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Bei der Erfassung kausaler Faktoren mannlicher Fertilitatsstorungen spielen Lebensstil und Umweltfaktoren eine wichtige Rolle. Das Wissen um die Wechselwirkungen zwischen derartigen Einflussen und reproduktiven Funktionen des Mannes eroffnet zudem die Moglichkeit eines praventiven Ansatzes in der Andrologie. Relevante exogene Noxen sind Genussgifte, Pharmaka einschlieslich Lifestyle-Medikamenten, Berufsstoffe, Umweltchemikalien sowie physikalische Faktoren. Reproduktionstoxische Effekte konnen sich pratestikular, testikular oder posttestikular entfalten und neben einer Beeintrachtigung der Spermatogenese oder Spermienfunktion auch Hormon- und Sexualstorungen verursachen. Aufgrund der komplexen Regulation des mannlichen Reproduktionssystems sowie der begrenzten Ubertragbarkeit tierexperimenteller Befunde und In-vitro-Daten auf die Situation beim Menschen liegen allerdings nur fur wenige Noxen gesicherte Erkenntnisse vor. In der andrologischen Sprechstunde sollten bei Erhebung der Anamnese potenzielle Expositionsrisiken erfasst und die Patienten uber eine gesicherte oder mogliche Relevanz fur ihre Fertilitat aufgeklart werden.

Introduction Supporting and counselling couples with fertility issues prior to starting ART is a multidisciplinary diagnostic and therapeutic challenge. The first German-language interdisciplinary S2k guideline on “Diagnosis and Therapy Before Assisted Reproductive Treatments (ART)” was published in February 2019. The guideline was developed in the context of the guidelines program of the German Society of Gynecology and Obstetrics (DGGG) in cooperation with the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). Aim In one third of cases, the cause of involuntary childlessness remains unclear, even if the woman or man have numerous possible risk factors. Because the topic is still very much taboo, couples may be socially isolated and often only present quite late to a fertility center. There is no standard treatment concept for these patients at present, as there are currently no standard multidisciplinary procedures for the diagnostic workup and treatment of infertility. The aim of this guideline is to provide physicians with evidence-based recommendations for counselling, diagnosis and treatment. Methods This S2k guideline was developed on behalf of the Guidelines Commission of the DGGG by representative members from different professional medical organizations and societies using a structured consensus process. Recommendations This second part of the guideline describes the hematological workup for women as well as additional diagnostic procedures which can be used to investigate couples and which are carried out in cooperation with physicians working in other medical fields such as andrologists, geneticists and oncologists.

Eine andrologische Abklarung ist sinnvoll, wenn trotz regelmasigen ungeschutzten Geschlechtsverkehrs nach 12 Monaten keine Schwangerschaft eingetreten ist. Eine andrologische Diagnostik vor Ablauf der 12 Monate kann notwendig werden, wenn die Partnerin uber 35 Jahre alt ist oder Faktoren beim Mann vorliegen, die auf eine eingeschrankte Fertilitat hindeuten. Die Ursachen fur eine ungewollte Kinderlosigkeit liegen zu etwa gleichen Teilen bei Mann und Frau. Der Beginn einer andrologischen Abklarung ist die Erhebung der Anamnese. Erste Angaben dazu konnen bereits abgefragt werden, wenn sich die Partnerin zur Beratung an ihren behandelnden Gynakologen wendet. Der Gynakologe sollte daher Kenntnisse zu relevanten Aspekten der andrologischen Krankenvorgeschichte haben und mit den wesentlichen Fragen vertraut sein, die er selbst stellen kann. Berucksichtigung von Empfehlungen aus Leitlinien und der Weltgesundheitsorganisation. Die andrologische Anamnese umfasst Fragen zur allgemeinen Krankenvorgeschichte, zu Sexualstorungen, spezifischen andrologischen Aspekten, Medikamenteneinnahme, Lebensfuhrung und Berufsleben. Gynakologen haben eine Lotsenfunktion fur das Paar und tragen dazu bei, dass sich die Manner fruhzeitig und gleichzeitig mit ihren Partnerinnen einer Abklarung unterziehen.

