Liu Df

Medical management of erectile dysfunction in aging males: is it too late to treat?

Erectile dysfunction (ED) is a common disorder among aging males. However, most aging males refuse to seek medical help and believe that ED is an irreversible event in the aging process. The purpose of this study was to describe the current medical management of ED in aging males and to examine whether it is too late to treat this disorder in these elderly men. From 2007 to 2008, 4507 patients diagnosed with ED were gathered from 46 centers in China; 4241 completed the study, 3837 of whom were treated with sildenafil. The 3837 patients were divided into five groups based on age (group A: 20–30 years; group B: 31–40 years; group C: 41–50 years; group D: 51–60 years; and group E: >60 years). After comparing pre- and posttreatment International Index of Erectile Function-Erectile Function domain (IIEF-EF) questionnaires, Erection Hardness Scale (EHS), and IIEF Q13 (“How satisfied have you been with your overall sex life?”), we discovered that the aging males had worse erectile function, erection hardness, and sexual satisfaction than the younger males (P < 0.001). After treatment, the improvement rates in the IIEF-EF, EHS, and IIEF Q13 scores were 107.0%, 83.1%, and 116.5%, respectively. The magnitude of these changes demonstrated significant differences among groups (P < 0.001). Accordingly, aging males are likely to benefit more from medical treatment. We propose that aging males should be informed that age is not a limiting factor for medical ED management, and it is never too late to treat.

Sodium-Hydrogen-Exchanger expression in human sperm and its relationship with semen parameters

PurposeSperm-specific sodium-hydrogen exchanger (sNHE) is essential to maintain sperm normal function in mice; however, its role in human sperm has not been clarified to date. The aim of this study is to investigate the expression pattern of sNHE in human spermatozoa and its relationship with sperm functional parameters.MethodSemen samples from 68 asthenozoospermic and 61 normozoospermic men were analyzed for sperm concentration, motility, and acrosome reaction, and high motile spermatozoa were collected by swim-up method. The expression of sNHE in spermatozoa was detected by Western blot and immunofluorescence staining. The relationship between sNHE expression and sperm parameters was assessed.ResultsWe identified sNHE is mainly localized to the principal piece of the human sperm tail. The expression of sNHE was positively correlated with sperm concentration, total number, and progressive motility. Moreover, sNHE expression was upregulated in swim-up sperm and associated with most of sperm motility parameters including straight line velocity and curvilinear velocity. Our results also showed that sNHE expression is decreased in sperm from patients with asthenozoospermia compared with that from normal controls. However, no correlation was found between sNHE expression and acrosome reaction in spermatozoa.ConclusionsThe expression pattern of sNHE suggested that this protein may be involved in the regulation of sperm motility, and aberration of its expression in sperm may contribute to the pathogenesis of asthenozoospermia.

Multiple factors affecting surgical outcomes and patency rates in use of single-armed two-suture microsurgical vasoepididymostomy: a single surgeon's experience with 81 patients.

Vasoepididymostomy (VE), as the most challenging procedure in microsurgeries, is often carried out with a double-armed two-suture technique. In this study, we evaluated the efficacy and safety of the single-armed two-suture VEs on humans and studied the factors that could possibly affect the patency rates. From July 2012 to July 2013, we reviewed 81 patients with consecutive primary epididymal obstruction who underwent single-armed two-suture longitudinal intussusception microsurgical VEs by a single surgeon, Kai Hong (KH). At the same time, we analyzed seven factors that possibly related to the patency rates. With the single-armed technique, a total of 81 men underwent the microsurgical VEs. Data on 62 patients were completely recorded. 19 patients were lost to follow-up. Mean age was 31 years old. Mean follow-up time was 8.8 (2-17) months. The patency rate was 66.1% (41/62). Natural pregnancy rate was 34.1% (14/41). Overall pregnancy rate was 22.6% (14/62). No severe surgical complications were noted. With logistic regression test analysis, there were two factors related to a higher patency rate: anastomosis sites (P = 0.035) and motile sperm found in the epididymal fluid (P = 0.006). Motile sperm found in the epididymal fluid were associated with a higher patency rate (OR = 11.80, 95% CI = 1.79, 77.65). The single-armed two-suture longitudinal VE technique is feasible for microsurgical practice. The patency and pregnancy rates are comparable to the doubled-armed technique. Anastomosis sites and motile sperm found in the epididymal fluid were the most two important factors related to higher patency.

