Nevin Manimala

Zhonghua Nan Ke Xue. 2024 Nov;30(11):1002-1008.

ABSTRACT

OBJECTIVE: To compare the recanalization rate of 2-suture longitudinal intussusception vasoepididymostomy (LIVE) with that of 4-suture end-to-side vasoepididymostomy (ESVE).

METHODS: This retrospective case-control study included 127 cases of obstructive azoospermia (OA) treated by LIVE (n = 87) or ESVE (n = 40) in our Center of Reproductive Medicine from October 2013 to July 2024. We analyzed the clinical data and compared the age, testis volume, level of serum follicle-stimulating hormone (FSH), operation time and postoperative recanalization rate between the two groups.

RESULTS: Spermatozoa were observed in 90 (70.9%) of the 127 cases after surgery. There were no statistical differences in age, testis volume and FSH between the two groups of patients (all P > 0. 05), and nor were there any serious surgical complications. The operation time was significantly longer in the ESVE than in the LIVE group (22.0 ［20.0－25.8］ vs 17.0 ［15.0－23.0］ min, P < 0.05), while the postoperative recanalization rate remarkably higher in the former than in the latter group （85.0% vs 64.4%, P < 0.05）. Vasoepididymostomy was performed at the caput epididymis in 11 cases, with a higher recanalization rate in the ESVE than in the LIVE group (50.0% ［1/2］ vs 33.3% ［3/9］).

CONCLUSION: ESVE achieved a higher postoperative recanalization rate than LIVE in the treatment of OA, but its advantages need further investigation.

PMID:40783869

Zhonghua Nan Ke Xue. 2024 Nov;30(11):994-1001.

ABSTRACT

OBJECTIVE: To investigate the effect of spouse smoking cessation (SSC) on the pregnancy outcome of the patients with polycystic ovary syndrome (PCOS) based on a secondary analysis of the results of a large randomized clinical trial.

METHODS: Based on the inclusion and exclusion criteria, this secondary analysis included 861 female participants in the Trial of Acupuncture Combined with Clomiphene for PCOS from 2011 to 2015. According to the smoking status of their husbands, we divided the subjects into a smoking group (n = 345), a non-smoking group (n =387), and a smoking cessation group (n =129), collected their general demographics, anthropometric indexes, laboratory results and pregnancy outcomes, compared them among the three groups, and analyzed the relationship of SSC with the pregnancy outcomes of the PCOS patients.

RESULTS: The levels of total testosterone (T) and low-density lipoprotein cholesterol (LDL-C) in the smoking cessation group were similar to those in the non-smoking group, but significantly lower than those in the smoking group (P= 0.014 and P= 0.011). The contents of fasting insulin, total cholesterol, and apolipoprotein B exhibited statistically significant differences among the three groups (P= 0.029, P= 0.018 and P= 0.024), dramatically lower in the smoking cessation and non-smoking groups than in the smoking group, but similar between the former two. The ovulation rate of the smoking cessation group was similar to that of the non-smoking group, remarkably higher than that of the smoking group (P= 0.038). No statistically significant differences were observed in other indicators among the three groups (P > 0.05). Multivariate logistic regression analysis showed that SSC during pregnancy preparation was a protective factor for ovulation in the PCOS patients (OR = 1.74, 95% CI: 1.04－2.92, P= 0.035).

CONCLUSION: SSC can improve androgen and glucolipid metabolisms of infertile patients with PCOS, and thereby significantly increase the ovulation rate. It is of positive significance to encourage SSC clinically for improving the pregnancy outcomes of infertile women with PCOS.

PMID:40783868

Zhonghua Nan Ke Xue. 2024 Nov;30(11):987-993.

ABSTRACT

OBJECTIVE: To investigate the factors influencing the hospitalization expenses of PCa patients and provide some evidence for effectively reducing the direct economic burden of disease caused by laparoscopic radical prostatectomy (LRP).