Both trabeculotomy (TE) as well as transscleral endodiode laser cyclophotocoagulation (CPC) are common approaches in glaucoma surgery. The purpose of this study was to perform an intraindividual comparison of these procedures carried out by the same surgeon in the same patient on the same day. An observational monocentric retrospective cohort study was conducted. Patients with a bilateral refractory open-angle glaucoma who underwent trabeculectomy in one eye and transscleral endodiode laser cyclophotocoagulation in the fellow eye simultaneously were included and followed up with over the course of 1 year. Eighty-two eyes of 41 patients were included. Seventeen patients (41.5%) were men and 24 (58.5%) women. The mean age was 68.7 ± 9.5 years. The diagnosis comprised 33 (80.5%) patients with a primary open-angle glaucoma, five (12.2%) patients with pseudoexfoliation glaucoma, and three (7.3%) patients with pigment dispersion glaucoma. A reduction in intraocular pressure (IOP) was seen in both after TE (from 26.2 ± 13.2 to 10.6 ± 4.1 mmHg, 52 weeks post-treatment) as well as CPC (from 24.2 ± 9.9 to 15.0 ± 5.4 mmHg, 52 weeks post-treatment). In comparison to each other, TE was significantly more effective in lowering the IOP (10.6 ± 4.1 vs. 13.4 ± 5.0; p = 0.0030, 52 weeks post-treatment) and needed antiglaucomatous medications (0.45 ± 0.80 vs. 1.24 ± 1.13; p = 0.0009, 52 weeks post-treatment). Consistently, the achievement rate of an IOP ≤ 16 mmHg without antiglaucomatous medications was significantly higher in TE-treated eyes (65.8% vs. 31.6%; p = 0.0019). Re-interventions, including 10 secondary TEs, were commonly required in those eyes undergoing CPC, especially in younger patients. Trabeculectomy was demonstrated to be more effective in reducing IOP in comparison to fellow eyes receiving CPC. In particular, in younger patients, an additional TE in the CPC-treated eyes was necessary. The outcome of those secondary TEs however was comparable to the primarily performed TEs. Our study thus supports the use of CPC as tool to control IOP, especially in the context of bilateral refractive glaucoma.

Extracellular ATP has been described to be involved in inflammatory cytokine production by human testicular peritubular cells (HTPCs). The ectonucleotidases ENTPD1 and NT5E degrade ATP and have been reported in rodent testicular peritubular cells. We hypothesized that if a similar situation exists in human testis, ATP metabolites may contribute to cytokine production. Indeed, ENTPD1 and NT5E were found in situ and in vitro in HTPCs. Malachite green assays confirmed enzyme activities in HTPCs. Pharmacological inhibition of ENTPD1 (by POM-1) significantly reduced pro-inflammatory cytokines evoked by ATP treatment, suggesting that metabolites of ATP, including adenosine, are likely involved. We focused on adenosine and detected three of the four known adenosine receptors in HTPCs. One, A2B, was also found in situ in peritubular cells of human testicular sections. The A2B agonist BAY60-6583 significantly elevated levels of IL6 and CXCL8, a result also obtained with adenosine and its analogue NECA. Results of siRNA-mediated A2B down-regulation support a role of this receptor. In mouse peritubular cells, in contrast to HTPCs, all four of the known adenosine receptors were detected; when challenged with adenosine, cytokine expression levels significantly increased. Organotypic short-term testis cultures yielded comparable results and indicate an overall pro-inflammatory action of adenosine in the mouse testis. If transferable to the in vivo situation, our results may implicate that interference with the generation of ATP metabolites or interference with adenosine receptors could reduce inflammatory events in the testis. These novel insights may provide new avenues for treatment of sterile inflammation in male subfertility and infertility.

