of this study was to evaluate the demand and evolution of seminal variables in the last two decades, characterise the current andrology laboratory, evaluate the impact of the incorporation of quality assurance and the introduction of computer assisted semen analysis (CASA). Data were taken from internal quality control (IQC) monthly means (n=22 528) and professionals in charge of laboratories (n=65) and fertility physicians' (n=33) surveys. Overall demand decreased significantly while first-time orders increased. Sperm volume and sperm count -androgen dependent parameters- decreased over the years. Strict morphology criteria reduced the percentage of normal results; half of the physicians received results between 0 and 10% and 40% considered that it compromised the clinical value of the variable. The CASA system made it possible to objectify sperm kinetic, increasing the percentage of fast progressives, but few laboratories have incorporated it. Sixty-six percent of physicians resolve severe andrological factor by clinical treatments and 95% use AR techniques in those cases. Semen analysis is mainly performed by specialised biochemists, with low adherence to laboratory automatisation and accreditation, but with participation in external quality assessment programmes. The demand decreased because of the increase in AR treatment. The lower percentage of normal forms compromises their clinical utility.

Resumo O aumento do acesso aos tratamentos de reprodução assistida (RA) e os avanços na criobiologia levaram a mudanças nos laboratórios de andrologia. O objetivo deste trabalho foi analisar a demanda e a evolução das variáveis de sêmen nas últimas duas décadas, caracterizar o laboratório de andrologia atual, avaliar o impacto da incorporação da garantia da qualidade e a inclusão dos sistemas computadorizados (CASA). Foram utilizados dados das médias mensais do controle de qualidade interno (n= 22 528) e pesquisas a profissionais de laboratórios andrológicos e a médicos especialistas em fertilidade (n=33). A demanda geral diminuiu significativamente com o aumento das solicitações de primeira vez. O volume e a contagem de esperma, parâmetros dependentes de andrógenos, diminuíram ao longo dos anos. O critério morfológico rigoroso diminuiu a porcentagem de normais; metade dos médicos entrevistados recebeu resultados entre 0 e 10% e 40% considerou que isso comprometía o valor clínico do parâmetro. O sistema CASA, permitiu objetivar a cinética espermática e aumentar o percentual de progressões rápidas, mas poucos laboratórios o incorporaram. 66% dos médicos resolvem o fator andrológico grave por tratamentos clínicos e 95% utilizam técnicas de RA nesses casos. A análise do sêmen é realizada principalmente por bioquímicos especializados, com baixa aderência à automação e acreditação laboratorial, mas com participação em programas de avalação externa de qualidade. A demanda diminuiu como consequência do aumento do tratamento por RA. A diminuição em percentagem de formas normais compromete sua utilidade clínica.

Cáncer de mama en coraza en hombre: un caso poco frecuente

El cáncer de mama en coraza constituye una de las formas clínicas de presentación de las metástasis cutáneas del cáncer mamario. Es de aparición poco frecuente, sobre todo, en el sexo masculino. Se presenta el caso de un paciente de sexo masculino, de 74 años de edad, de color de piel negra, con antecedente de diabetes e hipertensión arterial que acudió a consulta de mastología provincial por presentar desde hacía algunos meses dolor discreto y unas lesiones pruriginosas en la mama derecha. Además de otros exámenes se le realizó biopsia escisional de pequeño fragmento de la lesión con estudio por parafina que informó metástasis cutánea de un carcinoma mamario en coraza según su forma de presentación clínica. Se muestra el caso porque no se localizó ninguna publicación en la provincia Cienfuegos ni en el país de un caso en el sexo masculino, por lo cual se considera de interés para el personal médico la publicación de este reporte.

Shell breast cancer is one of the clinical forms of presentation of cutaneous metastases of breast cancer. It is rare, especially in males. The case of a 74-year-old male patient with black skin color, with a history of diabetes and high blood pressure, who attended a provincial mastology consultation for a few months of mild pain and pruritic lesions on his neck, is presented the right breast. In addition to other examinations, an excisional biopsy of a small fragment of the lesion was performed with a paraffin study, which reported cutaneous metastasis of a shell breast carcinoma according to its clinical presentation. The case is shown because no publication was found in the province of Cienfuegos or in the country of a male case, which is why the publication of this report is considered of interest to medical personnel.

