Male diabetic individuals present a marked impairment in fertility;however,knowledge regarding the pathogenic mechanisms and therapeutic strategies is unsatisfactory.The new hypoglycemic drug dapagliflozin has shown c...Male diabetic individuals present a marked impairment in fertility;however,knowledge regarding the pathogenic mechanisms and therapeutic strategies is unsatisfactory.The new hypoglycemic drug dapagliflozin has shown certain benefits,such as decreasing the risk of cardiovascular and renal events in patients with diabetes.Even so,until now,the effects and underlying mechanisms of dapagliflozin on diabetic male infertility have awaited clarification.Here,we found that dapagliflozin lowered blood glucose levels,alleviated seminiferous tubule destruction,and increased sperm concentrations and motility in leptin receptor-deficient diabetic db/db mice.Moreover,the glucagon-like peptide-1 receptor(GLP-1R)antagonist exendin(9-39)had no effect on glucose levels but reversed the protective effects of dapagliflozin on testicular structure and sperm quality in db/db mice.We also found that dapagliflozin inhibited the testicular apoptotic process by upregulating the expression of the antiapoptotic protein B-cell lymphoma 2(BCL2)and X-linked inhibitor of apoptosis protein(XIAP)and inhibiting oxidative stress by enhancing the antioxidant status,including total antioxidant capacity,total superoxide dismutase(SOD)activity,and glutathione peroxidase(GPx)activity,as well as decreasing the level of 4-hydroxynonenal(4-HNE).Exendin(9-39)administration partially reversed these effects.Furthermore,dapagliflozin upregulated the glucagon-like peptide-1(GLP-1)level in plasma and GLP-1R expression by promoting AKT8 virus oncogene cellular homolog(Akt)phosphorylation in testicular tissue.Exendin(9-39)partially inhibited Akt phosphorylation.These results suggest that dapagliflozin protects against diabetes-induced spermatogenic dysfunction via activation of the GLP-1R/phosphatidylinositol 3-kinase(PI3K)/Akt signaling pathway.Our results indicate the potential effects of dapagliflozin against diabetes-induced spermatogenic dysfunction.展开更多
This study aimed to evaluate the ability of rete testis thickness(RTT)and testicular shear wave elastography(SWE)to differentiate obstructive azoospermia(OA)from nonobstructive azoospermia(NOA).We assessed 290 testes ...This study aimed to evaluate the ability of rete testis thickness(RTT)and testicular shear wave elastography(SWE)to differentiate obstructive azoospermia(OA)from nonobstructive azoospermia(NOA).We assessed 290 testes of 145 infertile males with azoospermia and 94 testes of 47 healthy volunteers at Shanghai General Hospital(Shanghai,China)between August 2019 and October 2021.The testicular volume(TV),SWE,and RTT were compared among patients with OA and NOA and healthy controls.The diagnostic performances of the three variables were evaluated using the receiver operating characteristic curve.The TV,SWE,and RTT in OA differed significantly from those in NOA(all P≤0.001)but were similar to those in healthy controls.Males with OA and NOA were similar at TVs of 9–11 cm^(3)(P=0.838),with sensitivity,specificity,Youden index,and area under the curve of 50.0%,84.2%,0.34,and 0.662(95%confidence interval[CI]:0.502–0.799),respectively,for SWE cut-off of 3.1 kPa;and 94.1%,79.2%,0.74,and 0.904(95%CI:0.811–0.996),respectively,for RTT cut-off of 1.6 mm.The results showed that RTT performed significantly better than SWE in differentiating OA from NOA in the TV overlap range.In conclusion,ultrasonographic RTT evaluation proved a promising diagnostic approach to differentiate OA from NOA,particularly in the TV overlap range.展开更多
Male patients with prolactinomas usually present with typical hyperprolactinemia symptoms,including sexual dysfunction and infertility.However,clinical factors related to sexual dysfunction and surgical outcomes in th...Male patients with prolactinomas usually present with typical hyperprolactinemia symptoms,including sexual dysfunction and infertility.However,clinical factors related to sexual dysfunction and surgical outcomes in these patients remain unclear.This study aimed to investigate the outcomes of male patients with prolactinomas after transsphenoidal surgery and the risk factors affecting sexual dysfunction.This study was conducted on 58 male patients who underwent transsphenoidal surgery for prolactinomas between May 2014 and December 2020 at the First Affiliated Hospital of Sun Yat-sen University,Guangzhou,China.We evaluated the sexual function of patients before and after surgery through International Index of Erectile Function-5 scores,libido,and frequency of morning erection.Of the 58 patients,48(82.8%)patients had sexual intercourse preoperatively.Among those 48 patients,41(85.4%)patients presented with erectile dysfunction.The preoperative International Index of Erectile Function-5 scores in patients with macroprolactinomas were significantly higher than those in patients with giant prolactinomas(17.63±0.91 vs 13.28±1.43;P=0.01).Postoperatively,the incidence of erectile dysfunction was 47.9%,which was significantly lower than that preoperatively(85.4%;P=0.01).Twenty-eight(68.3%)patients demonstrated an improvement in erectile dysfunction.Tumor size and invasiveness were significantly correlated with the improvement of erectile dysfunction.Preoperative testosterone<2.3 ng ml^(-1)was an independent predictor of improvement in erectile dysfunction.In conclusion,our results indicated that tumor size and invasiveness were important factors affecting the improvement of sexual dysfunction in male patients with prolactinoma.The preoperative testosterone level was an independent predictor related to the improvement of erectile dysfunction.展开更多
