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Commentary on"An alternative surgical technique for varicoceles:a preliminary experience of the microsurgical spermatic(distal end)-inferior or superficial epigastric vein anastomosis in symptomatic varicoceles associated with perineal pain"

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Asian Journal of Andrology 2022年第6期24卷 680-680页

作者： peter n schlegel Weill Cornell Medicine New YorkNY10021USA

In the article by Wan et al.,the authors have described a different surgical approach limited to the treatment of men with varicoceles and pelvic floor congestion associated with perineal *** discuss the procedure used,which is essentially a decompression of the varicocele via anastomosis of the distal spermatic veins to the superficial epigastric veins and postoperative *** intervention is distinctly different from the standard approach of occlusion of spermatic veins(surgically or by embolization)typically at the subinguinal,inguinal,or retroperitoneal level.

关键词： superficial surgical varicocele

Microdissection testicular sperm extraction： an update

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Asian Journal of Andrology 2013年第1期15卷 35-39页

作者： Ali A Dabaja peter n schlegel Department of Urology Male Reproductive Medicine Weill Cornell Medical College New York NY 10065 USA

Patients with non-obstructive azoospermia （nOA） were once considered to be infertile with few treatment options due to the absence of sperm in the ejaculate. In the last two decades, the advent of intracytoplasmic sperm injection （ICSI）, and the application of various testicular sperm retrieval techniques, including fine needle aspiration （FnA）, conventional testicular sperm extraction （TESE） and microdissection testicular sperm extraction （micro-TESE） have revolutionized treatment in this group of men. Because most men with nOA will have isolated regions of spermatogenesis within the testis, studies have illustrated that sperm can be retrieved in most men with nOA, including Klinefelter＇s syndrome （KS）, prior history of chemotherapy and cryptorchidism. Micro-TESE, when compared with conventional TESE has a higher sperm retrieval rate （SRR） with fewer postoperative complications and negative effects on testicular function. In this article, we will compare the efficacy of the different procedures of sperm extraction, discuss the medical treatment and the role of testosterone optimization in men with nOA and describe the micro-TESE surgical technique. Furthermore, we will update our overall experience to allow counseling on the prognosis of sperm retrieval for the specific subsets of nOA.

关键词： azoospermia genetics male infertility microsurgery non-obstructive azoospermia sperm retrieval testicular sperm extraction

Deletion or underexpression of the Y-chromosome genes CDY2 and HSFY is associated with maturation arrest in American men with nonobstructive azoospermia

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Asian Journal of Andrology 2012年第5期14卷 676-682页

作者： peter J Stahl Anna n Mielnik Christopher E Barbieri peter n schlegel Darius A Paduch Department of Urology Weill Cornell Medical CollegeNew York Presbyterian HospitaI-CornellNew YorkNY 10065USA

Maturation arrest （MA） refers to failure of germ cell development leading to clinical nonobstructive azoospermia. Although the azoospermic factor （AZF） region of the human Y chromosome is clearly implicated in some cases, thus far very little is known about which individual Y-chromosome genes are important for complete male germ cell development. We sought to identify single genes on the Y chromosome that may be implicated in the pathogenesis of nonobstructive azoospermia associated with MA in the American population. Genotype-phenotype analysis of 132 men with Y-chromosome microdeletions was performed. Protein-coding genes associated with MA were identified by visual analysis of a genotype-phenotype map. Genes associated with MA were selected as those genes within a segment of the Y chromosome that, when completely or partially deleted, were always associated with MA and absence of retrievable testicular sperm. Expression of each identified gene transcript was then measured with quantitative RT-PCR in testicular tissue from separate cohorts of patients with idiopathic MA and obstructive azoospermia. Ten candidate genes for association with MA were identified within an 8.4-Mb segment of the Y chromosome overlapping the AZFb region. CDY2and HSFYwere the only identified genes for which differences in expression were observed between the MA and obstructive azoospermia cohorts. Men with obstructive azoospermia had 12-fold higher relative expression of CDY2transcript （1.33__.0.40 vs. 0.11＋_0.04; P=O.O003） and 16-fold higher expression of HSFYtranscript （0.78__.0.32 vs. 0.05_0.02; P=O.O005） compared to men with MA. CDY2 and HSFYwere also underexpressed in patients with Sertoli cell only syndrome. These data indicate that CDY2and HSFYare located within a segment of the Y chromosome that is important for sperm maturation, and are underexpressed in testicular tissue derived from men with MA. These observations suggest that impairments in CDY2 or HSFYexpression could be impli

关键词： CDY1 protein CDY2 protein genetics histology HSFY human make infertility nonobstructive azoospermia spermato-genesis sperm maturation

Cost-effectiveness of varicocele surgery in the era ot assisted reproductive technology

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Asian Journal of Andrology 2016年第2期18卷 259-261,J0006页

作者： Kelly A Chiles peter n schlegel Department of Urology George Washington University Washington DC USA Department of Urology Weill Cornell Medical College New York USA.

