Diagnostic and Prognostic Value of Neutrophil-Lymphocyte Ratio in Adrenocortical Carcinoma.

BACKGROUND: The aim was to explore the value of neutrophil-lymphocyte ratio (NLR) as a biomarker for predicting the prognosis or diagnosis in adrenocortical carcinoma (ACC). METHODS: We identified 262 patients with adrenal gland disease who underwent operation at our institution between 2013 and 2018. According to postoperative pathology, patients were divided into 2 groups: ACC and non-ACC groups. The neutrophil and lymphocyte count of patients were recorded. Within the intergroup comparison, data obtained from ACC and non-ACC groups were evaluated using ANOVA test. The cut-off values of NLR for the prognosis in ACC were determined according to 3 methods. RESULTS: The NLR values of ACC and non-ACC groups were 5.36 ± 5.30 and (1.73 ± 0.26) ∼ (2.56 ± 1.35), respectively (P < .001). NLR carry a differential property was evaluated with ROC curve to distinguish the above 2 groups. The cut-off value of NLR was estimated as 2.65 according to the Youden index. With this value, sensitivity was found as 67.5%, specificity was 83.8% and AUC was 0.749 (P < .001, confidence interval = 0.638-0.860). In ACC, the higher NLR group was not shown significantly poorer overall survival than the lower NLR group (NLR ≥2.65 vs. NLR < 2.65, NLR ≥5 vs. NLR <5, NLR ≥5.36 vs. NLR <5.36) (P > .05). CONCLUSION: According to the data in this study, it can be said that adrenocortical tumors are likely to be malignant by 67.5% if the NLR value is greater than 2.65. When we use the NLR to predict the prognosis of ACC, there is not statistically significant.

Primary synovial sarcoma of the pleura in an 18­year­old male patient: A case report.

Primary synovial sarcoma of the pleura (PSSP) is a rare disease. The present study reported the case of a patient (male; age, 18 years) with two tumors (7.8×2.8 cm and 6.5×5.8 cm) treated with surgery and chemotherapy. To the best of our knowledge, this is the first reported case of two tumors diagnosed as PSSP, which was confirmed by immunohistochemical staining. After six months of follow-up, the symptoms of dry cough and wheezing disappeared and all of the laboratory results were within normal limits. PSSP requires clinical suspicion combined with strategic diagnostic evaluation to confirm the diagnosis and a comprehensive treatment program based on surgery and assisted by chemotherapy.

Changes of Colon in Rats with Different Ages in Response to Lipopolysaccharide.

BACKGROUND: Lipopolysaccharide (LPS) is an endotoxin that causes inflammation, and the content of LPS increases gradually during the process of aging. Whether the response of the colon to LPS stimulation will increase with age is yet unknown. OBJECTIVE: The study investigated the effects of LPS stimulation on the colon of adult and aging rats. METHOD: 43 healthy male SD rats were divided into 4 different groups: adult group and LPS-stimulated adult group at the age of 4 months, and aging group and LPS-stimulated aging group at the age of 22 months. Rats were stimulated by intraperitoneal injection of LPS (1mg/kg) for 24 h. The morphological changes of the colon were observed, and intestinal inflammatory response, tight junction proteins, apoptosis, and proliferation in intestinal epithelial cells were detected. RESULTS: A series of morphology changes occurred in the colon of adult rats after LPS stimulation, the higher inflammatory response (TLR4, NF-κB, and IL-1ß), changes in the protein levels of tight junctions (ZO-1, Claudin1, and Claudin2), and increased apoptosis (Bax, Bcl2) and proliferation (PCNA) of intestinal epithelial cells. The above changes were also found in aging rats. LPS stimulation further promotes the above changes to some extent in the colon of aging rats. CONCLUSION: A series of colon changes in rats was significantly damaged during LPS stimulation and aging, and these changes were further aggravated to some extent in LPS-stimulated aging rats.

Competitive Risk Model for Specific Mortality Prediction in Patients with Bladder Cancer: A Population-Based Cohort Study with Machine Learning.