Nonobstructive azoospermia(NOA)refers to the failure of spermatogenesis,which affects approximately 1%of the male population and contributes to 10%of male infertility.NOA has an underlying basis of endocrine imbalance...Nonobstructive azoospermia(NOA)refers to the failure of spermatogenesis,which affects approximately 1%of the male population and contributes to 10%of male infertility.NOA has an underlying basis of endocrine imbalances since proper human spermatogenesis relies on complex regulation and cooperation of multiple hormones.A better understanding of subtle hormonal disturbances in NOA would help design and improve hormone therapies with reduced risk in human fertility clinics.The purpose of this review is to summarize the research on the endocrinological aspects of NOA,especially the hormones involved in hypothalamic–pituitary–testis axis(HPTA),including gonadotropin-releasing hormone,follicle-stimulating hormone,luteinizing hormone,prolactin,testosterone,estradiol,sex hormone binding globulin,inhibin B,anti-Müllerian hormone,and leptin.For the NOA men associated with primary testicular failure,the quality of currently available evidence has not been sufficient enough to recommend any general hormone optimization therapy.Some other NOA patients,especially those with hypogonadotropic hypogonadism,could be treated with hormonal replacement.Although these approaches have succeeded in resuming the fertility in many NOA patients,the prudent strategies should be applied in individuals according to specific NOA etiology by balancing fertility benefits and potential risks.This review also discusses how NOA can be induced by immunization against hormones.展开更多
This study aimed to propose an operational definition of late-onset hypogonadism(LOH)that incorporates both clinical symptoms and serum testosterone measurements to evaluate the prevalence of LOH in aging males in Chi...This study aimed to propose an operational definition of late-onset hypogonadism(LOH)that incorporates both clinical symptoms and serum testosterone measurements to evaluate the prevalence of LOH in aging males in China.A population-based sample of 6296 men aged 40 years-79 years old was enrolled from six representative provinces in China.Serum total testosterone(TT),sex hormone-binding globulin(SHBG),and luteinizing hormone(LH)were measured and free testosterone(cFT)was calculated.The Aging Males’Symptoms(AMS)scale was used to evaluate the LOH symptoms.Finally,5078 men were included in this analysis.The TT levels did not decrease with age(P=0.59),and had no relationship with AMS symptoms(P=0.87 for AMS total score,P=0.74 for≥3 sexual symptoms).The cFT levels decreased significantly with age(P<0.01)and showed a negative association with the presence of≥3 sexual symptoms(P=0.03).The overall estimated prevalence of LOH was 7.8%(395/5078)if a cFT level<210 pmol l−1 combined with the presence of≥3 sexual symptoms was used as the criterion of LOH.Among them,26.1%(103/395)and 73.9%(292/395)had primary and secondary hypogonadism,respectively.After adjustment for confounding factors,primary and secondary hypogonadism was positively related to age and comorbidities.Body mass index was an independent risk factor for secondary hypogonadism.The results suggest that the AMS total score is not an appropriate indicator for decreased testosterone,and that the cFT level is more reliable than TT for LOH diagnosis.Secondary hypogonadism is the most common form of LOH.展开更多
Dozens of genes are associated with idiopathic hypogonadotropic hypogonadism(IHH)and an oligogenic etiology has been suggested.However,the associated genes may account for only approximately 50%cases.In addition,a gen...Dozens of genes are associated with idiopathic hypogonadotropic hypogonadism(IHH)and an oligogenic etiology has been suggested.However,the associated genes may account for only approximately 50%cases.In addition,a genomic systematic pedigree analysis is still lacking.Here,we conducted whole exome sequencing(WES)on 18 unrelated men affected by IHH and their corresponding parents.Notably,one reported and 10 novel variants in eight known IHH causative genes(AXL,CCDC141,CHD7,DMXL2,FGFR1,PNPLA6,POLR3A,and PR0KR2),nine variants in nine recently reported candidate genes(DCAF17,DCC,EGF,IGSF10,NOTCH1,PDE3A,RELN,SLIT2,and TRAPPC9),and four variants in four novel candidate genes for IHH(CCDC88C,CDON,GADL1,and SPRED3)were identified in 77.8%(14/18)of IHH cases.Among them,eight(8/18,44.4%)cases carried more than one variant in IHH-related genes,supporting the oligogenic model.Interestingly,we found that those variants tended to be maternally inherited(maternal with n=17 vs paternal with n=7;P=0.028).Our further retrospective investigation of published reports replicated the maternal bias(maternal with n=46 i^s paternal with n=28;P=0.024).Our study extended a variant spectrum for IHH and provided the first evidence that women are probably more tolerant to variants of IHH-related genes than men.展开更多