The advent of innovative techniques for addressing infertility has made for exciting times in the arena of andrology. The success of microTESE for retrieving sperm has enabled azoospermic men to have the opportunity to father biological children when it was previously impossible. The ability to offer a variety of assisted reproductive techniques that includes intracytoplasmic sperm injection has opened the door for couples with male factor infertility who were otherwise untreatable. With the multitude of options available to infertile couples, however, comes an unsurprising degree of controversy regarding what treatments should be offered and when. Complicating the picture is the question of if and when varicocele repair should be undertaken, and the financial implications of the treatment decisions that are made. The infertile couple with varicocele warrants careful consideration. The overall efficacy of varicocele repair as well as cost-effectiveness of repair compared to immediate microTESE in azoospermic men and assisted reproductive technology in men with suboptimal semen parameters will be reviewed.

关键词： assisted reproductive technology male infertility microTESE varicocele

Bulbocavernosus muscle area measurement： a novel method to assess androgenic activity

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Asian Journal of Andrology 2014年第4期16卷 618-622页

作者： Ali A Dabaja Matthew S Wosnitzer Anna Mielnik Alexander Bolyakov peter n schlegel Darius A Paduch Department of Urology and Reproductive Medicine Weill Cornell Medical College New York USA.

Serum testosterone does not correlate with androgen tissue activity, and it is critical to optimize tools to evaluate such activity in males. Ultrasound measurement of bulbocavernosus muscle （BCM） was used to assess the relationship between the number of CAG repeats （CAGn） in the androgen receptor （AR） and the BCM size; the changes in the number of CAGn over age were also evaluated. Transperineal ultrasound measurement of the BCM was also performed. AR CAGn were determined by high performance liquid chromatography, and morning hormone levels were determined using immunoassays. Forty-eight men had CAG repeat analysis. Twenty-five were 〈30 years of age, mean 23.7 years （s.d, = 3.24） and 23 were 〉45 years of age, mean 53years （s.d. = 5.58）. The median CAGn was 21 （13-29）. BCM area was greater when the number of CAGn were 〈18 as compared to the number of CAGn 〉24 （P= 0.04）. There was a linear correlation between the number of CAGn and the BCM area R^2= 16% （P= 0.01）. In the 45 to 65-years-old group, a much stronger negative correlation （R^2 = 29%, P= 0.01） was noticed. In the 19 to 29-years-old group, no such correlation was found （R2 = 4%, P = 0.36）. In older men, the number of CAGn increased with age （R^2 = 32%, P= 0.01）. The number of CAGn in the AR correlates with the area of the BCM. Ultrasound assessment of the BCM is an effective surrogate to evaluate end-organ activity of androgens. The number of CAGn may increase with age.

关键词： age androgen activity androgen receptor androgen sensitivity bulbocavernosus muscle CAG repeats

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生精障碍的疗法

Asian Journal of Andrology 2012年第1期14卷 57-60,176页

作者： Ranjith Ramasamy peter J Stahl peter n schlegel Department of Urology Weill Cornell Medical College New York NY 10065 USA

Medical treatment of men with primary spermatogenic failure remains largely ineffective in contrast to those with secondary testicular failure. Treatment has been attempted with a multitude of agents ranging from hormones to nutritional supplements （antioxidants）. While some studies have demonstrated benefit to some treatments, no treatments have consistently demonstrated efficacy nor has it been possible to reliably identify patients likely to benefit. Idiopathic spermatogenic failure likely results from multiple discrete defects in sperm production that are as yet unidentified. A better understanding of these defects will yield more effective treatment options and appropriate triage of patients to specific therapeutic regimens. This review focuses on the rationale and current evidence for hormonal and antioxidant therapy in medical treatment of male infertility, spermatogenic failure in particular. Although empiric medical therapy for spermatogenic failure has been largely replaced by assisted reproductive techniques, both treatment modalities could play a role, oerhaos as combination therapy.