METHODS: The author obtained the hospitalization data on 893 cases of PCa treated by LRP in a top tertiary hospital in Wuhan between January 1, 2019 and June 30, 2024. A database was constructed using the Stata 18.0 software, the Mann-Whitney U and Kruskal-Wallis H tests performed using the SPSS 27.0 and R 4.4.1 softwares, and the influencing factors for the hospitalization expenses of the patients analyzed by multiple linear regression, quantile regression, and random forest algorithm.

RESULTS: Out-of-pocket payment accounted for 64.40% of the total hospitalization costs, averaging ￥60 794.9, with the per capita treatment cost (￥20 631.6), drug cost (￥15 046.2) and consumable cost (￥12 469.6) as the top 3 items of expenditure, accounting for 33.94%, 24.75% and 20.51%, respectively. The results of multiple linear regression analysis showed that the number of hospital days (β = 0.027), the number of comorbidities (β = 0.008), the mode of admission (with the outpatient department as reference, the emergency department ［β = 0.128］ and transfer from other institutions ［β = 0.251］), and the mode of surgery (with LRP ［β = 0.157］ as reference) all had statistically significant impacts on the sub-per capita hospitalization costs (P < 0.05). Quantile regression analysis revealed dramatic influence of the number of hospital days and surgical mode in different quantiles (P < 0.001), and random forest regression analysis showed the two influencing factors ranking the top two in terms of importance.

CONCLUSION: PCa patients bear a heavy burden of hospitalization costs. The composition of the costs needs to be optimized, and efforts should be made to reduce the hospitalization expenses of the PCa patients by promoting the inclusion of medical consumables in medical insurance, facilitating the development of drugs and domestication of surgical robots, and reasonably shortening the hospital stay of the patients.

PMID:40783867

J Drug Target. 2025 Aug 10:1-36. doi: 10.1080/1061186X.2025.2546477. Online ahead of print.

ABSTRACT

Autoimmune diseases represent a heterogeneous group of disorders characterized by immune system dysregulation, wherein aberrant responses to self-antigens result in cellular and tissue damage. According to statistics, there are over 80 different types of autoimmune diseases worldwide, among which psoriasis and rheumatoid arthritis (RA) are relatively common. Current therapeutic strategies emphasize long-term management to mitigate symptoms and retard disease progression. Conventional approaches, including systemic administration of oral medications, injectables, and biologics, are frequently limited by adverse effects that compromise patient adherence. In contrast, the use of microneedle (MN) technology as a minimally invasive transdermal delivery platform has emerged as a promising alternative, offering distinct advantages such as painless self-administration, enhanced patient compliance, localized delivery to disease-specific sites (e.g., skin lesions in psoriasis, inflamed joints in RA), and improved bioavailability of immunomodulatory agents while minimizing systemic toxicity. This review systematically examines MN classification, immunomodulatory mechanisms, and therapeutic efficacy in autoimmune disease management, while also providing a critical assessment of MN biosafety and clinical translation challenges in autoimmune patients. Furthermore, it highlights recent advancements in MN technology for prevalent autoimmune disorders, with the goal of informing future innovation and accelerating clinical translation.

PMID:40783860 | DOI:10.1080/1061186X.2025.2546477

Zhonghua Nan Ke Xue. 2024 Oct;30(10):910-914.

ABSTRACT

OBJECTIVE: To explore the application of modified scrotoscopic surgery (MSS) in the treatment of testicular hydrocele.

METHODS: We selected 45 cases of testicular hydrocele for this study, 22 treated by traditional scrotoscopic surgery (TSS) and the other 23 by MSS, which was performed with a pin-shaped electrode bent inward at an angle of 60° instead of a circular electrode used in TSS. We recorded the general clinical data, operation time, incision length, intraoperative injury, incision infection, scrotal edema, postoperative hospital stay and postoperative Visual Analogue Scale (VAS) scores of the patients and compared them between the two groups.