PURPOSE The purpose of this study is to analyze the course of corneal densitometry (CD), endothelial cell density (ECD), best-corrected visual acuity (BCVA), and central corneal thickness (CCT) 5 years after uneventful Descemet membrane endothelial keratoplasty (DMEK). METHODS Sixty uneventful cases (51 patients) with a minimum follow-up of 5 years were included. CD of various corneal layers (anterior, central, posterior, and total layer) and zones (0-2 mm, 2-6 mm, and 6-10 mm) were measured with Scheimpflug tomography. ECD, BCVA, and CCT were also evaluated. RESULTS Total CD at 0 to 2 mm and 2 to 6 mm zones significantly decreased from 33 ± 10 and 27.8 ± 8 grayscale units (GSU) preoperatively to 21.8 ± 3.1 and 22.2 ± 4.2 GSU at 5 years, respectively (P < 0.001). On the contrary, total CD at the 6 to 10 mm zone significantly increased from 30 ± 8.3 GSU preoperatively to 34.6 ± 7.8 GSU at 5 years (P < 0.001). ECD significantly decreased from 2496 ± 267 cells/mm2 preoperatively to 1063 ± 470 cells/mm2 at 5 years (P < 0.001). Similarly, CCT significantly decreased from 686 ± 109 μm preoperatively to 557 ± 37 μm at 5 years (P < 0.001). Postoperative BCVA was significantly better after DMEK for every examination time point. CONCLUSIONS Despite a slight CD increase at all layers of all corneal zones from the second to the fifth postoperative year, the excellent visual outcome was maintained throughout 5-year follow-up. Thus, DMEK seems to effectively treat corneal endothelial disease in the long term.

Palmitic acid (PA) is a major fatty acid, derived from diet and endogenous production, which is being linked to inflammation. While such actions of PA at the level of the testis remain difficult to examine, we reasoned that studies in human testicular cells may be instructive. Human testicular peritubular cells (HTPCs) can be isolated from men and cultured. They have contractile properties but also produce Interleukin 6 (IL6), express the inflammasome member NLRP3, and via glia cell line derived neurotrophic factor (GDNF), they contribute to the spermatogonial stem cell niche. We found that PA at 100 &micro, M significantly increased the levels of IL6, while NLRP3 or the related Interleukin 1 beta (IL1beta) were not affected. The contractility marker calponin (CNN1) and the growth factor GDNF were likewise not affected. ELISA studies confirmed the stimulatory PA actions on IL6. Hence, PA derived from diet and/or endogenous sources may be able to foster a pro-inflammatory milieu in the testis. A possible link of these results to diet and high fat intake and obesity is indicated by the about 12-fold elevated testicular levels of IL6 in testes of obese rhesus monkeys (n = 3), fed with a Western Style diet. They had elevated 2&ndash, 5-fold increased body fat and increased circulating triglyceride levels. Further consequences of PA and obesity for testicular functions remain to be evaluated.

Single-shot devices have been developed to simplify pulmonary vein isolation (PVI). Randomized studies of the second-generation cryoballoon (CB 2nd) demonstrated excellent results. There are limited data comparing results of circular pulmonary vein ablation catheter (PVAC) with conventional RF ablation or CB for PVI. Using a sequential registry cohort and a prospective randomized study, we aimed to compare the acute and long-term results of CB 2nd and PVAC Gold. In the registry, consecutive patients with paroxysmal atrial fibrillation (AF) undergoing their first PVI were included. The preferred method used was PVAC Gold in 2014 and CB 2nd in 2015. Subsequently, a randomized study (PVAC vs. CB 2nd) was performed. Ablation success was measured as freedom of AF or atrial tachycardias (AT) off antiarrhythmic drugs. In the registry cohort, PVAC Gold was used in 60 patients and CB 2nd in 56 patients (age 66 ± 11 years, 52% male, LAD 43 ± 6). In the randomized study, 20 patients were treated with PVAC Gold and 22 with CB 2nd (age 67 ± 9; 43% men, LAD 40 ± 7 mm). During a mean follow up of 13.2 ± 3.6 months, success was 54% in PVAC Gold patients and 81% in CB 2nd cases (p = 0.001). In the randomized study 12 months success was 50% versus 86%, p

Veranderungen am Penis kommen haufig erst zufallig zutage oder werden spontan vor allem im Rahmen der Jugend- oder auch Jungensprechstunde vorgestellt. Der zweite Teil des Beitrags zu Veranderung an der Haut des mannlichen Genitale widmet sich entzundlichen, infektiosen und traumatischen Veranderungen.

