生精类中成药治疗男性少、弱精子症的Network Meta分析和系统评价

目的:利用Network Meta分析观察生精类中成药治疗男性少、弱精子症的疗效。方法:检索Cochrane图书馆、Pubmed数据库、中国生物医学文献数据库、CNKI数据库、VIP数据库、万方数据库等,纳入生精类中成药治疗少、弱精子症的随机对照试验(RCT)研究,并进行方法学质量评价。采用ADDIS软件v1.16.5进行统计学分析,对纳入的RCT的研究结果进行合并,并进行偏倚评估和稳定性分析。结果:共纳入20篇RCT文献,累计病例2 947例,包括8种干预措施(生精胶囊、麒麟丸、养精胶囊、黄精赞育胶囊、复方玄驹胶囊、生精片、四子种王胶囊和五子衍宗丸)。Network Meta分析显示8种生精类中成药在两两比较改善和提高精子参数总有效率、a级精子率、a+b级精子率和精子浓度方面,除四子种王胶囊对五子衍宗丸在a级精子和精子浓度之间有统计学差异之外,其余各药之间对比差异则无统计学意义(P0.05)。结论:基于贝叶斯理论的Network Meta分析对8种干预措施进行疗效排序显示,虽然8种生精类中成药在治疗男性少、弱精子症方面对改善和提高精子参数各自具有独特的优势,但需要在辨病、辨证的基础上灵活组合搭配使用,并通过大数据、高质量、多中心的随机对照双盲临床试验进一步加以验证。     

Analysis of Atypical Squamous (Glandular) Cells of Undetermined Significance Smears by Neural Network–Directed Review

Objective: The objective of this study was to evaluate the value of neural network–directed review of smears determined to contain atypical squamous (glandular) cells of undetermined significance to identify those cases most likely to be associated with cervical intraepithelial neoplasia.Methods: One hundred sixty smears reported as atypical squamous (glandular) cells of undetermined significance on patients having colposcopy and directed biopsy within 1 year of the smear were identified. The smears were subjected to a neural network–directed review and classified according to findings on this review. The latter findings were related to those obtained on cervical biopsy.Results: One hundred sixty smears originally reported as atypical squamous (glandular) cells of undetermined significance were subjected to neural network–directed review. The smears were upgraded in 20.6% of cases. Ninety-one patients were found to have normal biopsies, and 69 had biopsies reported as abnormal. Of the smears in patients with abnormal biopsies, 37.7% were upgraded, whereas only 7.7% of smears from those with normal biopsies were upgraded (P < .001). Nine patients were found to have cervical intraepithelial neoplasia–3 on biopsy. Six of the nine smears (66.7%) taken on these patients were upgraded.Conclusion: Neural network-directed analysis of smears conventionally diagnosed as atypical squamous (glandular) cells of undetermined significance will reveal findings suggesting a squamous intraepithelial lesion in a significant number of cases. This approach requires further study because it is a relatively cost-effective means of triaging patients with a cytologic diagnosis of atypical squamous (glandular) cells of undetermined significance.     

Trends and determinants of stillbirth in developing countries: results from the Global Network’s Population-Based Birth Registry

Background

Stillbirth rates remain high, especially in low and middle-income countries, where rates are 25 per 1000, ten-fold higher than in high-income countries. The United Nations’ Every Newborn Action Plan has set a goal of 12 stillbirths per 1000 births by 2030 for all countries.

Methods

From a population-based pregnancy outcome registry, including data from 2010 to 2016 from two sites each in Africa (Zambia and Kenya) and India (Nagpur and Belagavi), as well as sites in Pakistan and Guatemala, we evaluated the stillbirth rates and rates of annual decline as well as risk factors for 427,111 births of which 12,181 were stillbirths.

Results

The mean stillbirth rates for the sites were 21.3 per 1000 births for Africa, 25.3 per 1000 births for India, 56.9 per 1000 births for Pakistan and 19.9 per 1000 births for Guatemala. From 2010 to 2016, across all sites, the mean stillbirth rate declined from 31.7 per 1000 births to 26.4 per 1000 births for an average annual decline of 3.0%. Risk factors for stillbirth were similar across the sites and included maternal age < 20 years and age > 35 years. Compared to parity 1–2, zero parity and parity > 3 were both associated with increased stillbirth risk and compared to women with any prenatal care, women with no prenatal care had significantly increased risk of stillbirth in all sites.