RESULTS: There was no statistically significant difference in the general clinical data between the two groups (P > 0.05). Compared with the patients of the TSS group, those of the MSS group showed significantly shorter operative time (［32.86 ± 3.80］ vs ［26.13 ± 2.81］ min, P<0.05), incision length (［14.09 ± 2.23］ vs ［8.73 ± 1.48］ mm, P<0.05) and postoperative hospital stay (［4.36 ± 1.05］ vs ［2.00 ± 0.90］ d, P<0.05), and achieved remarkably lower VAS scores on postoperative days 1 (4.41 ± 1.05 vs 3.09 ± 0.79, P<0.05), 2 (3.36 ± 1.05 vs 2.78 ± 1.13, P<0.05), 3 (2.65 ± 0.72 vs 1.74 ± 0.86, P<0.05) and 7 (1.91 ± 0.81 vs 1.04 ± 0.82, P<0.05). At 3 and 7 days after surgery, scrotal edema was markedly milder in the MSS than in the TSS group (P<0.05). No testicular or epididymal damage, or wound infection occurred in either of the two groups.

CONCLUSION: MSS is safe and effective in the treatment of testicular hydrocele, superior to TSS for its advantages of shorter operation time, smaller surgical incision, less postoperative pain and milder scrotal edema.

PMID:40783855

Zhonghua Nan Ke Xue. 2024 Oct;30(10):903-909.

ABSTRACT

OBJECTIVE: To investigate the effect of lipopolysaccharide (LPS) on the crawling ability of fibroblasts derived from the scrotal skin under hypoxic conditions, its impact on vascular regeneration during wound healing, and the potential mechanism underlying chronic non-healing scrotal wound caused by gram-negative bacterial infection.

METHODS: We extracted peripheral blood buffy coats from healthy donors after venous blood centrifugation, divided them into four groups (normoxia, normoxia+LPS, hypoxia, and hypoxia+LPS) for pretreatment, and isolated the corresponding cultured supernatant. Then we measured the levels of VEGF-A, FGF and IL-8 secreted using enzyme-linked immunosorbent assay (ELISA), determined the cytotoxicity of different pretreated supernatants by lactate dehydrogenase (LDH) release assay, and detected the cell migration ability and vascular formation in human-umbical vein endothelial cells (HUVEC).

RESULTS: Under hypoxic conditions, the expression of HIF-1α was significantly lower in the fibroblasts from the chronic scrotal wound than in the normal fibroblasts (0.09 ± 0.00 vs 0.48 ± 0.01, P < 0.05), the viability of the cells showed no statistically significant difference from that under normoxic conditions (P > 0.05), and the proliferation and migration abilities of the cells were markedly improved (［83.09 ± 2.56］% vs ［17.84 ± 1.12］%, P < 0.05). The viability of the scrotal fibroblasts was significantly lower in the normoxia+LPS than in the hypoxia+LPS group (［20.15 ± 1.19］% vs ［32.54 ± 1.57］%, P < 0.05). The cells treated with LPS, compared with those in the non-LPS groups, exhibited remarkably decreased endothelial cell tubes formed (5.20 ± 0.15 vs 55.30 ± 1.15, P < 0.05), down-regulated expression of VEGF (OD value: 0.59 ± 0.07 vs 1.25 ± 0.11, P < 0.05) and up-regulated expression of IL-8 (OD value: 2.42 ± 0.07 vs 0.87 ± 0.11, P < 0.05).

CONCLUSION: The supernatant derived from the peripheral blood buffy coats treated with LPS has a stronger cytotoxicity and weaker angiogenesis than that untreated under hypoxic or normoxic conditions, which may be one of the critical factors for difficult healing of scrotal wound.

PMID:40783854

Zhonghua Nan Ke Xue. 2024 Oct;30(10):896-902.

ABSTRACT

OBJECTIVE: To compare the clinical effects of different combinations of anesthetics in transperineal prostate biopsy in elderly male patients.