Hautveranderungen am mannlichen Genitale konnen in jedem Lebensalter auftreten. Wahrend manche davon harmlos sind, besteht bei anderen akuter Handlungsbedarf — aus gesundheitlichen Grunden, aber auch, wenn sie das Korperbild des Patienten storen oder sein Sexualleben beeintrachtigen.

Stress activates the sympathetic nervous system and is linked to impaired fertility in man. We hypothesized that catecholamines by acting on testicular cells have a role in these events, possibly by fostering an inflammatory environment. The cells of the wall of seminiferous tubules, human testicular peritubular cells (HTPCs), express adrenergic receptors (ADRs) α1B, α1D, β1 and β2. A selective α1-ADR agonist, phenylephrine, increased intracellular Ca 2+ -levels in cultured HTPCs and induced COX-2, IL-6 and MCP-1 mRNA expression without affecting IL-1β mRNA. These changes were paralleled by a significant increase in the secretion of IL-6 and MCP-1. Epinephrine was also effective, but salbutamol, a selective β2-ADR agonist was not. Our results suggest that stress-associated elevation of catecholamines may be able to promote inflammatory events by targeting peritubular cells in the human testis. Blockage of α1-ADRs may therefore be a novel way to interfere with stress-related impairment of male reproductive functions. Fil: Rossi, Soledad Paola. Ludwig Maximilians Universitat; Alemania. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina Fil: Walenta, Lena. Ludwig Maximilians Universitat; Alemania Fil: Rey Ares, Veronica. Ludwig Maximilians Universitat; Alemania Fil: Köhn, Frank-Michael. Andrologicum; Alemania Fil: Ulrich Schwarzer, J.. Andrology Center Munich; Alemania Fil: Welter, Harald. Ludwig Maximilians Universitat; Alemania Fil: Calandra, Ricardo Saul. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina Fil: Frungieri, Monica Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina Fil: Mayerhofer, Artur. Ludwig Maximilians Universitat; Alemania

Hautveranderungen am Penis beunruhigen betroffene Manner meist sehr stark. Aber nicht immer stellen sie sich zeitnah vor. Scham, Verdrangung, mangelnde Achtsamkeit oder auch Indolenz konnen Grunde dafur sein. Wie geht man in der Praxis mit dem Problem um?

Ein 35-jahriger Patient kommt mit Juckreiz und Hautveranderungen des Genitales (Abb. 1) in die Sprechstunde. Lokal angewandte, pflegende Externa hatten bisher keine Besserung gebracht.

Studies about SARS-CoV-2 infections and male fertility are based on small numbers of patients in volved;in addition, male patients and their semen quality were only monitored for short periods of time. The virus has not been definitely detected in ejaculates. However, their is some proof of orchitis and reduced semen quality especially after severe SARS-CoV-2 infections. Since serum LH levels are increased in some COVID-19 patients, SARS-CoV-2 infection may also have negative effects on Leydig cell function. © 2021, Krause und Pachernegg GmbH. All rights reserved.

Bei manchen Paaren will es mit einer Schwangerschaft einfach nicht klappen. Vor der Beratung dieser Paare sollten Sie sich informieren, welchen Einfluss der Lebensstil eines Mannes auf die Spermaqualitat hat.

Die Bestimmung des Testosteronwerts im Serum — oft in Zusammenhang mit Anti-Aging-Medizin — ist eine haufige Bitte mannlicher Patienten. Wann ist diese Untersuchung sinnvoll? Bei welchen Symptomen und Risikofaktoren sollten Sie an einen Hypogonadismus denken?