We aim to design a new glanuloplasty procedure combined with spongiosum to reduce the incidence of glans dehiscence and coronal fistula after proximal hypospadias repair.Patients who underwent urethroplasty by dorsal ...We aim to design a new glanuloplasty procedure combined with spongiosum to reduce the incidence of glans dehiscence and coronal fistula after proximal hypospadias repair.Patients who underwent urethroplasty by dorsal preputial island flap for proximal hypospadias between January 2014 and December 2016 were reviewed in this retrospective cohort study.Those who underwent spongiosum-combined glanuloplasty comprised the new-maneuver group,whereas those who underwent conventional glanuloplasty comprised the control group.The incidence of complications was then compared.In the new-maneuver group,dysplastic corpus spongiosum alongside lateral Buck's fascia(0.3-0.4 cm wide)on both sides of the urethral plate was separated from the proximal normal spongy tissue,joining into the glans wings to increase tissue volume and covering the neourethra in the glans penis.In the control group,the neourethra was covered with superficial fascia under the coronal sulcus.As a result,the new-maneuver and control groups comprised 47 and 28 patients,respectively.In the new-maneuver group,no glans dehiscence was detected;however,two(4.3%)patients had coronal fistula,two(4.3%)had urethral stricture,and four(8.5%)had diverticulum.In the control group,two(7.1%)patients had glans dehiscence,eight(28.6%)had coronal fistula,four(14.3%)had urethral stricture,one(3.6%)had diverticulum,and one(3.6%)had penile curvature recurrence.The new-maneuver group had less incidences of coronal fistula(P<0.001),glans dehiscence(P=0.033),and urethral stricture(P=0.008)but had a higher incidence of diverticulum than the control group(P=0.040).It clearly demonstrates that spongiosum-combined glanuloplasty can significantly reduce the incidences of coronal fistula and glans dehisce.展开更多
Testosterone(T)plays a crucial role in spermatogenesis because extremely low levels of intratesticular T lead to correspondingly low serum levels of total T(tT),severe disorders of spermatogenesis,and male sterility.H...Testosterone(T)plays a crucial role in spermatogenesis because extremely low levels of intratesticular T lead to correspondingly low serum levels of total T(tT),severe disorders of spermatogenesis,and male sterility.However,there is little consensus on the lower limits of serum tT in proven fertile men undergoing assisted reproductive technology treatments in Chinese or other Asian populations.We aimed to establish the reference range of serum tT based on a population of 868 fertile Chinese men undergoing in vitro fertilization or intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)treatments.We defined a fertile man as having had a live baby with his partner as recorded in our IVF registration system.The lower limits of serum tT were established using a Siemens IMMULITE 2000 chemiluminescent system.The 1st,2.5th,and 5th percentiles and their 95%confidence intervals(CIs)were 3.6(95%CI:2.7–4.1)nmol l−1,4.3(95%CI:4.1–5.0)nmol l−1,and 5.6(95%CI:4.8–5.8)nmol l−1,respectively.Using the linear correlation of serum tT between the Siemens platform and a liquid chromatography–tandem mass spectrometry platform,the calculated lower limits of serum tT were also established for fertile Chinese men undergoing IVF/ICSI-ET treatments,which will benefit the clinical diagnosis and treatment of male infertility during such procedures.展开更多
Many studies have shown that microRNAs(miRNAs)play vital roles during the spermatogenesis.However,little is known about the altered miRNA profiles of testicular tissues in nonobstructive azoospermia(NOA).Using microar...Many studies have shown that microRNAs(miRNAs)play vital roles during the spermatogenesis.However,little is known about the altered miRNA profiles of testicular tissues in nonobstructive azoospermia(NOA).Using microarray technology,the miRNA expression profiles of testicular biopsies from patients with NOA and of normal testicular tissues were determined.Bioinformatics analyses were conducted to predict the enriched biological processes and functions of identified miRNAs.The microarray data were validated by quantitative reverse transcriptase polymerase chain reaction(qRT-PCR),the results of which were then validated with a larger sample size.Correlations between the miRNA expression levels and clinical characteristics were analyzed.Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic ability of miRNAs for azoospermia.Hierarchical clustering showed that 129 miRNAs were significantly differentially expressed between the NOA and control groups.Bioinformatics analysis indicated that the differentially expressed miRNAs were involved in spermatogenesis,cell cycle,and mitotic prometaphase.In the subsequent qRT-PCR assays,the selected miRNA expression levels were consistent with the microarray results,and similar validated results were obtained with a larger sample size.Some clinical characteristics were significantly associated with the expression of certain miRNAs.In particular,we identified a combination of two miRNAs(miR-10b-3p and miR-34b-5p)that could serve as a predictive biomarker of azoospermia.This study provides altered miRNA profiles of testicular biopsies from NOA patients and examines the roles of miRNAs in spermatogenesis.These profiles may be useful for predicting and diagnosing the presence of testicular sperm in individuals with azoospermia.展开更多