Conclusions

At the current rates of decline, stillbirth rates in these sites will not reach the Every Newborn Action Plan goal of 12 per 1000 births by 2030. More attention to the risk factors and treating the causes of stillbirths will be required to reach the Every Newborn Action Plan goal of stillbirth reduction.

Trial registration

NCT01073475.

     

Comprehensive Analysis of lncRNA Expression Pattern and lncRNA–miRNA–mRNA Network in a Rat Model With Cavernous Nerve Injury Erectile Dysfunction

BackgroundLong noncoding RNAs (lncRNAs) are differentially expressed in erectile dysfunction (ED) associated with aging and diabetes mellitus; however, the lncRNA expression profile in cavernous nerve (CN) injury–related ED (CNI-ED) is unknown.AimTo investigate the dysregulated lncRNAs, microRNAs (miRNAs), and mRNA expression in CNI-ED and construct a potential lncRNA–miRNA–mRNA network.Methods22 male Sprague–Dawley (SD) rats were divided into bilateral CN crush (BCNC) and Sham groups. Using second-generation high-throughput sequencing technology, we analyzed the expression profiles of lncRNA, miRNA, and mRNA of the 2 groups. 17 differentially expressed lncRNAs were selected and further validated by quantitative real-time polymerase chain reaction (RT-qPCR). The lncRNA–miRNA–mRNA network, Gene Ontology (GO) term enrichment, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed using Cytoscape.OutcomesIntra-cavernosal pressure, mean arterial pressure, smooth muscle content, and the expression of miRNA, mRNA, and lncRNA were measured.ResultsThe BCNC group showed decreased intra-cavernosal/mean arterial pressure as well as decreased smooth muscle/collagen ratios compared with the Sham group. The RNA sequencing results revealed dysregulated expressions of 65 lncRNA, 14 miRNA, and 750 mRNA in the BCNC group based on the following criteria: fold change >2 and P < .05. Among the 17 lncRNAs further selected based on mean count number >4 in both groups, 3 lncRNAs (TCONS_00028173, TCONS_00049985, and TCONS_00058429) were further validated for differential expression by RT-qPCR. GO analysis suggests that these 3 lncRNAs could regulate various processes such as myotube differentiation and muscle cell differentiation. Furthermore, the KEGG pathway analysis showed that the mRNAs in the competing endogenous RNA (ceRNA) network are involved in pathways, including axon guidance and vascular endothelial growth factor signaling pathway.Clinical TranslationOur findings may provide new information on molecular pathophysiology of CNI-ED and suggest further research to find a more effective therapy for CNI-ED.Strengths & LimitationsThis study is the first to identify the lncRNA expression pattern and propose a ceRNA network in a rat model with cavernous nerve injury–related erectile dysfunction. However, analogous studies are needed to confirm these findings in humans. In addition, we constructed the network by only confirming the lncRNA.ConclusionOur study reveals differential expression profiles of lncRNAs, miRNAs, and mRNAs between the BCNC and Sham groups and suggests that these differentially expressed lncRNAs may play critical roles in CNI-ED by regulating apoptosis and fibrosis in the corpus cavernosum via targeting mRNAs or miRNAs.Cong R, Wang Y, Wang Y. Comprehensive Analysis of lncRNA Expression Pattern and lncRNA–miRNA–mRNA Network in a Rat Model With Cavernous Nerve Injury Erectile Dysfunction. J Sex Med 2020;17:1603–1617.     

European Network of Trainees in Obstetrics and Gynaecology—ENTOG Exchange 2017: an experience report from Slovenia outlining the different trainee situations around Europe

Purpose

The European Network of Trainees in Obstetrics and Gynaecology (ENTOG) is a non-profit, independent organisation that represents young trainees in obstetrics and gynaecology around Europe. At present, ENTOG has 32 member countries. The organisation was founded in 1997 and shall assure the exchange of experiences between young physicians all over Europe. The aim is to improve the quality of traineeship in all participating countries and consequently enhance the standards for women’s healthcare.

Methods

This article reports about the experiences of trainees during the ENTOG Exchange 2017 in Slovenia and gives an overview of the trainee situations in different ENTOG member countries.

Results

The ENTOG exchange in Slovenia was a unique opportunity to get insights to the Slovenian medical system. Reflecting about their training situations, the participants found considerable differences in the training of young gynaecologists throughout Europe.

Conclusions

Working on the ENTOG goal of raising the quality of training is still highly relevant. The ENTOG exchange is an excellent way to build a network among trainees and stimulate their commitment to improve women’s healthcare in their home countries and beyond.

