The development of a continuous quality control programme for strict sperm morphology among sub-Saharan African laboratories

Inter-technician and between-laboratory differences, especially during the evaluation of sperm morphology, have been a major cause of concern. The study aimed to develop an intensive training programme with intervals of continuous quality control assessments for sperm morphology. Twenty andrology laboratories from sub-Saharan Africa were invited to participate in a World Health Organization Special Programme of Research, Development and Research Training in Human Reproduction semenology workshop. Following intensive training in strict sperm morphololgy evaluation, a continuous quality control programme was introduced on a quarterly basis. At baseline, the mean (+/- SD) percentage difference reported between the participants and the reference laboratory reading was 33.50 +/- 11%. After training, the mean percentage difference had decreased to 14.32 +/- 5% at 3 months and to 5.00 +/- 5% at 6 months. Pairwise comparison of the differences at each evaluation time revealed the following: Baseline differences (pre-training) differed significantly from the differences at 3 months (P = 0.0002) as well as at 6 months after training (P = 0.007). The differences at 6 months did not differ significantly from those at 3 months (P = 0.27). Training of andrology technicians as well as continuous proficiency testing can be conducted on a national and international level with the support of a referring laboratory. Global quality control measurements in andrology laboratories should become mandatory, since these results indicate that continuous quality control for laboratory technicians can be highly successful.     

徐福松中医男科学术思想述要

介绍徐福松教授中医男科学术思想的形成历程,总结其学术思想及临床经验。①溯经典、构体系,规范男科病名治法;②立纲目、倡新说,升华创新男科理论;③重整体、辨联系,提升男科诊疗思维;④理病机、分内外,强调肾为男科枢要;⑤纳新知、重科研,衷中参西发展男科。     

The production of testis biomodels using three-dimensional (3D) technologies

This study aimed to investigate the potentiality of biomodels to be produced as alternative tools to slaughterhouse materials in andrology education. For this purpose, testis biomodels were produced with reference to bull testes. The biomodel production was carried out by the following steps: the preparation of the reference organs, 3D modelling, and processing of data sets and stages. The biomodels and reference testes were compared in terms of morphological parameters and tonicity. As a result of quantitative measurements, the average length in the reference testicles was 145.56 ± 21.3 mm, while the thickness was 61.94 ± 17.2 mm. The average length, thickness, volume and tonicity values of the biomodels showed similarity to the values of the reference testicles (p > .05). However, it was recorded that the average weight of the reference testicles was determined as 368.07 ± 40.3 g, while the average weight of the biomodels was 69.02 ± 3.18 g (p < .01). As a result, it has been shown that testis biomodels can be successfully produced using three-dimensional technologies. These biomodels are the first examples in the field. We think that the biomodels produced by using innovative technologies should be considered as serious alternatives, which could contribute to the learning processes of students, especially in andrology education.     

精液分析标准化的重要性与紧迫性

精液分析是一项十分重要的用于评估男性生殖能力的临床检验项目。然而,最近的报告提示精液分析的结 果并不可靠。男科学实验室的质控常常被认为是存在有问题的,在进行精液分析时许多实验室并不按常规进行质 量控制。质量保证工作在男科实验室常常被忽略。男科实验室室间检验能力验证计划还未被推广,最近几个项目 检测的结果表明,室间检验结果存在很大的变异。各实验室间执行着不同的标准使得一个实验室与另一个实验间 难以进行结果比对。通过执行以下几点建议可以获得可靠的精液分析结果:①所有实验室应该采用普遍接受的检 测标准和指标,②所有实验室应该参加室间测评计划,③实验室应该执行有效的室内质控和质量保证计划,以保证 报告结果准确和可重复,④临床医生应该指定患者在严格执行上述建议的实验室接受精液分析,或只认可这些实 验室提供的精液分析结果。     

Male reproductive health research needs and research agenda:Asian and Chinese perspective

Research that addresses male reproductive health should assist in the development of reproductive healthprogrammes and policy; identify and test new leads in male contraceptive technology; establish effective maleinvolvement initiatives which are likely to have a positive impact on the reproductive health of men and women; guidethe allocation of health care resources to ensure cost-effectiveness of interventions; generate new knowledge, developdiagnostic technology in reproductive health and offer optimal treatment/care regimens. In considering the needs and demands of male reproductive health research in Asia and the Pacific, the followingsix research topics are recommended as the priority research areas: male contraceptive technology; male reproductivehealth behaviour and male adolescent reproductive health; male reproductive aging including male menopause and otherdiseases; male RTIs, STDs, HIV/AIDS; prevalence, management and prevention of male infertility; environment andsemen quality and other mal     