The essential role of adenine nucleotide translocase 4 on male reproductive function in mice

Adenine nucleotide translocator 4 (Ant4), an ATP/ADP transporter expressed in the early phases of spermatogenesis, plays a crucial role in male fertility. While Ant4 loss causes early arrest of meiosis and increased apoptosis of spermatogenic cells in male mice, its other potential functions in male fertility remain unexplored. Here, we utilized Ant4 knockout mice to delineate the effects of Ant4-deficiency on male reproduction. Our observations demonstrated that Ant4-deficiency led to infertility and impaired testicular development, which was further investigated by evaluating testicular oxidative stress, autophagy, and inflammation. Specifically, the loss of Ant4 led to an imbalance of oxidation and antioxidants. Significant ultrastructural alterations were identified in the testicular tissues of Ant4-deficient mice, including swelling of mitochondria, loss of cristae, and accumulation of autophagosomes. Our results also showed that autophagic flux and AKT-AMPK-mTOR signaling pathway were affected in Ant4-deficient mice. Moreover, Ant4 loss increased the expression of pro-inflammatory factors. Overall, our findings underscored the importance of Ant4 in regulating oxidative stress, autophagy, and inflammation in testicular tissues. Taken together, these insights provided a nuanced understanding of the significance of Ant4 in testicular development.

Characteristics of resting energy expenditure and evaluation of prediction formulas in young men with different body mass indexes / 北京大学学报(医学版)

Objective:To compare the resting energy expenditure(REE)characteristics among young men with different body mass indexes(BMI).Methods:Thirty young men[average age was(26.93± 4.16)years]were enrolled in this study.They underwent resting metabolism tests in the Department of Sports Medicine of Peking University Third Hospital from December 2017 to June 2021.The resting meta-bolic rate(RMR)was measured by indirect calorimetry,the body composition was measured by bioresis-tance antibody component analyzer.The REE characteristics were analyzed,and 11 predictive equations were used to estimate RMR and compared with the measured value.The differences were analyzed by paired t-test and intra-class correlation coefficient(ICC).Results:The RMR of the overall 30 young men was(1 960.17±463.11)kcal/d(1 kcal=4.186 8 kJ).Including(1 744.33±249.62)kcal/d in those with normal BMI,which was significantly lower than that in those who were overweight or obese[(2 104.06±520.32)kcal/d,P＜0.01],but the weight-corrected RMR in those with normal BMI was significantly higher than that in those who were overweight or obese[(24.02±2.61)kcal/(kg·d)vs.(19.98±4.38)kcal/(kg·d),P＜0.01].The RMR was significantly and positively correlated with body weight,adiposity,lean body mass,body surface area,and extracellular fluid in the subjects with diffe-rent BMI(all P＜0.05).The predicted values of the 11 prediction equations were not in good agreement with the measured values(all ICC＜0.75),with relatively high agreement between the pre-dicted and measured values of the World Health Organization(WHO)equation in overweight obese young men(ICC=0.547,P＜0.01).Conclusion:There were significant differences in RMR among young men with different BMI,and the RMR after weight correction should be considered for those who were overweight or obese.The consistency between the predicted values of different prediction equations and the actual measured values of RMR was relatively poor,and it is recommended to accurately measure RMR by indirect calorimetry.For overweight or obese young men,the WHO prediction equation can be considered to calculate RMR,but it is necessary to establish an RMR prediction equation applicable to different BMI populations.

Exploration of Thoughts and Possible Therapeutic Mechanism of Treating Male Infertility from the Perspective of Spleen and Kidney by Regulating Intestinal Flora / 广州中医药大学学报

Based on the literature study,the thoughts and possible therapeutic mechanism in treating male infertility from the perspective of spleen and kidney by regulating intestinal flora were explored.Disturbance of intestinal flora is one of the important factors leading to the development of male infertility,and the spleen and kidney have certain similarities to intestinal flora in the physiological function and pathological changes.Moreover,tonifying the kidney and strengthening the spleen can regulate the intestinal flora by fostering the growth of beneficial bacteria,inhibiting the reproduction of pathogenic bacteria,and protecting the barrier of the intestinal mucosa.Therefore,the possible therapeutic mechanisms in treating male infertility with the prescriptions for tonifying the kidney and strengthening the spleen to regulate intestinal flora are as follows:inhibiting the expression of inflammatory factors to reduce the inflammatory reaction of testicular tissues;improving the antioxidant capacity to alleviate the damage of spermatozoa caused by oxidative stress,and improving the bad mood to alleviate the impact of psychological stress on the reproductive system.The exploration of the thoughts for treating male infertility from the perspective of spleen and kidney by regulating intestinal flora may provide a new entry point for modern Chinese medicine clinical treatment of male infertility.