Background: Noncancer death accounts for a high proportion of all patients with bladder cancer, while these patients are often excluded from the survival analysis, which increases the selection bias of the study subjects in the prediction model. Methods: Clinicopathological information of bladder cancer patients was retrieved from the Surveillance, Epidemiology, and End Results (SEER) database, and the patients were categorized at random into the training and validation cohorts. The random forest method was used to calculate the importance of clinical variables in the training cohort. Multivariate and univariate analyses were undertaken to assess the risk indicators, and the prediction nomogram based on the competitive risk model was constructed. The model's performance was evaluated utilizing the calibration curve, consistency index (C index), and the area under the receiver operator characteristic curve (AUC). Results: In total, we enrolled 39285 bladder cancer patients in the study (27500 patients were allotted to the training cohort, whereas 11785 were allotted to the validation cohort). A competitive risk model was constructed to predict bladder cancer-specific mortality. The overall C index of patients in the training cohort was 0.876, and the AUC values were 0.891, 0.871, and 0.853, correspondingly, for 1-, 3-, and 5-year cancer-specific mortality. On the other hand, the overall C index of patients in the validation cohort was 0.877, and the AUC values were 0.894, 0.870, and 0.847 for 1-, 3-, and 5-year correspondingly, suggesting a remarkable predictive performance of the model. Conclusions: The competitive risk model proved to be of great accuracy and reliability and could help clinical decision-makers improve their management and approaches for managing bladder cancer patients.

CUX2/KDM5B/SOX17 Axis Affects the Occurrence and Development of Breast Cancer.

OBJECTIVE: Abnormal expression of CUT-like homeobox 2 gene (CUX2) has been highlighted as potential clinical biomarkers in human cancers. Notably, the function of CUX2 has been less elucidated in breast cancer (BC). We focused on the role of the CUX2 in tumorigenesis and progression of BC with the involvement of the lysine demethylase 5B (KDM5B)/sex determining region Y-box 17 (SOX17) axis. METHODS: CUX2, KDM5B, and SOX17 expression levels in BC tissues and cells were tested by reverse transcription quantitative PCR and Western blotting. Later, the effects of CUX2, KDM5B, and SOX17 on the malignant behaviors of MDA-MB-231 and MCF-7 cells were analyzed by CCK-8, colony formation, and Transwell assays in vitro. The interactions of CUX2, KDM5B, and SOX17 were validated by online website prediction, ChIP assay, and dual luciferase reporter gene assay. The subcutaneous tumorigenesis in nude mice was conducted to observe the roles of CUX2, KDM5B, and SOX17 in BC tumor growth in vivo. RESULTS: CUX2 and KDM5B were highly expressed while SOX17 had low expression in BC. Inhibition of CUX2 suppressed BC cell malignant phenotypes. CUX2 promoted KDM5B expression through transcriptional activation, enabling its high expression in BC. KDM5B inhibited SOX17 expression through histone demethylation. Overexpression of KDM5B or downregulation of SOX17 reversed the inhibitory effect of CUX2 downregulation on the malignant behaviors of BC cells. Inhibition of CUX2 impeded BC cell growth in vivo through the KDM5B/SOX17 axis. CONCLUSION: This study highlights that suppression of CUX2 inhibits KDM5B to repress tumorigenesis and progression of BC through overexpressing SOX17.

The Efficacy of Sexual Intercourse Or Masturbation For The Expulsion Of Distal Ureteral Stones In Men: A Systematic Review And Meta-analysis Of Randomized-controlled Trials.

PURPOSE: Several randomized-controlled trials (RCTs) were performed to compare the efficacy of sexual intercourse or masturbation and no sexual activity in treating distal ureteral stones, indicating conflicting results. The meta-analysis was conducted to assess the role of sexual intercourse or masturbation in the treatment of distal ureteral calculi. MATERIALS AND METHODS: PubMed, Cochrane Library, EMBASE, Scopus, Clinicaltrail.gov, and Web of Science were searched by October 2021. Men who were instructed of no sexual intercourse or masturbation, and only received standard symptomatic treatment are comparators. Relative risk (RR), weighted mean difference (WMD), and their 95% confidence intervals (CIs) were calculated using random or fixed effects models. RESULTS: Five RCTs including 500 subjects were analyzed in the study. Compared with controls, subjects in experimental group had significantly higher expulsion rate at 2nd and 4th week (95%CI: 1.334 to 2.638, RR: 1.876, I2 = 73.6%, P < .001; 95%CI: 1.148 to 1.752, RR: 1.418, I2 = 55.9%, P < .001), significantly decreased requirement for analgesic injections (95%CI: -1.071 to -.126, WMD: -.598, I2 = 90.3%, P = .013), and significantly shorter expulsion time (95%CI: -6.941 to -.436, WMD: -3.689, I2 = 83.7%, P = .026). CONCLUSION: Performing sexual intercourse or masturbation 3 or 4 times a week can be an alternative treatment option of distal ureteral calculi (0-10 mm in size). However, more clinical evidence with better designs solving raised concerns is warranted.