Effects of maternal acrolein exposure during pregnancy on testicular testosterone production in fetal rats

Acrolein has been reported to have diverse toxic effects on various organs, including the reproductive system. However, little is known regarding the effects of maternal acrolein exposure on testicular steroidogenesis in male offspring. The present study investigated the effects of acrolein on fetal testosterone production and associated genes. Pregnant Sprague-Dawley rats were intraperitoneally injected with vehicle (normal saline) or 1, 2 or 5 mg/kg acrolein from gestational day (GD) 14–20, and fetal testes were examined on GD 21. Fetal body and testicular weights were markedly reduced in pups following exposure to high doses of acrolein (5 mg/kg) in late pregnancy. Notably, in utero exposure of 5 mg/kg acrolein significantly decreased the testicular testosterone level and downregulated the expression levels of steroidogenic acute regulatory protein (StAR) and 3β-hydroxysteroid dehydrogenase (3β-HSD), whereas the levels of other steroidogenic enzymes, including scavenger receptor class B, cholesterol side-chain cleavage enzyme and steroid 17 alpha-hydroxylase/17,20 lyase, were unaffected. Furthermore, the 3β-HSD immunoreactive area in the interstitial region of the fetal testes was reduced at a 5 mg/kg dose, whereas the protein expression levels of 4-hydroxynonenalwere dose-dependently increased following maternal exposure to acrolein. mRNA expression levels of insulin-like factor 3, a critical gene involved in testicular descent, were unaltered following maternal acrolein exposure. Taken together, the results of the present study suggested that maternal exposure to high doses of acrolein inhibited fetal testosterone synthesis, and abnormal expression of StAR and 3β-HSD may be associated with impairment of the steroidogenic capacity.

Trim27 interacts with Slx2, is associated with meiotic processes during spermatogenesis.

ABSTARCT Formation of the XY body is believed to prevent recombination between X and Y chromosomes during meiosis. We recently demonstrated that SYCP3-like X-linked 2 (Slx2) could be involved in synaptonemal complex formation as well as XY body maintenance during meiosis. In order to further investigate the role and composition of XY body protein complexes in meiotic processes and spermatogenesis, a yeast 2-hybrid screening was performed, and the tripartite motif protein 27(Trim27) was found to interact with Slx2 and co-localized in the XY body. Trim27 has a tripartite motif (TRIM) consisting of a RING finger, B-box and coiled-coil domains, and is a transcriptional regulator that is expressed in various tumor cell lines. In this study, we showed that Slx2 and Trim27 were highly expressed in meiosis of mouse testis. And the Slx2/Trim27 interaction was confirmed in vivo by co-immunoprecipitation and mammalian 2-hybrid interaction assays. Moreover, cytoimmuno localization experiments revealed that Slx2/Trim27 was co-localized to the XY body of spermatocytes during meiosis, and immunohistochemical results revealed co-localization of Trim27 and γ-H2AX in the XY body of primary spermatocytes in the mouse testis. Trim27 may therefore be a transcriptional regulation protein connecting Slx2 and γ-H2AX, thereby promoting the formation of a more potent XY body protein complex in meiotic processes and spermatogenesis. In conclusion, Trim27 connecting Slx2 may regulate meiotic processes in multiple ways by influencing XY body formation and germ cell proliferation during spermatogenesis.

A clinical trial on the consistency of bilateral testicular tissue histopathology and Johnsen score: single side or bilateral side biopsy?

To evaluate and compare left and right testicular tissue histopathology and Johnsen score, and to investigate the necessity for bilateral testicular biopsy. We recruited180 patients with non-obstructiveazoospermia (NOA) on testicular biopsy who had undergonetesticular sperm aspiration (TESA). Pathological sections of testicular tissue were diagnosed by specially-assigned doctors, who evaluated pathological findings, determined the Johnsen score and confirmed for the presence or absence of sperm. Sperm positive rates for left and right testicular histopathology were 55.0% and 51.7% respectively, and the proportion of Johnsen scores≥8 for left and right testes were 53.3% and 50.0%, respectively. Cohen kappa values revealed that the identification of sperm in bilateral testicular samples was not consistent and was related to random effects; Optimized cut-off value for bilateral testicular volume was 11ml (Johnsen score ≥8), and optimized cut-off values of E2 on left and right testes were 144.5pmol/L and 133.5 pmol/L (Johnsen score≤7). However, age, serum prolactin (PRL), follicle stimulating hormone (FSH), luteinizing hormone (LH) and total testosterone (TT) levels were not accurate predictors for the existence of testicular sperm. There was nostatistical significance between left and right testicular histopathology in terms of sperm positive rates or Johnsen score; the Johnsen score were caused entirely by random effects and a score from one side could not represent the other side. Therefore, we recommend that both testes need to undergo surgery when NOA patients undergo testicular biopsy or sperm retrieval.