Molecular mechanism of ATF6 regulating the reproduction related gene HSPA1L / 基础医学与临床

Objective To explore the effect of endoplasmic reticulum stress activating transcription factor 6(ATF6)on the expression of reproduction related gene heat shock protein family A member 1 like(HSPA1L)and preliminari-ly clarify its regulatory molecular mechanism.Methods The ATF6 over-expression plasmid was transfected into HEK-293T cells and the over-expression efficiency was verified by RT-qPCR and Western blot.The transcriptome sequen-cing information of testis tissue of male ATF6 knockout mice was used to screen five reproduction related genes down-stream of ATF6.The dual luciferase reporter assay selected the downstream genes with high promoter activity and de-tected the effect of over-expression of ATF6 on the promoter activity of downstream genes.The possible binding sites of ATF6 and downstream gene promoters were predicted by gene-regulation.RT-qPCR and Western blot were used to detect the effect of over-expression of ATF6 on downstream gene expression in HEK-293T cells.Whether ATF6 binds to downstream gene promoters was determined by electrophoretic mobility shift assay(EMSA).Results The expres-sion of ATF6 mRNA(P＜0.001)and protein(P＜0.001 and P＜0.05)in HEK-293T cells was significantly increased after transfection.HSPA1L(P＜0.001 and P＜0.05),a reproductive related gene downstream of ATF6 was screened by transcriptome sequencing and dual luciferase reporter assay.ATF6 promoted the truncated promoter activity of HSPA1L(P＜0.001).After over-expression of ATF6,the expression of HSPA1L was significantly increased(P＜0.001).The differences were statistically significant.ATF6 protein could bind to the aagtcgtcac DNA sequence of HSPA1L promoter.Conclusions ATF6,a key molecule of endoplasmic reticulum stress,regulates the expression of reproduction related gene HSPA1L by binding to the promoter of HSPA1L.This result will lay a foundation for further research on the prevention or treatment of endoplasmic reticulum stress(ERS)related male infertility.

The Effect of Smoking on the Semen Quality in Male Infertile / 昆明医科大学学报

Objective To investigate the effect of smoking on the semen quality in infertile men.Methods A total of 360 male infertility patients were enrolled and divided into the smoking group(n=190)and non-smoking group(n=170)based on whether they smoked or not.Furthermore,the smoking group was subdivided into group A(≤10 sticks/d,n=63),group B(11～20 sticks/d,n=80),and group C(>20 sticks/d group,n=47)according to the amount of smoking.Semen volume,liquefaction time,sperm concentration,motility,DNA fragmentation rate and normal morphological rate were observed and compared between and within the groups.Results There were significant differences in semen volume,liquefaction time,sperm motility,normal morphological rate and DNA fragmentation rate between the smoking group and the non-smoking group(P<0.05).The semen volume,sperm motility and normal morphological rate of the smoking group were lower than those in the non-smoking group,and the DNA fragmentation rate and semen liquefaction time were higher than those in the non-smoking group.And with the increase of smoking volume,sperm motility and normal morphological rate decreased,semen liquefaction time and DNA fragmentation rate increased,and there was no significant difference in the sperm concentration between the smoking group and non-smoking group(P>0.05).There was no significant difference in the semen volume between the three groups with different smoking amounts(P>0.05).Conclusion Smoking has a negative impact on the sperm quality parameters such as semen volume,sperm motility,normal morphological rate,sperm motility,liquefaction time and DNA fragmentation,and the effect of heavy smoking is particularly obvious.We should strengthen the comprehensive health education,promote the healthy lifestyles and reduce smoking.