     

Is the use of early nasal CPAP associated with lower rates of chronic lung disease and retinopathy of prematurity? Nine years of experience with the Vermont Oxford Neonatal Network

OBJECTIVE: The neonatal regional tertiary care center of the University of Vienna (VC) has been a member of the Vermont Oxford Neonatal Network (VONN) since 1994. During the period 1994--2002, important differences between the VC and the VONN in both pre- and postnatal management and in late morbidities such as chronic lung disease (CLD) and severe retinopathy of prematurity (ROP) were observed. We hypothesize that stabilization of very-low-birth-weight (VLBW) infants on nasal continuous positive airway pressure (NCPAP) immediately after birth, combined with a restrictive use of artificial ventilation, might be responsible for lower rates of CLD and ROP. PATIENTS AND METHODS: Obstetric and neonatal data for all 1299 VLBW infants (401-1500 g) from the VC were compared with corresponding data for the 201,167 VLBW infants from the VONN for the period 1994--2002 with regard to respiratory management and patient outcome. Morbidity criteria were in accordance with VONN definitions. RESULTS: The percentage range for treatment and morbidity criteria for the VC and VONN are related to differences among various years within the observation period. Infants were stabilized at birth on NCPAP in 45-86% of cases in the VC vs. 37-63% in the VONN, the rate of mechanical ventilation was 40-59% vs. 66-74%, and use of surfactant was 31-50% vs. 55-64%. CLD was diagnosed in 14-32% of cases in the VC vs. 27-39% in the VONN, discharge on supplemental oxygen took place in 2-4% vs. 12-17% of cases and ROP (stages III and IV) was found in 1-10% vs. 8-12%. CONCLUSION: The association of lower rates of CLD and ROP in the VC compared to the VONN might be related to differences in early respiratory management of VLBW infants at high risk of development of respiratory distress syndrome. This needs to be confirmed in a large multicenter trial.     

Cross‐Sex Hormone Therapy in Trans Persons Is Safe and Effective at Short‐Time Follow‐Up: Results from the European Network for the Investigation of Gender Incongruence

IntroductionData on the effects of cross‐sex hormone therapy (CHT) are limited due to the low prevalence of gender dysphoria, small number of subjects treated at each center, lack of prospective studies, and wide variations in treatment modalities.AimThe aim of this study is to report the short‐term effects of CHT on hormonal and clinical changes, side effects, and adverse events in trans men (female‐to‐male gender dysphoric persons) and trans women (male‐to‐female gender dysphoric persons).MethodsThis was a multicenter 1‐year prospective study in 53 trans men and 53 trans women. Trans men received injections of testosterone undecanoate every 3 months. Trans women younger than 45 years received 50 mg cyproterone acetate (CA) and 4 mg estradiol valerate daily, whereas those older than 45 years received 50 mg CA daily together with 100 μg/24 hours transdermal 17‐β estradiol.Main Outcome MeasuresSex steroids, prolactin, liver enzymes, lipids, hematocrit, blood pressure, anthropometrics, Ferriman and Gallwey score, and global acne grading scale were measured. Side effects, adverse events, and desired clinical changes were examined.ResultsNo deaths or severe adverse events were observed. Two trans men developed erythrocytosis, and two had transient elevation of the liver enzymes. Trans men reported an increase in sexual desire, voice instability, and clitoral pain (all P ≤ 0.01). Testosterone therapy increased acne scores, facial and body hair, and prevalence of androgenetic alopecia. Waist–hip ratio, muscle mass, triglycerides, total cholesterol (C), and LDL‐C increased, whereas total body fat mass and HDL‐C decreased. Three trans women experienced transient elevation of liver enzymes. A significant increase in breast tenderness, hot flashes, emotionality, and low sex drive was observed (all P ≤ 0.02). Fasting insulin, total body fat mass, and prolactin levels increased, and waist–hip ratio, lean mass, total C, and LDL‐C decreased.ConclusionsCurrent treatment modalities were effective and carried a low risk for side effects and adverse events at short‐time follow‐up. Wierckx K, Van Caenegem E, Schreiner T, Haraldsen I, Fisher A, Toye K, Kaufman JM, and T'Sjoen G. Cross‐sex hormone therapy in trans persons is safe and effective at short‐time follow‐up: Results from the European Network for the Investigation of Gender Incongruence. J Sex Med 2014;11:1999–2011.