Lidia Minguez-Alarcon,Jorge E Chavarro,Jaime Mendiola,Manuela Roca,Cigdem Tanrikut,Jesus Vioque,Niels Jorgensen,Alberto M Torres-Cantero.Fatty acid intake in relation to reproductive hormones and testicular volume amo...Lidia Minguez-Alarcon,Jorge E Chavarro,Jaime Mendiola,Manuela Roca,Cigdem Tanrikut,Jesus Vioque,Niels Jorgensen,Alberto M Torres-Cantero.Fatty acid intake in relation to reproductive hormones and testicular volume among young healthy men.Asian Journal ofAndrology 2017;19:184-90.展开更多
Aromatase activity has commonly been associated with male infertility characterized by testicular dysfunction with low serum testosterone and/or testosterone to estradiol ratio.In this subset of patients,and particula...Aromatase activity has commonly been associated with male infertility characterized by testicular dysfunction with low serum testosterone and/or testosterone to estradiol ratio.In this subset of patients,and particularly in those with hypogonadism,elevated levels of circulating estradiol may establish a negative feedback on the hypothalamic–pituitary–testicular axis by suppressing follicle-stimulating hormone(FSH)and luteinizing hormone(LH)production and impaired spermatogenesis.Hormonal manipulation via different agents such as selective estrogen modulators or aromatase inhibitors to increase endogenous testosterone production and improve spermatogenesis in the setting of infertility is an off-label option for treatment.We carried out a systematic review and meta-analysis of the literature of the past 30 years in order to evaluate the benefits of the use of aromatase inhibitors in the medical management of infertile/hypoandrogenic males.Overall,eight original articles were included and critically evaluated.Either steroidal(Testolactone)or nonsteroidal(Anastrozole and Letrozole)aromatase inhibitors were found to statistically improve all the evaluated hormonal and seminal outcomes with a safe tolerability profile.While the evidence is promising,future prospective randomized placebo-controlled multicenter trials are necessary to better define the efficacy of these medications.展开更多
"Reproductive health"was officially defined as humans and their individual activities related to reproduction throughout their lives,which should be in good health in physical,psychological,and social aspect..."Reproductive health"was officially defined as humans and their individual activities related to reproduction throughout their lives,which should be in good health in physical,psychological,and social aspects.1 The basic research on male reproductive health in China can be traced back to the 1960s.2 Since the National Natural Science Foundation of China(NSFC)began systematic support for basic research on male reproductive health in 1988,the field has been systematically developed in China.In this regard,we analyze the role of the NSFC on the development of basic research in the field of male reproductive health in China.展开更多
We evaluated contemporary trends in radical prostatectomy(RP)in men aged>70 years and investigated associations of selected variables with recovery of urinary continence(UC)in two age groups:>70 and<70 years....We evaluated contemporary trends in radical prostatectomy(RP)in men aged>70 years and investigated associations of selected variables with recovery of urinary continence(UC)in two age groups:>70 and<70 years.A retrospective cohort of 2301 eligible patients attending our institution from 2004 to 2015 was reviewed.Patients were divided into two groups based on age at surgery(>70 years[n=610]vs<70 years[n=1691])and four groups by year of surgery.Over the study period,the proportion of patients aged>70 years gradually increased up to 30.0%,and the rate of robot-assisted RP and neurovascular bundle(NVB)saving increased continually to 80.0%and 67.4%of older patients,respectively.Although the rate of recovery of UC within 12 months(3 months)in patients aged>70 years was lower than that in those aged S70 years(81.5%[52.6%]vs 88.6%[60.9%],respectively;both P<0.001),the gap between age groups in the rate of recovery within 12 mon ths n arrowed from the sec ond quarter of the study period.Among youn ger patie nts,age,robot-assisted RP,prostate volume,membra nous urethral length(MUL),and NVB savi ng were predictors of recovery of UC within 3 or 12 months.In contrast,only age and MUL were predictors of recovery of UC within 3 and 12 months in patients aged>70 years.Therefore,unlike younger patients,only variables(age and MUL),possibly associated with the inhere nt fun ction of the urinary sphi ncter,were predictors of recovery of UC in patients aged>70 years.展开更多
Dear Editor,Sex in mammals is genetically determined and defined at the cellular level by the sex chromosome constitution(XY males and XX females)and at the phenotypic level by the development of genderspecific anatom...Dear Editor,Sex in mammals is genetically determined and defined at the cellular level by the sex chromosome constitution(XY males and XX females)and at the phenotypic level by the development of genderspecific anatomy,physiology,and behavior.146,XY complete gonadal dysgenesis(46,XY CGD),first reported by Swyer in 1955,^2 is a rare congenital condition with completely or partially disordered gonadal development,leading to discordance between the genetic,gonadal,and phenotypic sex.Affected patients have a 46,XY karyotype,a female phenotype,normal female external genitalia,and CGD("streak gonads")without sperm production and follicular or steroid function.展开更多
基金This work was supported by the National Natural Science Foundation of China(81901535 and 82071698)the Natural Science Foundation of Beijing Municipality(7222208)the National Key Research&Developmental Program of China(2021YFC2700203).