Effect of SARS-CoV-2 infection on semen quality in males:a retrospective study and meta-analysis / 临床检验杂志

Objective To investigate the impact of SARS-CoV-2 infection on male semen quality through meta-analysis and retrospec-tive study.Methods Literature retrieval was conducted in PubMed,CNKI,Wanfang Database and CBM database.Meta-analysis was performed using Stata 15.0.The male patients meeting the inclusion criteria from our hospital were enrolled as study subjects.General demographic data and semen parameters were collected.Single factor analysis of variance and graphing of semen parameters were con-ducted using GraphPad Prism 9.5.1.The test level was set at 0.05.Results A total of 9 studies involving 267 patients were included in the meta-analysis.There were no significant differences in sperm concentration and survival rate before and after SARS-CoV-2 infec-tion(P＞0.05).Semen volume and percentage of normal morphology significantly increased during 1-3 months after infection(P=0.005,P=0.010),with semen volume recovering to pre-infection level＞3 months later(P＞0.05).Sperm motility and progressive mo-tility increased＞3 months after infection(P=0.046,P=0.045),recovering to pre-infection levels(P=0.099,P=0.098).Sperm DNA fragmentation index may be temporarily elevated within 3 months after infection but gradually decreased＞3 months later.In the retrospective study of 8 cases,there were no statistical differences in semen parameters at different stages compared with pre-infection(P＞0.05),but semen parameters showed a negative trend during＜1 month after infection and recovered to pre-infection levels＞3 months later.Conclusion The results of this laboratory study are basically consistent with the meta-analysis.SARS-CoV-2 infection in males only caused short-term negative effects on sperm morphology,vitality and DNA integrity,but generally recovered to pre-infection levels＞3 months after infection.Due to the limitations of study subjects and sample size,the impact of SARS-CoV-2 infection on male semen quality needs to be further confirmed by long-term large-scale prospective studies.

Analysis of HPV infection and genotype distribution among 1 658 male reproductive health outpatients / 复旦学报（医学版）

Objective To investigate the human papillomavirus(HPV)infection and genotype distribution characteristics among male reproductive health outpatients,and to compare the differences among different age groups of outpatients.Methods A total of 1 658 males,visited in the Affiliated Hospital of Shanghai Institute of Planned Parenthood Research from 2018 to 2022,were selected and 23 HPV genotypes were detected by PCR-reverse dot hybridization.Results Among the 1 658 subjects,the overall HPV infection rate was 22.50%.Single infection accounted for 66.76%,which was the main infection type.HPV infection among different age groups were statistically significant(P<0.001),with HPV infection of 16.83%,22.87%,34.63%,and 29.35%for 18-30,31-40,41-50,and≥51 years,respectively.The top 5 high risk HPV genotypes were HPV52(3.56%),HPV16(3.26%),HPV39(2.41%),HPV51(2.17%),HPV58(2.17%),and the top 1 low risk HPV genotype was HPV81(2.90%).The proportions of infected individuals in this study that could be completely covered by bivalent,quadrivalent,and nine-valent HPV vaccines were 7.77%,12.33%,and 26.27%,respectively.Conclusion The predominant infection type among male reproductive health outpatients was single infection type.HPV 52,16,39,51 and 58 were the most common high risk genotypes,while HPV 81 was the most common low risk genotype.Individuals aged 41-50 years had the highest HPV infection rate.

The relationship between semen quality and trace element levels in seminal plasma and miR-184 levels in seminal vesicles of male infertility patients / 实用医学杂志

Objective Explore the relationship between semen quality and trace element levels in seminal plasma,as well as miR-184 levels in exosomes of male infertility patients.Methods 155 male infertility patients in our hospital from January 2022 to July 2023 were selected as the infertility group,and another 155 male patients with normal physical examination during the same period were selected as the normal group.Compare the general information,semen quality parameters,trace elements,and miR-184 levels in exosomes between two groups,and analyze the correlation between male infertility patients and the above laboratory indicators through Spearman rank correlation analysis.Results The sperm concentration,total sperm motility(PR + NP),forward motility sperm(PR),average curve velocity,average linear velocity,average path velocity,and average lateral amplitude of sperm head(ALH)in the infertile group were lower than those in the normal group(P<0.05);The levels of Zn,Mg,and Ca in the infertile group were lower than those in the normal group,while the levels of Cu,Pb,and relative expression of miR-184 were higher than those in the normal group(P<0.05);The levels of Zn and Cu elements in male infertility patients are positively and negatively correlated with sperm concentration,total sperm motility(PR+NP),and forward motility sperm(PR),respectively.The levels of Pb elements are negatively correlated with the average lateral amplitude of sperm head(ALH),and P<0.05.The relative expression level of miR-184 in male infertility patients is negatively correlated with sperm concentration,total sperm motility(PR + NP),forward motility sperm(PR),and average sperm curve velocity,with P<0.05.Conclusion The quality of semen in male infertility patients is closely related to the levels of trace elements in semen and miR-184 levels in exosomes.