从3例诊疗报告看精子形态学与生精细胞学检测在男科临床中的应用

近年来,精子形态学和生精细胞学检测越来越受到男科特别是生殖中心的重视,然而将未染色的精液进行形态学和细胞学分析,其对精子的畸形率及圆细胞的判断存在极大的误差。笔者通过将3例典型患者的精液染色后分析精子形态和生精细胞,做出新的病情诊断及治疗方案,从而探讨精子细胞学与生精细胞学检测在男科临床中的应用价值。     

Klinefelter syndrome and fertility—Impact of X‐chromosomal inheritance on spermatogenesis

With the use of testicular sperm extraction (TESE), spermatozoa can be retrieved in about 30%‐50% of men with Klinefelter syndrome (KS). The reason for the absence or presence of spermatozoa in half of the men with KS remains unknown. Therefore, the search for an objective marker for a positive prediction in finding spermatozoa is of significant clinical value to avoid unnecessary testicular biopsies in males with (mostly) low testicular volume and impaired testosterone. The objective of this study was to determine whether paternal or maternal inheritance of the additional X‐chromosome can predict the absence or presence of spermatogenesis in men with KS. Men with KS who have had a testicular biopsy for diagnostic fertility workup TESE were eligible for inclusion. Buccal swabs from nine KS patients and parents (trios) were taken to compare X‐chromosomal inheritance to determine the parental origin of both X‐chromosomes in the males with KS. Spermatozoa were found in TESE biopsies 8 of 35 (23%) patients after performing a unilateral or bilateral TESE. Different levels of spermatogenesis (from the only presence of spermatogonia, up to maturation arrest or hypospermatogenesis) appeared to be present in 19 of 35 (54%) men, meaning that the presence of spermatogenesis not always yields mature spermatozoa. From the nine KS‐trios that were genetically analysed for X‐chromosomal inheritance origin, no evidence of a correlation between the maternal or paternal origin of the additional X‐chromosome and the presence of spermatogenesis was found. In conclusion, the maternal or paternal origin of the additional X‐chromosome in men with KS does not predict the presence or absence of spermatogenesis.     

Practical semen analysis： from A to Z

Accurate semen analysis is critical for decisions about patient care, as well as for studies addressing overall changes in semen quality, contraceptive efficacy and effects of toxicant exposure. The standardization of semen analysis is very difficult for many reasons, including the use of subjective techniques with no standards for comparison, poor technician training, problems with proficiency testing and a reluctance to change techniques. The World Health Organization （WHO） Semen handbook （2010） offers a vastly improved set of standardized procedures, all at a level of detail that will preclude most misinterpretations. However, there is a limit to what can be learned from words and pictures alone. A WHO- produced DVD that offers complete demonstrations of each technique along with quality assurance standards for motility, morphology and concentration assessments would enhance the effectiveness of the manual. However, neither the manual nor a DVD will help unless there is general acknowledgement of the critical need to standardize techniques and rigorously pursue quality control to ensure that laboratories actually perform techniques ＇according to WHO＇ instead of merely reporting that they have done so. Unless improvements are made, patient results will continue to be compromised and comparison between studies and laboratories will have limited merit.     

伴有支原体和／或衣原体阳性的男科病人心理状况分析

目的初步调查和评价伴有支原体衣原体阳性的男科病人的心理状况。方法运用症状自评量表（SCL-90），筛选出20-39岁的患者236例，其中曾经或现在诊断为支原体或／和衣原体阳性者106例，阴性者130例。主要统计资料为该量表的10个症状因子分和统计指标，如阳性项目数、阳性项目总分及均分、总分及总均分等；应用SPSS统计软件包统计和管理数据，将两组资料进行对比分析。结果曾经或现在诊断为支原体或／和衣原体阳性组所有统计指标和因子分均高于阴性组，差异有统计学意义（P〈0．01）。结论伴有支原体衣原体阳性的男科病人存在明显的心理健康问题，在临床治疗上应注意心理方面规范的咨询和辅导，并对一些较严重的心理疾病患者加入适当抗精神病药物进行治疗。