男科学的科研思路及选题

男科疾病诊治水平的不断提高离不开科研的发展。笔者根据自己多年在男科领域的科研工作经历,认为男科的科研选题对提高男科疾病的诊治水平意义重大。男科领域科研选题应密切结合男科临床需要,遵循重要性、创新性、科学性、可行性及现实性等原则,面向常见男科疾病的基础、治疗和流行病学方向选题。选题要注重方法。     

The effect of vitamin E on sperm motility and viability in asthenoteratozoospermic men: In vitro study

Induction of oxidative stress during the sperm preparation process for assisted reproductive techniques (ART) in men can weaken sperm parameters. Vitamin E (VE) is considered a factor in boosting male fertility. This experimental study (in vitro) aimed to assess the impact of VE supplementation on sperm quality and lipid peroxidation during sperm sampling at different times. For this mention, semen samples were collected from 50 asthenoteratozoospermic men. Samples were divided into control and test groups for 2, 4 and 6 hr that the test group was incubated with VE (2 mM). In two groups, total motility, progressive motility and viability based on the WHO 2010 criteria were assessed. Moreover, malondialdehyde (MDA) levels were evaluated in each group. In the control group, total and progressive motility and sperm viability were decreased significantly after 2 hr; however, MDA levels were increased significantly after 6 hr. Also, in the test group, sperm parameters were increased significantly after 2 hr, and MDA levels were decreased significantly after 6 hr compared to the control group. In outcome, in vitro VE supplementation may protect spermatozoa from the adverse effect of oxidative stress during sperm preparation via preservation antioxidant processes in normal condition.     

Two-generation reproductive toxicity evaluation of dietary 17beta-estradiol (E2; CAS No. 50-28-2) in CD-1 (Swiss) mice.

No information exists on reproductive/developmental effects in mice exposed to dietary 17beta-estradiol (E2) over multiple generations. Therefore, under OECD Test Guideline 416 with enhancements, CD-1 mice (F0 generation, 25 mice/sex/group) were exposed to dietary E2 at 0, 0.001, 0.005, 0.05, 0.15, or 0.5 ppm ( approximately 0, 0.2, 1, 10, 30, or 100 mug E2/kg body weight/day) for 8 weeks prebreed, 2 weeks mating, approximately 3 weeks gestation, and 3 weeks lactation. At weaning, selected F1 offspring (F1 parents; 25/sex/group) and extra retained F1 males (one per litter) were exposed to the same dietary concentrations and durations as the F0 generation; study termination occurred at F2 weaning; F1/F2 weanlings (up to three per sex per litter) were necropsied with organs weighed. At 0.5 ppm, effects were increased F1/F2 perinatal loss, prolonged F0/F1 gestational length, reduced numbers of F2 (but not F1) litters/group, reduced F1/F2 litter sizes, accelerated vaginal patency (VP) and delayed preputial separation (PPS), increased uterus + cervix + vagina weights (UCVW) in F0/F1 adults and F1/F2 weanlings, and decreased testes and epididymides weights (TEW) in F1/F2 weanlings. At 0.15 ppm, effects were increased UCVW in F0/F1 adults and F1/F2 weanlings, accelerated VP, delayed PPS, and reduced TEW in F1/F2 weanlings. At 0.05 ppm, UCVW were increased in F1/F2 weanlings, and PPS was delayed only in extra retained F1 males. There were no biologically significant or treatment-related effects on F0/F1 parental body weights, feed consumption, or clinical observations, or on F0/F1 estrous cyclicity, F0/F1 andrology, or F1/F2 anogenital distance at any dose. The no observable effect level was 0.005 ppm E2 ( approximately 1 mug/kg/day). Therefore, the mouse model is sensitive to E2 by oral administration, with effects on reproductive development at doses of 10- 100 mug/kg/day.     

Clinical andrology--still a major problem in the treatment of infertility

This paper highlights the need for formal training in andrology amongst those clinicians who are today managing the problem of infertility in the male. As all infertility now appears to be treated mainly by gynaecologists who have often had no teaching in the subject of andrology, suggestions are made as to how this situation can be improved and rectified. Specific training is needed for those gynaecologists involved in the management of male infertility and it is urged that training courses in clinical andrology are set up for this purpose.     