Study on the relationship between semen quality and bacterial infection in infertile men in Guangdong province / 现代医院

Objective To study the correlation between semen quality and bacterial infection in men with abnormal fer-tility,and provide clinical basis for guiding the reproductive health of men with abnormal fertility.Methods 200 male semen samples with abnormal fertility were collected,and then separated and cultured for 48 hours.According to the culture results,they were divided into three groups:the non-pathogenic group,the pathogenic group,and the sterile group.The bacterial resist-ance analysis of the pathogenic group was conducted,and the semen quality between each group was compared.Results After 48 hours of isolation and cultivation,200 semen samples had been tested,non-pathogenic bacteria was detected in 163 semen samples,accounting for 81.5% ;pathogenic bacteria was detected in 33 semen samples,accounting for 16.5% ;and bacteria was not detected in 4 semen samples,accounting for 2.0% .The top three strains of pathogenic bacteria in 33 cases were Escherichia coli,Streptococcus agalactiae,and Enterococcus faecalis,with drug resistance rates of 80.0% ,87.5% ,and 100.0% ,respec-tively.Conclusion The detection rate of bacterial culture in semen of men with abnormal fertility is relatively high,and patho-genic bacteria can affect semen quality.

Pharmacological Effects of Icariin on Male Reproductive System:A Review and Literature Visualization / 医药导报

Icariin,which belongs to the class of flavonoids,is the main active ingredient of the traditional tonic Chinese herb Epimedii Folium.Modern studies have shown that icariin has a wide range of effects on the male reproductive system.It has various pharmacological activities such as regulating cell proliferation and apoptosis,antioxidants,promoting testosterone secretion,improving erectile function,inhibiting prostate cancer cell migration,invasion,and regulating cell cycle.It has research value and application prospects in the field of urology and assisted reproduction.Therefore,Icariin's pharmacological effects and molecular mechanisms on the male reproductive system are reviewed in this paper combined with literature visualization analysis.It is expected to provide a theoretical basis for the therapeutic value development and application of icariin in male reproductive health.

ZHAO Hongli's Experience in Diagnosing and Treating Male Infertility with Six Meridians / 浙江中医药大学学报

[Objective]To summarize the academic experience of Director ZHAO Hongli in the treatment of male infertility with six meridians syndrome differentiation.[Methods]By summarizing the clinical cases of male infertility treated by Director ZHAO and combining his interpretation of the six meridians syndrome differentiation,this paper summarizes Director ZHAO's experience in treating this disease with six meridians syndrome differentiation,fully elaborates the characteristics of the disease and the diagnosis and treatment ideas,and verifies and analyzes it with a typical medical case.[Results]Director ZHAO believes that male infertility has many clinical symptoms and can be treated with six meridians syndrome differentiation.The first step in syndrome differentiation is to distinguish between deficiency and excess.Those who belong to the excess category are based on the disease of the six Fu organs and Yang meridians,which are mostly three Yang disease patterns.Those who belong to the deficiency category are based on the disease of the five Zang organs and Yin meridians,which are mostly three Yin disease patterns.Director ZHAO carefully observes the pathogenesis and also establishes cold-heat complex type of male infertility,using Banxia Xiexin Decoction to communicate Yin and Yang.In terms of drug application,attention should be paid to patients'innate physique,combining Chinese and western medicine according to the characteristics of laboratory tests,advocating food therapy at the same time as medication,and paying attention to psychological counseling.In the case presented,the patient experienced erectile dysfunction after marriage,symptoms differentiation was of Yangming Channel syndrome.Treatment involved modified Gegen Qinlian Decoction to clear the Yangming heat,combined with Simiao Powder to clear damp-heat in lower-Jiao.After more than three months of comprehensive treatment based on the evolving symptoms,the patient's wife was successfully conceived.[Conclusion]Director ZHAO deeply verses in the classics,applies the six meridians syndrome differentiation to the treatment of male infertility innovatively,emphasizing individualized treatment based on syndrome differentiation,receiving remarkable efficacy,which offers a new perspective for both the clinical application of classical prescriptions and the treatment of male infertility.