Androgene sind fur die sexuelle Differenzierung der Geschlechtsorgane sowie die Ausbildung des mannlichen Phanotyps essenziell. Im Hoden spielt Testosteron eine wesentliche Rolle bei der Spermatogenese. Uber diese androgene Wirkung hinaus werden Sexualverhalten und -aktivitat beim Mann beeinflusst. Dementsprechend vielgestaltig ist die klinische Auspragung eines Testosteronmangels. Die Substitutionsbehandlung mit Testosteronpraparaten ist in der Praxis fest etabliert. Therapienutzen und Risiken mussen jedoch je nach Indikation sorgfaltig abgewogen werden.

Background The prospective WEARIT-II-EUROPE registry aimed to assess the value of the wearable cardioverter-defibrillator (WCD) prior to potential ICD implantation in patients with heart failure and reduced ejection fraction considered at risk of sudden arrhythmic death. Methods and results 781 patients (77% men; mean age 59.3 ± 13.4 years) with heart failure and reduced left ventricular ejection fraction (LVEF) were consecutively enrolled. All patients received a WCD. Follow-up time for all patients was 12 months. Mean baseline LVEF was 26.9%. Mean WCD wearing time was 75 ± 47.7 days, mean daily WCD use 20.3 ± 4.6 h. WCD shocks terminated 13 VT/VF events in ten patients (1.3%). Two patients died during WCD prescription of non-arrhythmic cause. Mean LVEF increased from 26.9 to 36.3% at the end of WCD prescription (p Conclusions Mortality after WCD prescription was mainly driven by heart failure and non-cardiovascular death. In patients with HFrEF and a potential risk of sudden arrhythmic death, WCD protected observation of LVEF progression and appraisal of competing risks of potential non-arrhythmic death may enable improved selection for beneficial ICD implantation. Graphic abstract

PURPOSE To evaluate the effect of ultraviolet A radiation on retinal function and structure after the corneal collagen crosslinking procedure. METHODS In the present prospective, single-center cohort study 17 eyes of 17 patients who underwent collagen crosslinking (Dresden protocol) for the treatment of corneal ectasia were examined preoperatively and at 2 and 6 weeks postoperatively with multifocal electroretinogram and optical coherence tomography. The P1 amplitude density (P1-AD) of the central retinal response was documented in 5 concentric rings, with ring 1 (R1) representing the foveal response and rings 2 to 5 (R2-R5) corresponding to successive annuli of stimulation. Visual acuity, corneal densitometry at the 0 to 2 mm zone and at the 2 to 6 mm annulus, and macular thickness (MT; central, 1 mm, 3 mm, and 5 mm zones) were recorded. RESULTS The preoperative values of P1-AD were R1 = 109.96 ± 28.96, R2 = 49.8 ± 14.46, R3 = 29.85 ± 8.9, R4 = 19.33 ± 6.3, and R5 = 16.39 ± 5.48 nV/deg. At 2 weeks, these values were R1 = 77.54 ± 24.47, R2 = 36.55 ± 12.53, R3 = 21.53 ± 7.71, R4 = 15.3 ± 6.13, and R5 = 13.32 ± 5.48, showing a significant reduction for R1-R4 (P ≤ 0.026). The 6-week P1-AD was R1 = 99.8 ± 31.23, R2 = 40.67 ± 16.39, R3 = 24.98 ± 7.13, R4 = 16.35 ± 4.84, and R5 = 13.76 ± 3.98, showing no significant differences compared with preoperative values (P ≥ 0.054). Corneal densitometry increased significantly at 2 weeks (P < 0.001) and remained increased at 6 weeks (P < 0.001), showing statistically insignificant correlations with 2-week P1-AD (P ≥ 0.553). The central MT increased (P = 0.787), whereas MT at 1 mm (P = 0.444), 3 mm (P = 0.039), and 5 mm (P < 0.001) zones decreased. CONCLUSIONS The return of P1-AD to preoperative (physiologic) values at 6 weeks confirms the safety standards of the duration and intensity of ultraviolet A radiation, as proposed by the Dresden protocol. However, temporary postoperative retinal dysfunction cannot be excluded.