Lack of standardization in performance of the semen analysis among laboratories in the United States

OBJECTIVE: To determine the level of standardization in performance of the semen analysis among clinical laboratories in the United States.DESIGN: A survey was mailed to laboratories requesting information about the laboratory and performance of the semen analysis. Responses were received from 536 laboratories.SETTING: Clinical laboratories enrolled in the American Association of Bioanalysts Andrology Proficiency Testing Program.PATIENT(S): None.INTERVENTION(S): None.MAIN OUTCOME MEASURE(S): Agreement among laboratories.RESULT(S): Sixty-one percent of respondent laboratories were part of an assisted reproductive technology program. The laboratories perform less than 50 (53%), less than 10 (25%), or less than 5 (16%) andrology laboratory procedures per month. The laboratories routinely report sperm count (94% of laboratories), motility (95%), morphology (85%) and forward progression (69%), and semen volume (96%) as part of the semen analysis. Only 64% of laboratories routinely report abstinence, and 60% of laboratories indicate the criteria used for sperm morphology on the report form. The most common lower limits of normality for sperm count and motility were >20 x 10(6)/mL (77% of laboratories) and >50% (59% of laboratories), respectively. Few laboratories performed quality control for sperm counts (29%), motility (41%), and morphology (41%).CONCLUSION(S): These data indicate a significant lack of standardization in the performance and reporting of semen analyses among laboratories in the United States.     

2004～2008年《中国男科学杂志》载文计量学分析

目的 探讨<中国男科学杂志>在国内男科领域的学术地位.方法 依据CNKI文献数据库检索系统,采用文献计量学的方法对2004-2008年间<中国男科学杂志>所载论文及其引用与被引用等情况进行统计分析,揭示该刊在作者群、引文分布、被引与自引等方面的特征,并从影响因子及期刊H指数等角度评价该刊在国内同类期刊中的学术地位.结果 提示该刊已是我国男科学研究领域最重要的信息源之一.结论 <中国男科学杂志>在男科领域具有较高的学术影响力.     

Edward Martin (1859–1938). The founding father of modern clinical andrology

Edward Martin (1858-1938) was the first surgeon to treat successfully the problem of obstructive azoospermia, a feat that he first described in 1902. He subsequently carried out a total of 11 such operations that resulted in seven patencies and three pregnancies. He also demonstrated that the epididymis was the major site of these obstructive lesions. He pointed out the need for semen analysis in diagnosis and also demonstrated that azoospermia could have two causes, namely spermatogenic failure and ductal obstruction. He also made some important observations on sperm movement. He was probably the first clinician to demonstrate surgically ejaculatory duct obstruction, vasal atrophy and congenital absence of the vas. Most important of all, he demonstrated the need for accurate diagnosis in the treatment of male infertility. An argument is put forward that Edward Martin deserves the title of the 'Founding Father of Modern Clinical Andrology'.     

微信公众平台在男科围术期患者中的应用效果评价

目的：了解微信公众平台在男科围术期护理中的应用效果     

Systemic dermatological treatment with relevance for male fertility

The dermatologist employs systemic agents with likely gametotoxic side effects, including cytotoxic, immunosuppressive, immunomodulatory and biological agents. The impact of chemotherapy on male fertility depends on the treatment protocol as well as the pre‐treatment spermatogenesis status. Sperm concentration starts to drop about 2 weeks after beginning chemotherapy and reaches a maximum after 2–3 months. About half show recovery after 12–36 months. One year after therapy is completed, a treated patient has no increased risk of fathering a malformed child. There are no reports of methotrexate patients fathering children with malformations, most likely because impaired fertility or embryogenesis arrest. Cryopreservation of male gametes should be recommended prior to cytotoxic treatment, since the likelihood of post‐treatment fertility is unpredictable. The cryopreservation causes a loss of vital spermatozoa by 30–70% but does not influence the genetic information of gametes. Males treated with retinoids have no reproductive safety risk. Biologicals inhibiting TNF α show a positive effect on sperm function in vitro.     

Methods to increase the success rate of artificial insemination with donor semen

Donor insemination was performed in two fertility clinics usingcryopreserved semen from the same sperm bank. Donors were selectedin agreement with American Fertility Society recommendations.In the first clinic, cup insemination was combined with intra-uterineinsemination in 321 cycles. Follicular development was closelymonitored with vaginal echography and serum hormonal measurements.In the second clinic, 1287 insemination cycles were performedusing intra-cervical insemination, timed only on basal bodytemperature. In the first clinic, a total of 53 pregnancieswere obtained, of which seven were in 55 unstimulated cycles(12.5%), 21 in 159 cycles with clomiphene citrate stimulation(13.1%, P> 0.1), and 25 in 107 cycles stimulated with clomipheneplus human menopausal gonadotrophin (HMG) (23.9%, P< 0.03).No multiple pregnancies were observed in the latter group. Inthe second clinic, 159 pregnancies occurred during 1287 inseminationcycles (12.4%). It is concluded that neither intra-uterine insemination,nor hormonal and echographic cycle monitoring, nor clomiphenecitrate enhances the success rate of artificial inseminationwith donor semen, but HMG treatment probably exerts a favourableeffect