Molecular differentiation of coagulase-positive staphylococcal isolates carrying mecA- and PVL-encoding genes among healthy males

Aims@#This study was aimed to monitor the asymptomatic carriage of coagulase-positive staphylococcal bacteria among university male students and detect the prevalence of virulence marker genes that encode methicillin resistance (mecA) and Panton-Valentine leukocidin (PVL) toxin among the isolates.@*Methodology and results@#Single nasal swaps were collected from 144 participating students who resided at four different locations within Al-Madinah city. A total of 112 Gram-positive staphylococcal isolates were recovered from the 144 participants (carriage rate of 77.8%). Coagulase-positive staphylococci were differentiated using duplex PCR amplification of the 16S rRNA and nuc genes and accounted for 30 isolates (carriage rate of 20.8%). These isolates were most prevalent in the northern and southern parts of Al-Madinah city, while the lowest numbers of isolates were detected in students of the eastern part. Coagulase-positive isolates were further phenotypically characterized for methicillin resistance by the disc diffusion method. Uniplex PCR assays were conducted to screen for mecA- and PVL toxin-encoding genes. The mecA gene was amplified from all 15 (50%) methicillin-resistant coagulase-positive isolates, while the PVL toxin-encoding gene was detected in 19 isolates (63.3%), 10 (33.3%) of which contained the mecA gene. Lastly, PCR amplification of the NRPS gene from coagulase-positive isolates revealed the absence of Staphylococcus argenteus, the recently discovered genetically divergent lineage of Staphylococcus aureus.@*Conclusion, significance and impact of study@#An elevated prevalence of coagulase-positive isolates harboring mecA and PVL virulence genes was observed compared with previous investigations. This poses a potential threat if they spread among the population, resulting in outbreaks of community-acquired infections.

The penile vibrating perception threshold assay can help diagnose the severity of erectile dysfunction / 现代泌尿外科杂志

【Objective】 To analyze the application value of penile vibrating perception threshold measurement in the diagnosis of erectile dysfunction (ED) and provide reference for the seversity of ED patients. 【Methods】 The clinical data, Erectile Hardness Scale (EHS) score, International Index of Erectile Function Questionnaire-5 (IIEF-5) score, and the vibrating perception threshold (VPT) of the penis of 257 patients with decreased erectile function as the main complaint or accompanying symptoms treated during Jan. and Dec.2021 were retrospectively collected and analyzed.Patients with EHS=4 and IIEF-5≥22 were classified into the normal group, and the rest into the ED group.The differences in VPT in patients with different EHS scores were compared, and the correlation between IIEF-5 and VPT was analyzed.The diagnostic value of VPT for ED was evaluated with receiver operating characteristic (ROC) curve. 【Results】 The difference in penile VPT among patients with different EHS scores was statistically significant (P<0.05).With the decrease of EHS score, VPT showed an increasing trend.Glans VPT was negatively correlated with IIEF-5 score (ρ=-0.22, P<0.001), and penile shaft VPT was also negatively correlated with IIEF-5 score (ρ=-0.26, P<0.001).The VPT of glans penis [(4.17±1.37) V vs.(3.47±1.24) V, P=0.009] and the VPT of penis body [(3.73±1.41) V vs.(2.99±1.14)V, P=0.003] in the ED group were both higher than those in the normal group.The area under the ROC curve (AUC) of the glans VPT was 0.642.When the cut-off value was 3.537 V, the sensitivity was 63.4%, and the specificity was 63.6%.The AUC of the penile shaft VPT was 0.659.When the cut-off value was 2.775 V, the sensitivity was 72.3%, with a specificity of 54.5%. 【Conclusion】 The penile VPT of ED patients is higher than that of normal ones, and there is a correlation between VPT and the severity of ED.Severe ED is associated with higher VPT.The measurement of penile VPT is helpful for the clinical diagnosis of ED patients.

