Male infertility (MI) and male sexual dysfunction (MSD) can often coexist together due to various interplay factors such as psychosexual, sociocultural and relationship dynamics. The presence of each form of MSD can adversely impact male reproduction and treatment strategies will need to be individualized based on patients’ factors, local expertise, and geographical socioeconomic status. The Asia Pacific Society of Sexual Medicine (APSSM) and the Asian Society of Men’s Health and Aging (ASMHA) aim to provide a consensus statement and practical set of clinical recommendations based on current evidence to guide clinicians in the management of MI and MSD within the Asia-Pacific (AP) region. A comprehensive, narrative review of the literature was performed to identify the various forms of MSD and their association with MI. MEDLINE and EMBASE databases were searched for the following English language articles under the following terms: “low libido”, “erectile dysfunction”, “ejaculatory dysfunction”, “premature ejaculation”, “retrograde ejaculation”, “delayed ejaculation”, “anejaculation”, and “orgasmic dysfunction” between January 2001 to June 2022 with emphasis on published guidelines endorsed by various organizations. This APSSM consensus committee panel evaluated and provided evidence-based recommendations on MI and clinically relevant MSD areas using a modified Delphi method by the panel and specific emphasis on locoregional socioeconomic-cultural issues relevant to the AP region. While variations exist in treatment strategies for managing MI and MSD due to geographical expertise, locoregional resources, and sociocultural factors, the panel agreed that comprehensive fertility evaluation with a multidisciplinary management approach to each MSD domain is recommended. It is important to address individual MI issues with an emphasis on improving spermatogenesis and facilitating reproductive avenues while at the same time, managing various MSD conditions with evidence-based treatments. All therapeutic options should be discussed and implemented based on the patient’s individual needs, beliefs and preferences while incorporating locoregional expertise and available resources.

The present situation of the clinical application of dog-days moxibustion (moxibustion applied in the three periods of the hot season) is summarized so as to provide the guide for the theoretic study and clinical application of dog-days moxibustion. The intervention time of dog-days moxibustion is on the 1st day of each of the three periods of the hot season. Simultaneously, the geographic factors are considered. The disorders of lung system are mostly dominant among the indications of dog-days moxibustion, complicated with spleen and stomach disorders as well as cold and deficiency syndromes/patterns. The acupoints are mainly selected from the front- points on the chest and the back- points on the back, in combination with the differentiation of diseases, symptoms/patterns and the disorder stages. The duration of treatment is ranged from 1 to 3 years. The clinical therapeutic effect is improved constantly along with the increase of treatment periods by years.
Acupuncture Points ; Acupuncture Therapy ; Humans ; Lung Diseases ; Moxibustion ; Seasons ; Splenic Diseases ; Stomach Diseases

Objective: To observe the difference in clinical efficacy between acupuncture with point selection based on syndrome differentiation along the meridians and acupuncture at non-meridian and non-acupoint points for functional dyspepsia (FD). Methods: A total of 74 FD patients were randomized into an observation group and a control group, with 37 cases in each group. Both groups received acupuncture treatment. Zusanli (ST 36) and Neiguan (PC 6) were selected in the observation group, with Taichong (LR 3) and Neiting (ST 44) added for excess syndrome, and Gongsun (SP 4) and Yinlingquan (SP 9) added for deficiency syndrome. Four non-meridian and non-acupoint points were selected in the control group. The treatments in both groups were performed once a day with a 2-day break after 5 consecutive treatments, which constituted one treatment course. A total of 4 courses were performed. The scores of Nepean dyspepsia index (NDI) and Leeds dyspepsia questionnaire (LDQ) were recorded before and after treatment, and during follow-up (8, 12, 16, 20 and 24 weeks after recruitment) to assess the clinical efficacy. Results: The NDI scores in the two groups after treatment and at each time point during follow-up were higher than those before treatment (all P<0.05), and the LDQ scores were lower than those before treatment (all P<0.05). The NDI scores after treatment and at each time point during follow-up in the observation group were higher than those in the control group (all P<0.01); the total LDQ score and scores of upper abdominal pain, postprandial satiety and upper abdominal burning sensation after treatment and at each time point during follow-up in the observation group were significantly lower than those in the control group (P<0.01 or P<0.05).. Conclusion: Acupuncture with point selection based on syndrome differentiation along the meridians has a better curative effect than acupuncture at non meridian and non-acupoint points in the treatment of FD.