文摘Male diabetic individuals present a marked impairment in fertility;however,knowledge regarding the pathogenic mechanisms and therapeutic strategies is unsatisfactory.The new hypoglycemic drug dapagliflozin has shown certain benefits,such as decreasing the risk of cardiovascular and renal events in patients with diabetes.Even so,until now,the effects and underlying mechanisms of dapagliflozin on diabetic male infertility have awaited clarification.Here,we found that dapagliflozin lowered blood glucose levels,alleviated seminiferous tubule destruction,and increased sperm concentrations and motility in leptin receptor-deficient diabetic db/db mice.Moreover,the glucagon-like peptide-1 receptor(GLP-1R)antagonist exendin(9-39)had no effect on glucose levels but reversed the protective effects of dapagliflozin on testicular structure and sperm quality in db/db mice.We also found that dapagliflozin inhibited the testicular apoptotic process by upregulating the expression of the antiapoptotic protein B-cell lymphoma 2(BCL2)and X-linked inhibitor of apoptosis protein(XIAP)and inhibiting oxidative stress by enhancing the antioxidant status,including total antioxidant capacity,total superoxide dismutase(SOD)activity,and glutathione peroxidase(GPx)activity,as well as decreasing the level of 4-hydroxynonenal(4-HNE).Exendin(9-39)administration partially reversed these effects.Furthermore,dapagliflozin upregulated the glucagon-like peptide-1(GLP-1)level in plasma and GLP-1R expression by promoting AKT8 virus oncogene cellular homolog(Akt)phosphorylation in testicular tissue.Exendin(9-39)partially inhibited Akt phosphorylation.These results suggest that dapagliflozin protects against diabetes-induced spermatogenic dysfunction via activation of the GLP-1R/phosphatidylinositol 3-kinase(PI3K)/Akt signaling pathway.Our results indicate the potential effects of dapagliflozin against diabetes-induced spermatogenic dysfunction.
基金This work was supported by the National Natural Science Foundation of China(No.82071931 and No.82130057)the Program for Shanghai Outstanding Medical Academic Leaders(2019LJ18)+2 种基金the Interdisciplinary Program of Shanghai Jiao Tong University(ZH2018ZDA17)the Program from Science and Technology Commission of Shanghai Municipality(20Y11912400)the Clinical Research Innovation Team of Shanghai General Hospital(No.CTCCR-2019B05).
文摘This study aimed to evaluate the ability of rete testis thickness(RTT)and testicular shear wave elastography(SWE)to differentiate obstructive azoospermia(OA)from nonobstructive azoospermia(NOA).We assessed 290 testes of 145 infertile males with azoospermia and 94 testes of 47 healthy volunteers at Shanghai General Hospital(Shanghai,China)between August 2019 and October 2021.The testicular volume(TV),SWE,and RTT were compared among patients with OA and NOA and healthy controls.The diagnostic performances of the three variables were evaluated using the receiver operating characteristic curve.The TV,SWE,and RTT in OA differed significantly from those in NOA(all P≤0.001)but were similar to those in healthy controls.Males with OA and NOA were similar at TVs of 9–11 cm^(3)(P=0.838),with sensitivity,specificity,Youden index,and area under the curve of 50.0%,84.2%,0.34,and 0.662(95%confidence interval[CI]:0.502–0.799),respectively,for SWE cut-off of 3.1 kPa;and 94.1%,79.2%,0.74,and 0.904(95%CI:0.811–0.996),respectively,for RTT cut-off of 1.6 mm.The results showed that RTT performed significantly better than SWE in differentiating OA from NOA in the TV overlap range.In conclusion,ultrasonographic RTT evaluation proved a promising diagnostic approach to differentiate OA from NOA,particularly in the TV overlap range.
基金funded by the National Natural Science Foundation of China (No.82073049 and No.81802484)Postdoctoral Research Foundation of China (No.2019TQ0376)+1 种基金Science and Technology Program of Guangzhou City (No.201903010093)Natural Science Foundation of Guangdong Province (No.2018A030313549).