Background: Erectile dysfunction (ED) is a common public health issue with a significant impact on quality of life. The associations between ED and several risk factors have been reported previously. The continuously increasing incidence of these factors is contributing to the increasing prevalence of ED. Aim: To assess ED prevalence and severity in a representative sample of 45-year-old German men and to analyze the association with risk factors (lifestyle risk factors/comorbidities). Methods: Data were collected within the German Male Sex-Study. Randomly selected 45-year-old men were invited. A total of 10,135 Caucasian, heterosexual, sexually active men were included in this analysis. The self-reported prevalence of ED was assessed using the Erectile Function domain of the International Index of Erectile Function. Risk factors for ED were ascertained using self-report questionnaires. An anamnesis interview and a short physical examination were performed. Main Outcome Measure: ED prevalence and severity were evaluated in a cross-sectional design. The associations of ED with comorbidities (eg, depression, diabetes, hypertension, lower urinary tract symptoms) and lifestyle factors (ie, smoking, obesity, central obesity, physical inactivity, and poor self-perceived health-status) were analyzed by logistic regression. Results: The overall prevalence of ED was 25.2% (severe, 3.1%; moderate, 9.2%; mild to moderate, 4.2%; mild, 8.7%). Among the men with ED, 48.8% had moderate or severe symptoms. ED prevalence increased with the number of risk factors, to as high as 68.7% in men with 5–8 risk factors. In multiple logistic regression with backward elimination, the strongest associations with ED were found for depression (odds ratio [OR] = 1.87), poor self-perceived health status (OR = 1.72), lower urinary tract symptoms (OR = 1.68), and diabetes (OR = 1.38). Conclusion: One out of 4 men already had symptoms of ED at age 45. Almost one-half of the men with ED had moderate to severe symptoms. ED was strongly associated with each analyzed risk factor, and the prevalence and severity of ED increased with an increasing number of risk factors. Hallanzy J, Kron M, Goethe VE, MD, et al. Erectile Dysfunction in 45-Year-Old Heterosexual German Men and Associated Lifestyle Risk Factors and Comorbidities: Results From the German Male Sex Study. Sex Med 2018;XX:XXX–XXX. CA extern

To present normative corneal densitometry (CD), thickness (CT), and volume (CV) after uneventful Descemet membrane endothelial keratoplasty (DMEK).Medical records of 212 consecutive surgeries were reviewed. One hundred cases without intraoperative and postoperative complications were included (group 1). Scheimpflug CD of the optically relevant 0- to 2-mm zone and 2- to 6-mm annulus, CT at the 2-, 4-, and 6-mm rings, and CV at the 3-, 5-, and 7-mm zones were evaluated preoperatively and at 3, 6, 12, and 24 months postoperatively. The 24-month results were compared with an age-matched group of uncomplicated pseudophakic eyes (group 2; n = 20) and a group of healthy, young subjects (group 3; n = 30).Total CD at 0 to 2 mm was 33.9 ± 10.7 grayscale units preoperatively and decreased to 20.3 ± 4.7 at 24 months (P0.001), being significantly higher compared with both control groups (P ≤ 0.026). Total CD at 2 to 6 mm was 27.9 ± 8.1 preoperatively and decreased to 20.2 ± 4.6 at 24 months (P0.001), showing no statistically significant difference compared with group 2 (P = 0.061). At 24 months, group 1 showed a similar central CT, CT at the 2-mm and 4-mm rings compared with group 2 (P ≥ 0.440); however, CT at 6 mm increased significantly (P = 0.008). CV at 3, 5, and 7 m decreased significantly at 24 months (P0.001), showing no significant differences compared with both control groups (P ≥ 0.122).Twenty four months after uneventful DMEK, CT within the central 4-mm zone and CV at the 3-, 5-, and 7-mm zones were similar to uncomplicated pseudophakic eyes. The total CD at the 0- to 2-mm zone and midperipheral CT at the 6-mm ring were higher compared with the pseudophakic controls.