Prevalence and Reasons for the Absence of Vaginal Intercourse in Chinese Middle-Aged and Elderly Men.

INTRODUCTION: As the global population ages, research on the health of middle-aged and elderly men has intensified. AIM: To report a paucity of data on the prevalence, etiology, and risk factors associated with lack of vaginal intercourse in middle-aged and elderly Chinese men. METHODS: Between January, 2018, and May, 2020, 6,096 men aged 40-90 years old who reside in mainland China were included in the community-based study. Validated scales related to erectile dysfunction (EHS and IIEF-5) and late-onset hypogonadism (ADAM and AMS), and in-person interview method were used to collect data. Multivariable analysis was performed to examine the risk factors associated with the absence of intercourse. OUTCOMES: Prevalence estimate of no current vaginal intercourse and its associations with basic factors and medical comorbidities. Reasons for no current vaginal intercourse. RESULTS: The prevalence of intercourse absence was 19.8% (95% CI; 18.8-20.8%) in middle-aged and elderly Chinese males, and this proportion was significantly higher in older age groups (8.6%, 11.5%, 24.1%, and 34.2% for men aged 40-49, 50-59, 60-69, and 70-90, respectively; P < .05). Among the men who attributed the lack of intercourse to themselves, 168 (21.4%, 95% CI; 18.7-24.4%) had erectile problems and were apprehensive about erectile failure during intercourse. Strained spousal relationships (35 men, 8.4%, 95% CI; 6.1-11.4%), marital issues (163 men, 39%, 95% CI; 34.4--43.8%), and poor health of the partner (179 men, 42.8%, 95% CI; 38.2-47.6%) were described as reasons for lack of intercourse with spouses. Same risk factors were also found in the multivariate analysis. CLINICAL IMPLICATIONS: Modifiable factors that are related to lack of intercourse may be beneficial to Chinese middle-aged and elderly men. STRENGTH & LIMITATIONS: The main strength of the study is that it involved real-world settings. The limitations are as follows. Firstly, psychological data, data on sexual frequency and data regarding types of sex other than vaginal intercourse were not recorded. Secondly, this is a cross-sectional study, from which definite or causative conclusions can't be drawn. Thirdly, the spouses of the participants were not included in the study, and hence the data represent the perceptions of males only. Finally, objective data are required. CONCLUSION: Modifiable factors related to both the patients and their partners were associated with an increased rate of no intercourse in Chinese middle-aged and elderly men. Guidance for sexual life may benefit men with an absence of intercourse. Future studies are warranted to reexamine our findings. Lu Y, Zhang J, Ma C, et al. Prevalence and Reasons for the Absence of Vaginal Intercourse in Chinese Middle-Aged and Elderly Men. Sex Med 2022;10:100511.

Impact of atorvastatin on erectile dysfunction: A meta-analysis and systematic review.

Atorvastatin may be an effective treatment for erectile dysfunction (ED). The purpose of this meta-analysis was to determine whether atorvastatin therapy is effective in the treatment of ED. All published research on atorvastatin in the treatment of ED patients in EMBASE, PubMed, Web of Science and Cochrane were investigated till 30 October 2021. A meta-analysis of randomized controlled trials (RCTs) was done to investigate the efficacy of atorvastatin and placebo in the treatment of ED. Moreover, we also performed a meta-analysis based on single-arm trials (SATs) to explore the atorvastatin treatment on the efficacy of ED. In a meta-analysis based on RCTs, the weighted mean difference of the change of International Index for Erectile Function-5 (IIEF-5) score in the atorvastatin treatment group with or without treatment was 4.53 (95 per cent confidence interval [CI] of 3.28-5.79) higher than in the control group. In an SAT-based meta-analysis, the ES of the change in IIEF-5 score in the atorvastatin treatment group before and after treatment was 3.22 (95 per cent CI of 1.32-5.12). Atorvastatin is an effective therapeutic drug for patients with ED. However, we expect that more multicentre clinical trials will be conducted to support this assertion.