Objective:To observe the clinical efficacy of Shugan granule on perimenopausal depressive disorder (stagnation of liver Qi and Qi stagnation) and its effect on sex hormone and inflammatory factors. Method:One hundred and twenty patients were randomly divided into control group (60 cases) and observation group (60 cases) by random number table. Both groups got Tibolone tablets, 2.5 mg/time, 1 time/day. Patients in control group got flupentixol and melitracen tablets once every morning and noon, 1 tablet/time. In addition to the therapy of control group, patients in observation group got Shugan granule, 1 pack/time, 2 times/days. And a course of treatment was 8 weeks. Main indexes were graded by Hamilton depression scale (HAMD-17), self-rating depression scale (SDS) and Eysenck Personality Questionnaire (EPQ). And secondary indexes were scored by self-rating anxiety scale (SAS), stagnation of liver Qi and Qi stagnation, improved kupperman (KI), levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E₂), 5-serotonin (5-HT), brain derived neurotrophic factor (BDNF), interleukin-1β (IL-1β), IL-6 and tumor necrosis factor-α (TNF-α) before and after treatment. Result:By rank sum test, the clinical efficacy on depressed and perimenopausal syndrome in observation groups was better than that in control group (Z=2.038, P<0.05, Z=2.316, P<0.05).Scores of HAMD-17, SDS, EPQ-N, SAS, KI and stagnation of liver qi and qi stagnation were lower than those in control group (P<0.01), whereas score of EPQ-E was higher than that in control group (P<0.01). And levels of FSH, LH, IL-1β, IL-6 and TNF-α were lower than those in control groups (P<0.01). Levels of E₂, BDNF and 5-HT were higher than those in control groups (P<0.01). Conclusion:Shugan granule can relieve depression, inquietude and symptoms caused by perimenopausal syndrome, regulate sex hormone, 5-HT, BDNF and inflammatory reaction, with a better clinical effect than pure western medicine treatment.

Objective:To observe the clinical efficacy of treating infantile diarrhea due to spleen deficiency with five-step pediatric tuina of Huxiang school. Methods:Using a randomized controlled trial design, sixty eligible kids with diarrhea due to spleen deficiency were randomized into an observation group and a control group, with 30 cases in each group. The observation group was intervened by the five-step pediatric tuina method of Huxiang school, and the control group received conventional tuina treatment. The intervention was conducted once a day, consecutive 5-day treatment as 1 course, at a 2-day interval between courses, successively for a total of 4 courses. Changes in the primary and secondary symptoms of diarrhea due to spleen deficiency were observed, and the clinical efficacy was evaluated. Results: After treatment, the scores of primary and secondary symptoms and the general score of diarrhea due to spleen deficiency were improved; the improvements in fecal form and frequency, decreased appetite, bloating after meals and fatigue and sluggishness were more significant in the observation group than in the control group. Conclusion: The five-step pediatric tuina method of Huxiang school and conventional tuina both can improve the primary and secondary symptoms in infantile diarrhea due to spleen deficiency, while the former one can produce more significant efficacy.

OBJECTIVETo evaluate the efficiency of one-step multiplex RT-PCR for identifying four common fusion transcripts (TEL/AML1, E2A/PBX1, MLL/AF4 and BCR/ABL) in children with acute lymphoblastic leukemia (ALL).