Although terrorism is widely understood to be the politically motivated creation of fear by means of violence in a target group, the nature of that fear is seldom explained or even considered. The present article attempts to close that gap by proposing a definition of terror as the apprehension of (more) violence to come. Because every terrorist act is perceived to be part of a potential series, terror is oriented towards the future and involves the imaginary anticipation of prospective events. On the basis of this definition, I will examine the problematical role of counterterrorist discourse. As the statements of public officials and security experts in the run-up to, and during, the “War on Terror” demonstrate, the peculiar dynamic of terror is, seemingly paradoxically, reinforced by counterterrorist rhetoric. With its insistence on the escalatory nature of terrorist violence and its repeated prediction of even worse attacks, counterterrorism contributes to the evocation of terror in the sense proposed...

Die Kryokonservierung von Spermien ist ein seit vielen Jahren etabliertes Verfahren. Mindestanforderungen an die Qualitat des Ejakulats gibt es heute nicht mehr. Somit konnen auch sehr junge und altere Krebspatienten davon profitieren. Klaren Sie rechtzeitig auf!

Hautveranderungen im Genitalbereich konnen in Aussehen und Krankheitswert variieren. Auch die Ursachen sind zahlreich und konnen — etwa wenn die zugrundeliegende Krankheit oder die Lokalisation im Schambereich selten ist — schwer dingfest zu machen sein. Im folgenden Beitrag werden einige seltene genitale Dermatosen vorgestellt, die dem praktisch tatigen Hautarzt die Diagnose der entsprechenden Erkrankungen erleichtern sollen.

The original version of this article unfortunately contained mistakes.

Background Physical literacy (PL), given as a multidimensional construct, is considered a person’s capacity and commitment to a physically active lifestyle. We investigated the effect of a holistic physical exercise training on PL among physically inactive adults. Methods A non-randomised controlled study was conducted. Thirty-one physically inactive adults in the intervention group (IG; 81% females, 44 ± 16 years) participated in a holistic physical exercise training intervention once weekly for 15 weeks. A matched, non-exercising control group (CG) consisted of 30 physically inactive adults (80% female, 45 ± 11 years). PL, compliance and sociodemographic parameters were measured. PL was evaluated by a questionnaire, covering five domains: physical activity behaviour, attitude towards a physically active lifestyle, exercise motivation, knowledge and self-confidence/self-efficacy. Data were analysed using ANCOVA models, adjusted for age, gender and BMI at baseline. Results At post-training intervention, the IG showed significant improvements in PL (p = 0.001) and in the domains physical activity behaviour (p = 0.02) and exercise self-confidence/self-efficacy (p = 0.001), with no changes overserved for the CG regarding PL and those domains. No intervention effect were found for the other three domains, i.e. attitude, knowledge and motivation. Additionally, for the IG baseline BMI was identified to be positively correlated with physical exercise-induced improvements in PL (β = 0.51, p = 0.01). Conclusions The results from this study are very useful for further public health activities, which aim at helping physically inactive adults to adopt a physically active lifestyle as well as for the development of further PL intervention strategies. This pilot-study was a first attempt to measure PL in inactive adults. Yet, a validated measurement tool is still not available. Further research is necessary to determine the psychometric properties for this PL questionnaire. Trial registration German Clinical Trials Register (DRKS), DRKS00013991, date of registration: 09.02.2018, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12889-019-6719-z) contains supplementary material, which is available to authorized users.