Fertility achieved through in vitro fertilization in a male patient with 48,XXYY syndrome

microalbumin, and 24 h urinary protein (urinary protein: 555.0 mg l−1; urinary total protein/creatinine: 286.5; urinary albumin/creatinine: 186.9; microalbumin: 362.5 mg l−1; and 24 h urinary protein: 522 mg per 24 h). Thus, we diagnosed the patient with proteinuria resulting from some unknown reason. Biological data revealed that cholesterol and triglycerides were much higher than normal, suggesting the presence of hyperlipidemia (cholesterol: 6.87 mmol l−1; triglycerides: 5.74 mmol l−1). Hormonal data showed a low testosterone level accompanied by elevated basal gonadotropin levels (Table 1), and these data were suggestive of a sex chromosome aneuploidy. We performed karyotype analysis twice for this patient using lymphocytes from peripheral blood; 30 metaphases were counted in the first analysis (320–400 G‐banding) and 100 metaphases were counted in the second analysis (550 G‐banding). Results from the two analyses showed the presence of the 48,XXYY aneuploidy in all the cells that were analyzed (Figure 1). The result of Y chromosome microdeletion detection showed no deletion of the six sequence tagged sites (sY84, sY86, sY127, sY134, sY254, sY255) and SRY gene, suggesting that the AZF regions are complete. Although the patient suffers from azoospermia, his family had a strong fertility requirement. Microdissection testicular sperm extraction was successfully performed; surprisingly, normally shaped sperm were found under a microscope after tearing of the seminiferous tubules. Blood from the patient’s wife was examined, and the results were consistent with the experimental requirements. Under intravenous anesthesia, ovarian puncture ovulation was carried out with the guidance of vaginal ultrasound imaging. Nine eggs were successfully removed, six were mature, and four were fertilized by intracytoplasmic sperm injection. Then two embryos developed into blastula stage and were frozen, followed by in vitro fertilization with preimplantation genetic diagnosis. All the procedures were approved by the Ethics Committee of our hospital, and the informed consent was obtained from the patient and his spouse. The patient’s spouse is currently successfully pregnant, and the embryo is normal. In this report, the patient had been married for three years and had conceived no children even without contraception. Infertility Dear Editor, The 48,XXYY syndrome is a rare sex chromosome aneuploidy with an incidence of 1:18 000–1:40 000 male births1 and is associated with hypergonadotropic hypogonadism as an endocrine disorder.2,3 Most men with this syndrome are never diagnosed in China. Due to sex chromosome aneuploidies and limited effective communication, these patients suffer from infertility.4 With a rare incidence rate, 48,XXYY syndrome is characterized by tall stature, abdominal adiposity, and small testicles; it often appears after puberty.5 These patients often present with azoospermia and have difficulty with fertility. However, the literature provides little information about the fertility issues resulting from this syndrome. Advances in assisted reproductive techniques have, in rare cases, allowed for the production of offspring by patients with certain diagnoses thought to be associated with universal infertility.6,7 Here, we report the case of a 30‐year‐old male patient with 48,XXYY syndrome who was referred to our hospital in April 2016 for fertility treatment. In his family history, he was the only child of healthy nonconsanguineous parent. His mother’s pregnancy and delivery were normal. The patient was born at term with normal measurements. We noted that the patient had greater difficulties in understanding and developing social relationships. He married three years before presentation but did not have children at that time. However, there were no available data regarding his parent. The patient had a height of 185 cm, a weight of 80 kg, a body mass index of 23.4 kg m−2, and a blood pressure of 125/75 mmHg. The secondary sexual characteristics of the patient are poorly developed, and he has some feminine characteristics, such as no beard, less hair, and breast development. In addition, he presents orbital hypertelorism, eunuchoid skeleton, reduced muscle mass, elongated arms and legs, and small testicles and penis. Laboratory investigations showed a normal blood cell count, normal thyroid‐stimulating hormone (TSH), iron and calcium levels, and abnormal hepatic, renal, and gonadal functions. Most biological data from urine were within normal limits, with the exception of urinary protein, urinary total protein/creatinine, urinary albumin/creatinine, LETTER TO THE EDITOR