METHODSTotal RNA was extracted from bone marrow samples of 76 children who were newly diagnosed with ALL between January 2003 and December 2010. These RNAs were analyzed for TEL/AML1, E2A/PBX1, MLL/AF4 and BCR/ABL by one-step multiplex RT-PCR or common nested-multiplex PCR. The PCR products were confirmed by DNA sequencing.

RESULTSTEL/AML1 was found in 12 cases (the length of products was 298 bp in 9 cases and 259 bp in 3 cases), E2A/PBX1 was found in 3 cases (the length of products was 373 bp), BCR/ABL was found in 1 case (the length of products was 2 124 bp), and MLL/AF4 was found in 7 cases (the length of products was 427 bp in 1 case and 673 bp in 6 cases) using one-step multiplex RT-PCR combined with DNA sequencing. The results were consistent with those using common nested-multiplex PCR.

CONCLUSIONSOne-step multiplex RT-PCR may be another alternative for detection of common fusion transcripts in children with ALL.

Child ; Child, Preschool ; Core Binding Factor Alpha 2 Subunit ; genetics ; Female ; Fusion Proteins, bcr-abl ; genetics ; Humans ; Infant ; Male ; Multiplex Polymerase Chain Reaction ; methods ; Myeloid-Lymphoid Leukemia Protein ; genetics ; Oncogene Proteins, Fusion ; genetics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; genetics ; Reverse Transcriptase Polymerase Chain Reaction ; methods ; Sequence Analysis, DNA

OBJECTIVETo study the status of iron deposition in patients with β-thalassemia intermedia and major in mainland China.

METHODSThe status of transfusion and chelation was examined in 39 patients with β-thalassemia intermedia or major. Serum ferritin levels were measured. MRI T2* technique was used to detect cardiac and hepatic iron deposition.

RESULTSSerum ferritin levels ranged from the minimum of 1500 ng/mL up to a maximum of 11491 ng/mL. From liver MRI T2* measurement, 15 cases had severe hepatic iron deposition (38%) and moderate deposition was found in 15 cases (38%), mild in 7 cases (18%), and normal in 2 cases (5%). Heart MRI T2* showed severe heart iron deposition in 7 cases (18%), mild in 5 cases (13%), and normal in 27 cases (69%). One case had cardiac arrhythmia. Four cases were over 20 years of age, and presented with gonadal function hypoplasia. The majority of patients did not receive regular transfusion and they had delayed, suboptimal chelation due to financial problems. Serum ferritin level was closely related with timing and dosage of chelation.

CONCLUSIONSIn patients with β-thalassemia who do not receive early regular transfusion and iron chelation therapy, iron deposition may occur at an early age. Important organs and tissue functional lesions and related complications also result. Relevant agencies and family members should be aware of this trend and develop appropriate strategies to improve the medical condition and quality of life of patients with this disorder.

Adolescent ; Adult ; Blood Transfusion ; Child ; Female ; Ferritins ; blood ; Humans ; Iron ; metabolism ; Liver ; metabolism ; Magnetic Resonance Imaging ; methods ; Male ; Myocardium ; metabolism ; beta-Thalassemia ; metabolism ; therapy

OBJECTIVETo study the status of iron metabolism and erythropoietic proliferation in children with various genotypes of thalassemia.

METHODSSerum concentrations of ferritin (SF), transferrin receptor (sTfR) and erythropoietin (EPO) were measured in 158 children with thalassemia. The differences in the concentrations of the three indices among children with different genotypes of thalassemia were compared. The correlations of the hemoglobin level with sereum SF, sTfR and EPO levels were assessed.