文摘Male patients with prolactinomas usually present with typical hyperprolactinemia symptoms,including sexual dysfunction and infertility.However,clinical factors related to sexual dysfunction and surgical outcomes in these patients remain unclear.This study aimed to investigate the outcomes of male patients with prolactinomas after transsphenoidal surgery and the risk factors affecting sexual dysfunction.This study was conducted on 58 male patients who underwent transsphenoidal surgery for prolactinomas between May 2014 and December 2020 at the First Affiliated Hospital of Sun Yat-sen University,Guangzhou,China.We evaluated the sexual function of patients before and after surgery through International Index of Erectile Function-5 scores,libido,and frequency of morning erection.Of the 58 patients,48(82.8%)patients had sexual intercourse preoperatively.Among those 48 patients,41(85.4%)patients presented with erectile dysfunction.The preoperative International Index of Erectile Function-5 scores in patients with macroprolactinomas were significantly higher than those in patients with giant prolactinomas(17.63±0.91 vs 13.28±1.43;P=0.01).Postoperatively,the incidence of erectile dysfunction was 47.9%,which was significantly lower than that preoperatively(85.4%;P=0.01).Twenty-eight(68.3%)patients demonstrated an improvement in erectile dysfunction.Tumor size and invasiveness were significantly correlated with the improvement of erectile dysfunction.Preoperative testosterone<2.3 ng ml^(-1)was an independent predictor of improvement in erectile dysfunction.In conclusion,our results indicated that tumor size and invasiveness were important factors affecting the improvement of sexual dysfunction in male patients with prolactinoma.The preoperative testosterone level was an independent predictor related to the improvement of erectile dysfunction.
文摘Nonobstructive azoospermia(NOA)refers to the failure of spermatogenesis,which affects approximately 1%of the male population and contributes to 10%of male infertility.NOA has an underlying basis of endocrine imbalances since proper human spermatogenesis relies on complex regulation and cooperation of multiple hormones.A better understanding of subtle hormonal disturbances in NOA would help design and improve hormone therapies with reduced risk in human fertility clinics.The purpose of this review is to summarize the research on the endocrinological aspects of NOA,especially the hormones involved in hypothalamic–pituitary–testis axis(HPTA),including gonadotropin-releasing hormone,follicle-stimulating hormone,luteinizing hormone,prolactin,testosterone,estradiol,sex hormone binding globulin,inhibin B,anti-Müllerian hormone,and leptin.For the NOA men associated with primary testicular failure,the quality of currently available evidence has not been sufficient enough to recommend any general hormone optimization therapy.Some other NOA patients,especially those with hypogonadotropic hypogonadism,could be treated with hormonal replacement.Although these approaches have succeeded in resuming the fertility in many NOA patients,the prudent strategies should be applied in individuals according to specific NOA etiology by balancing fertility benefits and potential risks.This review also discusses how NOA can be induced by immunization against hormones.
文摘This study aimed to propose an operational definition of late-onset hypogonadism(LOH)that incorporates both clinical symptoms and serum testosterone measurements to evaluate the prevalence of LOH in aging males in China.A population-based sample of 6296 men aged 40 years-79 years old was enrolled from six representative provinces in China.Serum total testosterone(TT),sex hormone-binding globulin(SHBG),and luteinizing hormone(LH)were measured and free testosterone(cFT)was calculated.The Aging Males’Symptoms(AMS)scale was used to evaluate the LOH symptoms.Finally,5078 men were included in this analysis.The TT levels did not decrease with age(P=0.59),and had no relationship with AMS symptoms(P=0.87 for AMS total score,P=0.74 for≥3 sexual symptoms).The cFT levels decreased significantly with age(P<0.01)and showed a negative association with the presence of≥3 sexual symptoms(P=0.03).The overall estimated prevalence of LOH was 7.8%(395/5078)if a cFT level<210 pmol l−1 combined with the presence of≥3 sexual symptoms was used as the criterion of LOH.Among them,26.1%(103/395)and 73.9%(292/395)had primary and secondary hypogonadism,respectively.After adjustment for confounding factors,primary and secondary hypogonadism was positively related to age and comorbidities.Body mass index was an independent risk factor for secondary hypogonadism.The results suggest that the AMS total score is not an appropriate indicator for decreased testosterone,and that the cFT level is more reliable than TT for LOH diagnosis.Secondary hypogonadism is the most common form of LOH.
基金the National Key Research and Development Program of China(2016YFC0905100)National Natural Science Foundation of China(31625015 and 31521003)+2 种基金Shanghai Medical Center of Key Programs for Female Reproductive Diseases(2017ZZ01016)Shanghai Municipal Science and Technology Major Project(2017SHZDZX01)Shanghai Municipal Commission for Science and Technology(19QA1407500).
文摘Dozens of genes are associated with idiopathic hypogonadotropic hypogonadism(IHH)and an oligogenic etiology has been suggested.However,the associated genes may account for only approximately 50%cases.In addition,a genomic systematic pedigree analysis is still lacking.Here,we conducted whole exome sequencing(WES)on 18 unrelated men affected by IHH and their corresponding parents.Notably,one reported and 10 novel variants in eight known IHH causative genes(AXL,CCDC141,CHD7,DMXL2,FGFR1,PNPLA6,POLR3A,and PR0KR2),nine variants in nine recently reported candidate genes(DCAF17,DCC,EGF,IGSF10,NOTCH1,PDE3A,RELN,SLIT2,and TRAPPC9),and four variants in four novel candidate genes for IHH(CCDC88C,CDON,GADL1,and SPRED3)were identified in 77.8%(14/18)of IHH cases.Among them,eight(8/18,44.4%)cases carried more than one variant in IHH-related genes,supporting the oligogenic model.Interestingly,we found that those variants tended to be maternally inherited(maternal with n=17 vs paternal with n=7;P=0.028).Our further retrospective investigation of published reports replicated the maternal bias(maternal with n=46 i^s paternal with n=28;P=0.024).Our study extended a variant spectrum for IHH and provided the first evidence that women are probably more tolerant to variants of IHH-related genes than men.