The underlying molecular mechanism and drugs for treatment in adrenal cortical carcinoma.

Purpose: The study aimed to predict and explore the possible clinical value and mechanism of genetic markers in adrenal cortical carcinoma using a bioinformatics analysis method. Methods: The RNA-seqs and miRNAs data were downloaded from TCGA database to identify the differentially expressed genes and differentially expressed miRNAs. The hub-genes were screened by building protein-protein interaction sub-networks with 12 topological analysis methods. We conducted the receiver operating characteristic curve to elevate the diagnostic value of hub-genes in distinguishing the death and alive groups. The survival analysis of hub-genes and key miRNAs were conducted using Kaplan-Meier curves. Furthermore, most significant small molecules were identified as therapeutic candidates for adrenal cortical carcinoma by the CMap analysis. Results: Compared to survival group, we found 475 up-regulated genes and 354 genes and the key pathways leading to the death of different ACC individual patients. Then we used 12 topological analysis methods to found the most possible 22 hub-genes. Among these hub-genes, nine hub-genes (C3, CXCL5, CX3CR1, GRM8, HCAR2, HTR1B, SUCNR1, PTGER3 and SSTR1) could be used to distinguish the death and survival groups for patients. We also revealed that mRNA expressions of 12 genes (C3, CXCL8, CX3CR1, GNAT3, GNGT1, GRM8, HCAR2, HTR1B, HTR1D, PTGER3, SSTR1 and SUCNR1) and four key miRNAs (hsa-mir-330, hsa-mir-489, hsa-mir-508 and hsa-mir-513b) were related to survival. Three most small molecules were identified (H-9, AZ-628 and phensuximide) as potential therapeutic drugs for adrenal cortical carcinoma. Conclusion: The hub-genes expression was significant useful in adrenal cortical carcinoma, provide new diagnostic, prognosis and therapeutic approaches for adrenal cortical carcinoma. Furthermore, we also explore the possible miRNAs involved in regulation of hub-genes.

Premature Ejaculation, True or False? Clinical evaluation of PE patients with multiple intercourse in one day.

Clinical characteristics of 216 adult males previously diagnosed with premature ejaculation (PE) were studied. Using a survey questionnaire, characteristics included intravaginal ejaculation latency time (IELT), penile hardness scores and the refractory period (RP). Ninety-four PE patients reported they had experienced vaginal intercourse more than once (2 to 4 times) in one day (~44%). IELT was significantly increased at the second and subsequent intercourses, and IIEF-15 (International Index of Erectile Function-15) and relevant subclass scores were markedly improved compared to their first intercourse and also compared to the single intercourse group in this cohort study. Overall sexual satisfaction was achieved in the PE patients with multiple intercourse experiences. The same trend was observed in both the patients diagnosed with lifelong and acquired PE. Based on the evidence, the argument is that the PE patients who were diagnosed using their performance at the first intercourse but who have the ability to participate in multiple vaginal intercourses in one day are unlikely to be true PE. The false PE may account for over 40% of PE patients diagnosed by current guidelines and definitions.

Anti-infection mechanism of phosphodiesterase-5 inhibitors and their roles in coronavirus disease 2019 (Review).