Transcriptomic Analysis of Wuzi Yanzongwan on Testicular Spermatogenic Function in Semi-castrated Male Mice / 中国实验方剂学杂志

ObjectiveTo screen out the transcriptomes related to the intervention of Wuzi Yanzongwan on the spermatogenic function of semi-castrated male mice， and to explore its potential mechanism in the intervention of the progress of low spermatogenic function. MethodBalb/c mice were randomly divided into sham-operated group， model group， testosterone propionate group（0.2 mg·kg-1·d-1， intramuscular injection） and Wuzi Yanzongwan group（1.56 g·kg-1·d-1， intragastric administration） according to body weight， with 12 mice in each group. The right testicle and epididymis were extracted from the model group and the drug administration group to construct the semi-castrated model of low spermatogenic function， while the fur and the right scrotum of the sham-operated group were only cut and immediately sterilized and sutured. At the end of the intervention， hematoxylin-eosin（HE） staining was used to observe the histopathology of testis， enzyme-linked immunosorbent assay（ELISA） was used to detect the levels of serum testosterone（T）， luteinizing hormone（LH） and follicle stimulating hormone（FSH）. The sperm count and motility of epididymis were measured by automatic sperm detector of small animal. Transcriptomic microarray technology was used to detect the mRNA expression level of testicular tissue in each group， the transcriptome of genes related to the regulation of Wuzi Yanzongwan was screened， and three mRNAs were selected for Real-time fluorescence quantitative polymerase chain reaction（Real-time PCR） to verify the transcriptome data. Through the annotation analysis of Gene Ontology（GO） and the signaling pathway analysis of Kyoto Encyclopedia of Genes and Genomes（KEGG）， the related functions of drugs regulating transcriptome were analyzed. ResultCompared with the sham-operated group， the testicular tissue of mice in the model group showed spermatogenic injury， contraction and vacuolization of the seminiferous tubules， reduction of spermatogenic cells at all levels， widening of the interstitial space， obstruction of spermatogonial cell development and other morphological abnormalities， and serum T significantly decreased， LH significantly increased（P<0.01）， and FSH elevated but no statistically significant difference， the count and vitality of epididymal sperm significantly decreased（P<0.01）. There were 882 differentially expressed mRNAs in the testicular tissues， of which 565 were up-regulated and 317 were down-regulated. Cluster analysis showed that these differentially expressed mRNA could effectively distinguish between the sham-operated group and the model group. Compared with the model group， the damage to testicular tissue in the Wuzi Yanzongwan group was reduced， the structure of the seminiferous tubules was intact， vacuolization was reduced， and the number of spermatogenic cells at all levels was significantly increased and arranged tightly. The serum T significantly increased， LH significantly decreased（P<0.01）， and FSH decreased but the difference was not statistically significant. The count and vitality of sperm in the epididymis were significantly increased（P<0.01）. Moreover， Wuzi Yanzongwan could regulate 159 mRNA levels in the testes of semi-castrated mice， of which 32 were up-regulated and 127 were down-regulated， and the data of the transcriptome assay was verified to be reliable by Real-time PCR. GO and KEGG analysis showed that the transcriptome functions regulated by Wuzi Yanzongwan were involved in the whole cell cycle process of sperm development such as sex hormone production of interstitial cells in testis， renewal， differentiation， metabolism， apoptosis and signal transduction of spermatogenic cells， and were closely related to the biological behaviors of signaling pathways such as spermatogenic stem cell function， endoplasmic reticulum protein processing and metabolic program. ConclusionWuzi Yanzongwan can effectively improve the low spermatogenic function of semi-castrated male mice， and its mechanism may be related to the regulation of testicular transcriptional regulatory network， the synthesis of sex hormones in testicular interstitial cells， the function of spermatogenic stem cells， the whole cell cycle process of spermatogenesis， as well as the expression of endoplasmic reticulum protein processing and metabolic program related genes transcription.