METHODS: We randomly divided 132 ≥65-year-old male patients to receive transperineal prostate biopsy under combined intravenous anesthesia with propofol + sufentanil (the PS group), remimazolam + sufentanil (the RS group), propofol + alfentanil (the PA group), or remimazolam + alfentanil (the RA group). We recorded the mean arterial pressure (MAP) and heart rate (HR) of the patients, the required rescue sedation, the Richmond Agitation-Sedation Scale (RASS) scores upon admission into the postanesthesia care unit (PACU) after surgery, the length of stay in the PACU and the incidence of adverse reactions, followed by comparison of the data obtained among the four groups.

RESULTS: Operations were successfully completed in all the patients. At 5 moment points from T3 to t2, RA and RS groups had less effect on MAP than PA and PS groups (P < 0.05); at 5 moment points from T1 to T5, RA and RS groups had less effect on HR than PA and PS groups (P<0.05), and this effect was more obvious in RA group than in RS group.During anesthesia-induction, the incidence rate of injection pain was remarkably lower in the RA and RS than in the PA and PS groups (P<0.05), and that of respiratory depression was higher in the PS than in the other three groups (P = 0.013). The RASS scores were significantly higher (P<0.05) and the PACU stay shorter in the RA and RS than in the PA and PS groups (P<0.05). Dramatically more cases of intraoperative body movement and remedial medication requirement were observed in the former than in the latter two groups (P = 0.013), but there was no statistically significant difference in the dose of remedial medication between the four groups of patients (P > 0.05).

CONCLUSION: For elderly male patients undergoing transperineal prostate biopsy under intravenous anesthesia with preservation of spontaneous breathing, the combined use of remimazolam and alfentanil can achieve more stable intraoperative hemodynamics, faster recovery from anesthesia and a lower incidence of perioperative adverse reactions, and produce an even better anesthetic effect with a small dose of propofol to suppress the body movement at the time of needle puncture.

PMID:40783853

Zhonghua Nan Ke Xue. 2024 Oct;30(10):878-883.

ABSTRACT

OBJECTIVE: To investigate the psychological status of the outpatients in the andrology clinic and the effect of risk warning combined with multidisciplinary team (MDT) intervention on their satisfaction.

METHODS: Using convenience sampling, we enrolled 600 outpatients seeking medical attention in the Department of Andrology of our hospital from July to October 2022. We randomized the patients into a control (n = 300) and an observation group (n = 300), obtained their basic information, evaluated their psychological status with the Hospital Anxiety and Depression Scale (HADS), and assessed their satisfaction with the Xijing Hospital Outpatients’ Satisfaction Questionnaire (HOSQ). The controls followed the routine procedure of treatment, while the patients in the observation group received early warning before intervention based on their HADS scores. We provided normal medical care for those with HADS scores ≤ 7, employed empathetic communication for those with HADS scores of 8－10, and conducted MDT intervention for those with HADS scores ≥ 11, followed by comparison of the patients’ satisfaction with the outpatient service between the two groups.

RESULTS: There were no statistically significant differences in general conditions between the groups of patients (P > 0.05). The mean prevalence rate of anxiety and depression was 47.83% among the male subjects, lower in the control than in the observation group (47.00% vs 48.67%, P > 0.05), but higher in the patients with the education of junior high school or below (60.99%) than in those with that of senior high school (22.34%) and university or above (16.67%), and also higher in those aged 18－40 years (67.38%) than in those aged 41－60 years (51.82%) and over 60 years old (38.33%). A significantly higher rate of satisfaction with the outpatient service was found in the observation group than in the controls (97.18% vs 90.39%, P < 0.05).

CONCLUSION: Anxiety and depression are prevalent among the outpatients in the andrology clinic, with a higher prevalence rate in those with lower education and at a younger age. Early risk warning combined with MDT intervention can improve the satisfaction of the patients.

PMID:40783850

Zhonghua Nan Ke Xue. 2024 Oct;30(10):872-877.