Coronavirus disease 2019 (COVID-19) has a variety of impacts on the human body. Severe acute respiratory syndrome coronavirus 2 is the pathogen that causes COVID-19. It invades human tissues through the receptor angiotensin-converting enzyme 2, resulting in an imbalance in the angiotensin II (AngII) level and upregulation of renin-angiotensin system/AngII pathway activity. Furthermore, the binding of AngII to its receptor leads to vasoconstriction, endothelial injury and intravascular thrombosis. In addition, COVID-19 may have adverse effects on male reproductive organs and a marked impact on male reproductive health. Phosphodiesterase-5 inhibitors (PDE5Is) may improve vascular endothelial function, promote testicular and systemic blood circulation and testosterone secretion and enhance epididymal function, as well as sperm maturation and capacitation. PDE5Is may also be of use in the treatment of infectious diseases by enhancing immunity and anti-inflammatory responses and improving vascular endothelial function. Based on the pharmacological mechanism of PDE5Is, they are of unique value in the fight against infectious diseases and may be effective in combination with direct antiviral drugs. The anti-infection mechanisms of PDE5Is and their roles in COVID-19 were reviewed in the present study.

Comparing the risk of cardiovascular disease following GnRH agonist and GnRH antagonist therapy for patient with prostate cancer: a systematic review and meta-analysis.

INTRODUCTION: The aim of this review is to compare the risk of cardiovascular disease (CVD) following gonadotropin-releasing hormone (GnRH) agonist and GnRH antagonist therapy for patient with prostate cancer (PCa). EVIDENCE ACQUISITION: We searched PubMed, Web of science, Opengery, Cochrane library databases and international congress reports for studies published before December 2019. This meta-analysis was conducted using Stata v. 12.0. Relative ratios (RRs) and their credible intervals (CI) were applied for the cardiovascular safety evaluation of androgen-deprivation therapy (ADT) medical interventions, including GnRH agonist and GnRH antagonist therapy. In addition, fixed-effect or random-effect models were applied in the statistical analyses according to the heterogeneity. EVIDENCE SYNTHESIS: Six articles including 32,997 participants were analyzed with a random effects model. The results of meta-analysis showed that compared with GnRH agonist, the incidents of CVD was equal to GnRH antagonist therapy for patient with PCa (RR=0.98, 95% CI: 0.94-1.02). When considering, under sub-group analysis with randomized controlled trials (RCTs) or controlled clinical trials (CCTs), no statistical differences in risk of CVD were found in two sub-group analyses. No evidence of publication bias was found in our meta-analysis by a funnel plot (Pr> | z |=0.26). CONCLUSIONS: This meta-analysis indicates that compared treatment with GnRH antagonist, risks of CVD in PCa patients was the same as GnRH agonist. Further RCTs are strongly required to provide more definitive evidence.

[Advances in the studies of special biomarkers for the experimental diagnosis of CP/CPPS].

At present, there are no widely accepted specific biomarkers for the experimental diagnosis of chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS). Recent studies show that many related biomarkers exist in expressed prostatic secretions (EPS) or semen, urine and blood or serum. The monocyte chemotactic protein-1 (MCP-1/CCL-2), macrophage-inflammatory-protein-1 alpha (MIP-1α/CCL-3), interleukin-6 (IL-6), interleukin-8 (IL-8), nerve growth factor (NGF) and B7-H3 in EPS, prostatic exosomal protein (PSEP) in the urine, and prostate-specific antigen (PSA), mean platelet volume (MPV) and macrophage migration inhibitory factor (MIF) in the serum are believed to be of significant clinical and research value, and expected to become important laboratory biomarkers for the diagnosis of CP/CPPS.

Evaluation of the Psychological Status, Infertility-Associated Factors, and Erectile Function in Patients with Timely Ovulatory Intercourse Failure in China: Evidence from a Cross-Sectional Study.

RESULTS: A total of 1128 patients were enrolled, and 264 of them (23.40%) suffered from TOIF. TOIF was positively associated with smoking, drinking, hypertension, diabetes, anxiety, unknown cause of infertility, lower semen concentration, lower frequency of intercourse, and decreased erectile function. The total IIEF-15 scores, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction were significantly decreased in patients with TOIF. CONCLUSION: TOIF is associated with lower semen concentration, anxiety, and other comorbidities such as hypertension and diabetes. Clinicians are required to focus on these associated factors in addition to improve the erectile function.

History of Prostatitis Is an Independent Risk Factor for Erectile Dysfunction: A Cross-Sectional Study.