Association of agression and angry expression category perception under social exclusion among male students in reform school / 中国学校卫生

Objective@#To explore the relationship between aggression and category perception of angry expression in reform school students under social exclusion, so as to provide reference for the reform school students mental health promotion.@*Methods@#In May 2023, 144 students were randomly selected from a reform school in Guizhou Province, and were divided into high and low aggression groups(77 and 67 students) by Aggression Questionnaire. Cyberball game was used to induce social exclusion and acceptance, subjects were divided into high aggressive exclusion group ( n =42), high aggressive acceptance group ( n =35), low aggressive exclusion group ( n =37) and low aggressive acceptance group ( n =30). All the participants completed the discrimination and identification tasks of category perception paradigm, and the relationship between aggression and category perception of angry expression of reform school students under social exclusion was analyzed by using category turning point, identification curve and analysis of variance.@*Results@#The total score of aggression(97.34±8.00) and four dimensions (physical aggression: 29.75± 4.61, verbal aggression:17.19±2.58, anger:22.29±3.66, hostility:28.10±3.54) in the high aggression group were higher than those in the low aggression group(74.10±9.02，21.09±4.98，14.30±2.66，17.16±3.83，21.55±3.88), and the differences were statistically significant ( t =16.38, 10.85, 6.62, 8.20, 10.59, P <0.01). For identifying the turning point of the fear anger continuum, the social exclusion group（2.58±0.07）was significantly smaller than the social acceptance group（2.79±0.07）( F =4.85, η 2=0.07, P < 0.05 ）, and the social exclusion group had a tendency to shift the category boundary to the fear side. For identifying the slope at the angry happiness continuum category boundary curve, the high aggression group (0.63±0.03) was significantly higher than the low aggression group (0.53±0.03)( F =5.38, η 2=0.08, P <0.05). In the fear anger continuum,the high aggression group[(694.86± 78.29 )ms] reacted more quickly than the low aggression group[(660.70±79.86)ms]( F =5.08, η 2=0.05， P <0.05) In the angry happiness continuum, there was no statistical significance of social exclusion and aggression( P >0.05).@*Conclusions@#The suggests that social exclusion can lead to hostility attribution bias in individuals, while aggression can make individuals more sensitive to angry expression. The mechanisms by which social exclusion and aggression affect expression category perception are independent rather than interactive. The society should give tolerance and acceptance to reform school students, reduce exclusion and discrimination, and the reform education department should correct the aggressive behavior of reform school students and promote their mental health.

Analysis of pre-exposure prophylaxis awareness, willingness, uptake patterns, barriers and needs among MSM students and its influencing factors / 中国学校卫生

Objective@#To explore the pre-exposure prophylaxis (PrEP) awareness, willingness, uptake patterns, barriers and needs among Chinese student men who have sex with men (MSM), so as to provide relevant evidence for targeted interventions with PrEP.@*Methods@#A proportional sampling method was used to conduct a cross sectional survey of MSM aged 16 years and older residing in 21 provinces, municipalities, and autonomous regions in mainland China between October 20 and December 20, 2021, to collect information on demographic and sexual behavioral characteristics, and 923 students of them were selected as the subjects of this study. The chi-square test and Fisher s test were used for univariate analysis, followed by multivariate Logistic regression to analyze the influencing factors of PrEP awareness and uptake.@*Results@#According to the cascade analysis method, the awareness, willingness, uptake and adherence rates of PrEP among the student MSM were obtained as 88.95%, 67.36%, 13.20% and 45.21 %, respectively. HIV testing more than once in the last 3 months, and all of them were aware of the HIV test results of their sexual partners, and those with high frequency of condom use had a higher rate of awareness ( OR =2.32, 1.79, 1.69, P <0.05). Willingness rates were higher for those from the pilot city, using substances, and HIV testing more than once in the last 3 months ( OR =2.13, 1.65, 1.69, P <0.05). Higher rates of uptake were found among those from high risk and pilot areas, presence of commercial sex, substance use, and high literacy ( OR =5.60, 3.54,2.81, 1.92, 4.54, P <0.05). Adherence rates were higher among those who used one pill per day or both ( OR =12.77, 13.26, P <0.05). The barriers and needs faced by student MSM were primarily personal concerns about medication side effects, preventative effects, and confidence in sexual behavioral styles, and the high cost of medication and related service costs.@*Conclusions@#The student MSM population in China is characterized by high awareness, low willingness, low uptake, and low adherence to PrEP. Targeted interventions should be considered and tailored by the departments to facilitate PrEP promotion among student MSM.