关键词： antioxidant hormones male infertility sperm spermatogenesis spermatogenic failure testicular failure

Testis sperm extraction

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Asian Journal of Urology 2015年第2期2卷 79-84页

作者： Kirsten J.C.Janosek-Albright peter n.schlegel Ali A.Dabaja Department of Urology Vattikuti Urology InstituteHenry Ford HospitalDetroitMIUSA Department of Urology Weill Cornell Medical CollegeNew YorkNYUSA

The last 20 years have produced developments in the treatment for patients with non-obstructive azoospermia(nOA)who were once considered to be *** combination of intracytoplasmic sperm injection together with various testicular sperm retrieval techniques,including conventional testicular sperm extraction(TESE),microdissection TESE(micro-TESE)and fine needle aspiration(FnA),have revolutionized treatment for these *** men with nOA,isolated regions of spermatogenesis within the testis are *** goal for all types of sperm retrieval procedures is locating the focal region(s)of spermatogenesis,and harvesting the sperm for assisted *** review article explores the surgical management of men with nOA and describes all techniques that can be used for testicular sperm retrieval.A PubMed search was conducted using the key words:“sperm extraction”,“nOA”,“testicular FnA”,“testicular mapping”,“TESE”,and“testicular biopsy”.All articles were *** were included if they provided data on sperm retrieval *** methods for performing sperm retrieval rates and outcomes of the various techniques are ***-TESE has a higher sperm retrieval rates with fewer postoperative complications and negative effects on testicular function compared with conventional TESE.

关键词： non-obstructive azoospermia Microdissection testicular sperm extraction Fine needle aspiration Sperm retrieval

KIinefeIter综合征的诊断：新型甲基化特异性实时定量PCR

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Asian Journal of Andrology 2014年第5期16卷 684-688,I0006页

作者： Akanksha Mehta Anna Mielnik peter n schlegel Darius A Paduch Department of Urology Weill Cornell Medical College New York NY USA Department of Urology Emory University School of Medicine Atlanta GA USA

The aim of this study was to design a molecular assay for the diagnosis of Klinefelter syndrome （KS）, based on the detection of supernumerary X-chromosomes （X-chs）. DnA was extracted from peripheral blood samples of twenty-six 47,XXY males; two 46,XY/47,XXY males; twenty-two 46,XY males; and 15 females; and deaminated. Methylation-specific quantitative polymerase chain reaction （MS-qPCR） was performed using primers for unmethylated and methylated copies of the X-ch inactive-specific transcript （XIST-U and XIST-M） gene. X-ch disomy was determined on the basis of XIST methylation status. Degree of mosaicism in the 46,XY/47,XXY males was compared with karyotype and fluorescent in situ hybridization （FISH） results. Data analysis was performed using the Roche LightCycler software V. 3.5.3, including determination of crossing points （CPs） by fit-point analysis and melting curve analysis. Xoch disomy was detected in all female controls and KS patients; male controls expressed XIST-M only. CPs ranged from 29.5 to 32.5 （standard deviation （s.d.） 0.8） for XIST-U and from 29 to 31 （s.d. 0.6） for XIST-M. Limit of detection of mosaicism was 1%. Based on XlST-U/XIST-M ratios for the two 47,XXY/46,XY patients, the calculated degree of mosaicism （1.8% and 17.8%） was comparable to FISH results （2.3% and 15%, respectively）. Turnaround time from DnA deamination to final data analysis was under 9 h. We conclude that MS-qPCR is a sensitive, specific and rapid test for the detection of X-ch disomy, with applicability for the screening and diagnosis of KS, even in the setting of low grade 47,XXY/46,XY mosaicism.

关键词： DnA methylation Klinefelter syndrome mosaicism polymerase chain reaction

A product version of the Hilton-Milner-Frankl theorem

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Science China Mathematics 2024年第2期67卷 455-474页

作者： peter Frankl Jian Wang Alfréd Rényi Institute of Mathematics Hungarian Academy of SciencesBudapest H-1053Hungary Department of Mathematics Taiyuan University of TechnologyTaiyuan 030024China

Two families F and G of k-subsets of {1, 2,..., n} are called non-trivial cross t-intersecting if|F ∩ G|≥t for all F ∈ F, G ∈ G and | ∩ {F : F ∈ F}| < t, | ∩ {G : G ∈ G}| < t. In the present paper,we determine... 详细信息

Two families F and G of k-subsets of {1, 2,..., n} are called non-trivial cross t-intersecting if|F ∩ G|≥t for all F ∈ F, G ∈ G and | ∩ {F : F ∈ F}| n the present paper,we determine the maximum product of the sizes of two non-trivial cross t-intersecting families of k-subsets of{1, 2,..., n} for n≥4(t + 2)2k2, k≥5, which is a product version of the Hilton-Milner-Frankl theorem.

关键词： extremal set theory cross t-intersecting family product version non-trivial