PURPOSE: To determine the role of history of prostatitis (HP) as an independent risk factor for erectile dysfunction (ED) in Chinese adult males. METHODS: We conducted an online survey using a crowd-sourced questionnaire in Chinese adult males. The participants were separated into two groups as adult participants with HP and with no history of prostatitis (NHP) according to the medical history record. As diagnosis criteria of ED, we used the 5 questions of the International Index for Erectile Function (IIEF-5). The general data including height, weight, monthly income, academic background, smoking history, alcohol drinking, marital status, conjugal affection, and other disease history was asked and recorded. The relationship between HP and ED using the chi-square test and logistic regression analyses was investigated and analyzed. RESULTS: In total, 1873 participants answered the questionnaire. 95 participants in the HP group and 1778 participants in the NHP group were included in this study. The rate of participants with HP was 5.343%. ED was found in 68.4% of the HP group and 43% of the NHP group (p < 0.001). Regression analysis showed that participants in HP were more likely to have ED (OR 2.135, 95% CI 1.266-3.60) after adjusting for the participant's age, body mass index (BMI), monthly income, academic background, smoking history, alcohol drinking, marital status, conjugal affection, BPH, hypertension, and diabetes mellitus, when compared with NHP. CONCLUSIONS: The present study indicated a high prevalence of ED in Chinese adult males with history of prostatitis, and HP is an independent risk factor for erectile dysfunction.

Analysis of CNVs of CFTR gene in Chinese Han population with CBAVD.

BACKGROUND: Congenital bilateral absence of vas deferens (CBAVD) is an important disease of male infertility, which affects 1%-2% of infertile population. In addition to common mutations of CFTR, copy number variants (CNVs) have also been implicated as one of the pathogenesis of CBAVD. The present study aimed to investigate the genetic contribution of CFTR CNVs in Chinese Han population with CBAVD. METHODS: Two hundred and sixty-three CBAVD patients were recruited. Genomic DNA was extracted from peripheral blood samples. The Multiplex Ligation-dependent Probe Amplification assay was performed which targets the region of the CFTR gene. RESULTS: Among 263 Chinese men affected with CBAVD in this study, 5 (1.90%) patients were detected for copy number variants in the region of CFTR gene (4 of them carried partial deletions and 1 of them carried partial duplication of CFTR gene). CONCLUSIONS: The study showed that the rate of CFTR CNVs in Chinese population with CBAVD were basically consistent with the previous reports. And the study first revealed genetic risk of CNVs of CFTR on a large sample size of CBAVD patients in Chinese Han population, which prompted that it was necessary to detect CNVs of CFTR in Chinese Han people with CBAVD.

Gene Expression in Human Polymorphonuclear Neutrophils (PMNs) Stimulated by Bacillus Calmette-Guérin (BCG).

Neutrophils are the most abundant leukocytes in the blood. Moreover, neutrophils form the first line of host immune defense against bacterial and fungal invasion, and also play an important part in inflammatory and immune system responses. Intravesical bacillus Calmette-Guérin (BCG) has been shown to reduce and delay tumor progression to muscle-invasive disease after transurethral resection of bladder tumors (TRUBTs). Following intravesical BCG, neutrophils gather around tissues infected by BCG in the early stage of inflammatory and immune responses. In our previous study, we reported that BCG induced the formation of neutrophil extracellular traps (NETs), which play an important role in tumor treatment. Therefore, in the present study, we analyzed the gene expression profile of neutrophils stimulated by BCG through high-throughput arrays, which helped us determine the potential roles of neutrophils in BCG immunotherapy. The results showed that the expression of neutrophil genes led to changes in the early stage of BCG stimulation. The changed genes were involved in many functions of neutrophils such as mobility, proliferation, and secretion of cytokines, chemokines, and adhesion molecules. These changes in neutrophil biological functions may play an essential role in BCG induction of inflammatory and immune responses, and in anti-tumor processes.

Impacts of Outdoor Air Pollution on Human Semen Quality: A Meta-Analysis and Systematic Review.