基金the Program on"Reconstruction of glans with dysplastic urethral cavernosum and Bucks fascia to reduce the complication rate of fistula at coronal sulcus and dehiscence after hypospadias repair"funded under the Science and Technology Commission of Shanghai Municipality(grant number 15411966900)the Program on"Reconstruct the urethra plate by dorsal inner prepuce island flap in proximal hypospadias repair"funded under the Clinical Research Project of Shanghai Municipal Health Commission(grant number 201940223).
文摘We aim to design a new glanuloplasty procedure combined with spongiosum to reduce the incidence of glans dehiscence and coronal fistula after proximal hypospadias repair.Patients who underwent urethroplasty by dorsal preputial island flap for proximal hypospadias between January 2014 and December 2016 were reviewed in this retrospective cohort study.Those who underwent spongiosum-combined glanuloplasty comprised the new-maneuver group,whereas those who underwent conventional glanuloplasty comprised the control group.The incidence of complications was then compared.In the new-maneuver group,dysplastic corpus spongiosum alongside lateral Buck's fascia(0.3-0.4 cm wide)on both sides of the urethral plate was separated from the proximal normal spongy tissue,joining into the glans wings to increase tissue volume and covering the neourethra in the glans penis.In the control group,the neourethra was covered with superficial fascia under the coronal sulcus.As a result,the new-maneuver and control groups comprised 47 and 28 patients,respectively.In the new-maneuver group,no glans dehiscence was detected;however,two(4.3%)patients had coronal fistula,two(4.3%)had urethral stricture,and four(8.5%)had diverticulum.In the control group,two(7.1%)patients had glans dehiscence,eight(28.6%)had coronal fistula,four(14.3%)had urethral stricture,one(3.6%)had diverticulum,and one(3.6%)had penile curvature recurrence.The new-maneuver group had less incidences of coronal fistula(P<0.001),glans dehiscence(P=0.033),and urethral stricture(P=0.008)but had a higher incidence of diverticulum than the control group(P=0.040).It clearly demonstrates that spongiosum-combined glanuloplasty can significantly reduce the incidences of coronal fistula and glans dehisce.
基金the National Key Research and Development Program of China(No.2016YFC1000201,No.2018YFC1002104,No.2018YFC1002106,and No.2016YFC1000302)the National Natural Science Foundation of China(No.81300373,and No.81771650)+2 种基金the Capital Health Research and Development of Special Projects(No.2018-1-4091)the Program for Innovative Research Team of Yunnan,China(No.2017HC009)the Major National R&D Projects of China(No.2017ZX09304012-012).
文摘Testosterone(T)plays a crucial role in spermatogenesis because extremely low levels of intratesticular T lead to correspondingly low serum levels of total T(tT),severe disorders of spermatogenesis,and male sterility.However,there is little consensus on the lower limits of serum tT in proven fertile men undergoing assisted reproductive technology treatments in Chinese or other Asian populations.We aimed to establish the reference range of serum tT based on a population of 868 fertile Chinese men undergoing in vitro fertilization or intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)treatments.We defined a fertile man as having had a live baby with his partner as recorded in our IVF registration system.The lower limits of serum tT were established using a Siemens IMMULITE 2000 chemiluminescent system.The 1st,2.5th,and 5th percentiles and their 95%confidence intervals(CIs)were 3.6(95%CI:2.7–4.1)nmol l−1,4.3(95%CI:4.1–5.0)nmol l−1,and 5.6(95%CI:4.8–5.8)nmol l−1,respectively.Using the linear correlation of serum tT between the Siemens platform and a liquid chromatography–tandem mass spectrometry platform,the calculated lower limits of serum tT were also established for fertile Chinese men undergoing IVF/ICSI-ET treatments,which will benefit the clinical diagnosis and treatment of male infertility during such procedures.
文摘Many studies have shown that microRNAs(miRNAs)play vital roles during the spermatogenesis.However,little is known about the altered miRNA profiles of testicular tissues in nonobstructive azoospermia(NOA).Using microarray technology,the miRNA expression profiles of testicular biopsies from patients with NOA and of normal testicular tissues were determined.Bioinformatics analyses were conducted to predict the enriched biological processes and functions of identified miRNAs.The microarray data were validated by quantitative reverse transcriptase polymerase chain reaction(qRT-PCR),the results of which were then validated with a larger sample size.Correlations between the miRNA expression levels and clinical characteristics were analyzed.Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic ability of miRNAs for azoospermia.Hierarchical clustering showed that 129 miRNAs were significantly differentially expressed between the NOA and control groups.Bioinformatics analysis indicated that the differentially expressed miRNAs were involved in spermatogenesis,cell cycle,and mitotic prometaphase.In the subsequent qRT-PCR assays,the selected miRNA expression levels were consistent with the microarray results,and similar validated results were obtained with a larger sample size.Some clinical characteristics were significantly associated with the expression of certain miRNAs.In particular,we identified a combination of two miRNAs(miR-10b-3p and miR-34b-5p)that could serve as a predictive biomarker of azoospermia.This study provides altered miRNA profiles of testicular biopsies from NOA patients and examines the roles of miRNAs in spermatogenesis.These profiles may be useful for predicting and diagnosing the presence of testicular sperm in individuals with azoospermia.