ABSTRACT

OBJECTIVE: To assess the value eosin-nigrosine (E-N) staining and hypo-osmotic swelling test (HOST) in the diagnosis of necrospermia and investigate the correlation of the degree of sperm necrosis with sperm DNA fragmentation index (DFI) and high DNA stainability (HDS).

METHODS: Using computer-assisted sperm analysis (CASA), we examined the sperm motility of 7 333 males seeking medical care in Maternal and Child Health Hospital of Hunan Province from May 2023 to July 2024, detected the sperm viability of those with asthenozoospermia by E-N staining and HOST, and measured the sperm DFI and HDS of those with necrospermia by sperm chromatin structure assay (SCSA). Based on sperm progressive motility (PR%), we divided the asthenozoospermia patients into three groups (PR% 20%－<30%, PR% 10%－<20% and PR% <10%), assessed the value of E-N staining and HOST in the diagnosis of necrospermia, and analyzed the correlation of the severity of sperm necrosis with sperm DFI and HDS.

RESULTS: Asthenozoospermia was diagnosed in 1 374 (18.74%) of the 7 333 males. The incidence rates of necrospermia revealed by E-N staining in the mild, moderate and severe asthenozoospermia groups were 0.55% (5/913), 3.80% (12/316) and 35.86% (52/145), respectively, with a total incidence of 0.94% (69/7333), while those detected by HOST were 0.99% (9/913), 6.96% (22/316) and 46.21%(67/145), respectively, with a total incidence of 1.34% (98/7333). There were no statistically significant differences in the results of diagnosis between the two methods (χ2 = 0.97, P > 0.05). Both E-N staining and HOST showed that sperm DFI in the necrospermia males was negatively correlated with sperm viability (r =－0.366, r=－0.333, P < 0.05), and so was sperm HDS, though with no statistically significant difference (P > 0.05).

CONCLUSION: For males with PR％ <30%, sperm viability test should be conducted, with E-N staining as the choice of priority for the diagnosis of necrospermia. Sperm necrosis and sperm nuclear chromatin damage may be interactive risk factors.

PMID:40783849

J Drug Target. 2025 Aug 10:1-16. doi: 10.1080/1061186X.2025.2546489. Online ahead of print.

ABSTRACT

Acne vulgaris is a common dermatological disorder with current treatments often limited to poor skin penetration, instability, irritation, and suboptimal therapeutic outcomes. There is a pressing need for advanced drug delivery systems that can overcome these challenges and enhance treatment efficacy. In this context, the current research was undertaken to develop and optimize a novel tazarotene-loaded emulgel formulation that merges the advantages of emulsions and gels to achieve controlled drug release, improved stability, and superior clinical performance for topical acne therapy. The formulation was prepared using the incorporation method and optimized through the Box-Behnken statistical design (BBD). Three independent variables, such as Carbopol 940 (X₁), Span 80 (X₂), and Tween 80 (X₃), were assessed for their effects on drug release (Y₁) and viscosity (Y₂). The optimized formulation exhibited desirable characteristics, including pH: 6.6 ± 0.3, viscosity: 28,945 cPs, spreadability: 6.17 ± 0.02 cm², extrudability: 18 ± 2.49 gm/cm², and drug content: 85.46 ± 4.02%. In vitro drug release studies demonstrated 87.59 ± 2.6% drug release over 7 hours. A skin irritation test on mice confirmed its dermatological safety, with no signs of erythema or edema. Anti-acne efficacy was evaluated using a Propionibacterium acnes-induced murine model, where the optimized emulgel significantly reduced acne lesion size from 4.5 mm to 0 mm, compared to a marketed gel, which reduced lesions from 4.6 mm to 2.3 mm. These results highlight the tazarotene-loaded emulgel as a promising and safe topical treatment for acne, offering superior efficacy over marketed formulations.

PMID:40783846 | DOI:10.1080/1061186X.2025.2546489