INTRODUCTION: Several studies have explored the association between outdoor air pollution and semen quality. However, the results were inconsistent. We performed the current meta-analysis to evaluate the role of outdoor air pollution in semen quality. Material and Methods. Databases including PubMed, Web of Science, and Embase were searched to identify relevant studies. Relative data in participants under higher exposure and lower exposure to air pollution were extracted. Pooled weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) were utilized to assess the effects of outdoor air pollution on semen quality. In addition, trial sequential analyses (TSAs) were performed to obtain a more comprehensive assessment of analyses. RESULTS: A total of 11 studies with 4562 males were enrolled in the current meta-analysis. Higher air pollution levels were associated with significant decreases in semen volume (WMD: -0.16, 95% CI: -0.27 to -0.05), sperm concentration (WMD: -5.52, 95% CI: -9.88 to -1.16), progressive motility (WMD: -6.23, 95% CI: -11.64 to -0.81), total motility (WMD: -7.65, 95% CI: -14.09 to -1.20), and normal sperm morphology rate (WMD: -3.71, 95% CI: -5.59 to -1.82). In addition, the DNA fragmentation index significantly increased (WMD: 4.11, 95% CI: 1.94 to 6.29). CONCLUSIONS: Air pollution is associated with decreased semen volume, sperm concentration, motility, and normal morphology rate.

New insights into the potential mechanisms of spermatogenic failure in patients with idiopathic azoospermia.

Idiopathic azoospermia (IA) refers to azoospermia without a clear aetiology. Due to the unclear aetiology and pathological mechanism of IA, there is no effective treatment for IA. The development of assisted reproductive and microsperm extraction technologies has brought hope to patients with IA with fertility problems. However, there are still many patients with IA whose testes lack healthy sperm, causing infertility. Therefore, it is key to identify how testicular spermatogenic failure can be reversed to promote spermatogenesis in patients with IA to resolve fertility problems; these goals are a great challenge in reproductive medicine. The underlying genetic factors seem to be important pathological factors of IA. Understanding the role of genetic factors in the pathological mechanism of spermatogenic failure in patients with IA is of great value for future studies and treatments and is also an important reference for the reproductive health of males and their offspring. A method combining sequencing technology and bioinformatics analysis is an important means to understand the genetic pathological mechanisms. We used bioinformatics analysis to study the public human IA dataset. We found that the pathogenic mechanism of IA may be related to abnormal ciliary structure and function and disrupted RNA metabolism in spermatogenic cells. Disrupted m6A regulation of spermatogenesis may be an important pathological mechanism of IA and warrants attention. Finally, we screened for key genes and potential therapeutic drugs to determine future research directions.

Defining the Efficacy and Safety of Phosphodiesterase Type 5 Inhibitors with Tamsulosin for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia with or without Erectile Dysfunction: A Network Meta-Analysis.

PURPOSE: The purpose of this study was to compare the relative safety and efficacy of different types of phosphodiesterase type 5 inhibitors (PDE5-Is) with tamsulosin for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) (BPH-LUTS) with or without erectile dysfunction (ED). METHODS: We use the Stata version 13.0 to conduct the network meta-analysis (NMA) with a random effects model of the Bayesian framework. The International Prostate Symptom Score (IPSS), Maximum Urinary Flow Fate (Q max), International Index of Erectile Function (IIEF), and their credible intervals (CI) were used to compare the efficacy and safety of every medical intervention, including sildenafil plus tamsulosin, tadalafil plus tamsulosin, and vardenafil plus tamsulosin. RESULTS: Seven RCTs including 531 participants with seven interventions were analyzed. The results of NMA SUCRA showed that compared with different doses or types of PDE5-Is combined with tamsulosin (0.4 mg qd), the sildenafil (25 mg qd) combined with tamsulosin (0.4 mg qd) group had the greatest probabilities of being the best in the achievement of improving IIEF. The sildenafil (25 mg 4 days per week) combined with tamsulosin (0.4 mg qd) group had the greatest probabilities of being the best in the achievement of improving Q max, whereas sildenafil (25 mg qd) combined with tamsulosin (0.4 mg qd) ranked the best for the safety outcomes. CONCLUSIONS: This meta-analysis indicates that sildenafil combined with tamsulosin is the best effective and tolerated treatment option for BPH-LUTS with or without ED. Further RCTs are strongly required to provide more direct evidence.