RESULTSAmong the 158 children with thalassemia, 52(32.9%) were diagnosed with alpha-thalassemia minor, 27(17.1%) with HbH disease, 59(37.4%) with beta-thalassemia minor, 13(8.2%) with beta-thalassemia major, and 7(4.4%) with combining alpha beta thalassemia. The SF levels in children with HbH disease or beta-thalassemia major were significantly higher than those in the other thalassemia groups (P<0.01). The sTfR levels in children with beta-thalassemia major were the highest when compared with those in the other thalassemia groups (P<0.05). The EPO levels in children with beta-thalassemia major were also the highest when compared with those in the other thalassemia groups (P<0.01). There was a negative correlation between hemoglobin and EPO levels in children with HbH disease (r=-0.656, P<0.01) and beta-thalassemia major (r=-0.641; P<0.05).

CONCLUSIONSThe status of iron metabolism and erythropoietic proliferation is different in children with different genotypes of thalassemia. A combined measurement of SF, sTfR and EPO may reflect the status of erythropoietic proliferation.

Adolescent ; Child ; Child, Preschool ; Erythropoiesis ; Erythropoietin ; blood ; Female ; Ferritins ; blood ; Genotype ; Humans ; Infant ; Iron ; metabolism ; Male ; Receptors, Transferrin ; blood ; Thalassemia ; blood ; metabolism

OBJECTIVETo identify the relationship between the expression of alpha and beta-isoforms of glucocorticoid receptors (GR) in peripheral blood mononuclear cells (PBMC) and glucocorticoid resistance in children with idiopathic thrombocytopenia purpura (ITP).

METHODSReal-time PCR was used to detect the expression of GR alpha and GR beta mRNA in PBMC from 30 children with ITP (glucocorticoid-sensitive, n=18; glucocorticoid-resistant, n=12) and 10 healthy children (control group). Enzyme immunoassay was used to measure plasma levels of total glucocorticoids.

RESULTSThere were no significant differences in PBMC GR alpha mRNA levels among the glucocorticoid sensitive, the glucocorticoid-resistant and the control groups. Compared with the glucocorticoid-sensitive and the control groups, the expression of GR beta mRNA in the glucocorticoid-resistant group was significantly up-regulated (p<0.01). Plasma total glucocorticoids level in the glucocorticoid-resistant group was found to be much higher than that in the glucocorticoid-sensitive and the control groups (p<0.01).

CONCLUSIONSThe up-regulated expression of GR beta mRNA may associated with glucocorticoid resistance in children with ITP.

Child ; Child, Preschool ; Drug Resistance ; Female ; Glucocorticoids ; pharmacology ; Humans ; Male ; Purpura, Thrombocytopenic, Idiopathic ; blood ; drug therapy ; RNA, Messenger ; analysis ; Receptors, Glucocorticoid ; blood ; genetics

OBJECTIVETo study the feasibility of genetic diagnosis for female carriers of human glucose-6-phosphate dehydrogenase (G6PD) deficiency by reverse transcriptase-PCR-denaturing gradient gel electrophoresis (RT-PCR-DGGE).

METHODSBlood samples were collected from suspected 54 female carriers of G6PD deficiency. Total RNAs of peripheral blood were prepared and reverse-transcripted into cDNA. Design of 6 primer pairs for DGGE was based on 17 mutation sites of G6PD cDNA described in the Chinese population. Mutations in the coding region of G6PD gene were screened and genotyped by combination of PCR-DGGE and DNA sequencing.

RESULTSOne case of 1024C/T, 20 cases of 1376G/T and 12 cases of 1388G/A were detected in the 54 samples. The total detection rate was 66.1% (33/54).

CONCLUSIONSHeterozygous mutation rate in female carriers of G6PD deficiency detected by RT-PCR-DGGE is high. RT-PCR-DGGE is value of clinical diagnosis for G6PD-deficiency female carriers.

Adolescent ; Adult ; Child ; Child, Preschool ; Electrophoresis, Polyacrylamide Gel ; Female ; Glucosephosphate Dehydrogenase Deficiency ; diagnosis ; genetics ; Heterozygote ; Humans ; Infant ; Reverse Transcriptase Polymerase Chain Reaction ; methods