文摘Lidia Minguez-Alarcon,Jorge E Chavarro,Jaime Mendiola,Manuela Roca,Cigdem Tanrikut,Jesus Vioque,Niels Jorgensen,Alberto M Torres-Cantero.Fatty acid intake in relation to reproductive hormones and testicular volume among young healthy men.Asian Journal ofAndrology 2017;19:184-90.
文摘Aromatase activity has commonly been associated with male infertility characterized by testicular dysfunction with low serum testosterone and/or testosterone to estradiol ratio.In this subset of patients,and particularly in those with hypogonadism,elevated levels of circulating estradiol may establish a negative feedback on the hypothalamic–pituitary–testicular axis by suppressing follicle-stimulating hormone(FSH)and luteinizing hormone(LH)production and impaired spermatogenesis.Hormonal manipulation via different agents such as selective estrogen modulators or aromatase inhibitors to increase endogenous testosterone production and improve spermatogenesis in the setting of infertility is an off-label option for treatment.We carried out a systematic review and meta-analysis of the literature of the past 30 years in order to evaluate the benefits of the use of aromatase inhibitors in the medical management of infertile/hypoandrogenic males.Overall,eight original articles were included and critically evaluated.Either steroidal(Testolactone)or nonsteroidal(Anastrozole and Letrozole)aromatase inhibitors were found to statistically improve all the evaluated hormonal and seminal outcomes with a safe tolerability profile.While the evidence is promising,future prospective randomized placebo-controlled multicenter trials are necessary to better define the efficacy of these medications.
文摘"Reproductive health"was officially defined as humans and their individual activities related to reproduction throughout their lives,which should be in good health in physical,psychological,and social aspects.1 The basic research on male reproductive health in China can be traced back to the 1960s.2 Since the National Natural Science Foundation of China(NSFC)began systematic support for basic research on male reproductive health in 1988,the field has been systematically developed in China.In this regard,we analyze the role of the NSFC on the development of basic research in the field of male reproductive health in China.
文摘We evaluated contemporary trends in radical prostatectomy(RP)in men aged>70 years and investigated associations of selected variables with recovery of urinary continence(UC)in two age groups:>70 and<70 years.A retrospective cohort of 2301 eligible patients attending our institution from 2004 to 2015 was reviewed.Patients were divided into two groups based on age at surgery(>70 years[n=610]vs<70 years[n=1691])and four groups by year of surgery.Over the study period,the proportion of patients aged>70 years gradually increased up to 30.0%,and the rate of robot-assisted RP and neurovascular bundle(NVB)saving increased continually to 80.0%and 67.4%of older patients,respectively.Although the rate of recovery of UC within 12 months(3 months)in patients aged>70 years was lower than that in those aged S70 years(81.5%[52.6%]vs 88.6%[60.9%],respectively;both P<0.001),the gap between age groups in the rate of recovery within 12 mon ths n arrowed from the sec ond quarter of the study period.Among youn ger patie nts,age,robot-assisted RP,prostate volume,membra nous urethral length(MUL),and NVB savi ng were predictors of recovery of UC within 3 or 12 months.In contrast,only age and MUL were predictors of recovery of UC within 3 and 12 months in patients aged>70 years.Therefore,unlike younger patients,only variables(age and MUL),possibly associated with the inhere nt fun ction of the urinary sphi ncter,were predictors of recovery of UC in patients aged>70 years.
基金This work is supported by the National Key Research and Development Program(Grand No.2017YFC1002003)the National High-tech Research and Development Program(863)of China(Grand No.2015AA020404)+1 种基金the National Natural Science Foundation of China(Grand No.81771637,81571488)the Frontier Technology Project of Shanghai(Grand No.SHDC12015122)
文摘Dear Editor,Sex in mammals is genetically determined and defined at the cellular level by the sex chromosome constitution(XY males and XX females)and at the phenotypic level by the development of genderspecific anatomy,physiology,and behavior.146,XY complete gonadal dysgenesis(46,XY CGD),first reported by Swyer in 1955,^2 is a rare congenital condition with completely or partially disordered gonadal development,leading to discordance between the genetic,gonadal,and phenotypic sex.Affected patients have a 46,XY karyotype,a female phenotype,normal female external genitalia,and CGD("streak gonads")without sperm production and follicular or steroid function.