In man, blockage of prostaglandin (PG)-production e.g. by non-steroidal anti-inflammatory drug (NSAIDs) may have negative testicular side effects, implying beneficial actions of PGs in the testis. We examined human testicular samples and isolated human testicular peritubular cells (HTPCs) to explore sites of PG-synthesis and targets. HTPCs express cyclooxygenase 1 (COX1) and secrete PGE 2 . Receptors (EP1, 2, 4) were specifically identified in peritubular cells. In HTPCs PGE 2 significantly increased mRNA levels of the contractility protein calponin, but did not induce contractions. PGE 2 , as well as EP1 and EP4 receptor agonists, significantly increased glia cell line derived neurotrophic factor (GDNF) mRNA and/or protein levels. Importantly, the NSAID ibuprofen reduced PGE 2 and this action also lowered SMA and calponin mRNA levels and levels of secreted GDNF protein. The results reveal an unknown PGE 2 system in the human testis, in involving peritubular cells, which may be prone to interference by NSAIDs. Fil: Rey Ares, Veronica. Ludwig Maximilians Universitat; Alemania Fil: Rossi, Soledad Paola. Ludwig Maximilians Universitat; Alemania. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina Fil: Dietrich, Kim Gwendolyn. Ludwig Maximilians Universitat; Alemania Fil: Köhn, Frank Michael. Ludwig Maximilians Universitat; Alemania Fil: Ullrich Schwarzer, J. Andrologicum; Múnich, Alemania; Alemania Fil: Welter, Hared. Ludwig Maximilians Universitat; Alemania Fil: Frungieri, Monica Beatriz. Ludwig Maximilians Universitat; Alemania. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina Fil: Mayerhofer, Artur. Ludwig Maximilians Universitat; Alemania

Learning from rewards and punishments is essential to survival, and facilitates flexible human behavior. It is widely appreciated that multiple cognitive and reinforcement learning systems contribute to behavior, but the nature of their interactions is elusive. Here, we leverage novel methods for extracting trial-by-trial indices of reinforcement learning (RL) and working memory (WM) in human electroencephalography to reveal single trial computations beyond that afforded by behavior alone. Within-trial dynamics confirmed that increases in neural expectation were predictive of reduced neural surprise in the following feedback period, supporting central tenets of RL models. Cross-trial dynamics revealed a cooperative interplay between systems for learning, in which WM contributes expectations to guide RL, despite competition between systems during choice. Together, these results provide a deeper understanding of how multiple neural systems interact for learning and decision making, and facilitate analysis of their disruption in clinical populations.One sentence summaryDecoding of dynamical neural signals in humans reveals cooperation between cognitive and habit learning systems.

Aim The aim of this official guideline published by the German Society of Gynecology and Obstetrics (DGGG) and coordinated with the German Society of Urology (DGU) and the German Society of Reproductive Medicine (DGRM) is to provide consensus-based recommendations, obtained by evaluating the relevant literature, on counseling and fertility preservation for prepubertal girls and boys as well as patients of reproductive age. Statements and recommendations for girls and women are presented below. Statements or recommendations for boys and men are not the focus of this guideline. Methods This S2k guideline was developed at the suggestion of the guideline commission of the DGGG, DGU and DGRM and represents the structured consensus of representative members from various professional associations (n = 40). Recommendations The guideline provides recommendations on counseling and fertility preservation for women and girls which take account of the patient's personal circumstances, the planned oncologic therapy and the individual risk profile as well as the preferred approach for selected tumor entities. Ziel Das Ziel dieser offiziellen Leitlinie, die von der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) publiziert und zusammen mit der Deutschen Gesellschaft für Urologie (DGU) sowie Deutschen Gesellschaft für Reproduktionsmedizin (DGRM) koordiniert wurde, ist es, durch die Evaluation der relevanten Literatur konsensbasierte Handlungsempfehlungen für die Beratung und den Einsatz von fertilitätserhaltenden Maßnahmen bei präpubertären Mädchen und Jungen sowie für Patienten/-innen im reproduktiven Alter zu geben. Im Folgendem werden die Statements und Empfehlungen für Mädchen und Frauen dargestellt. Die Statements und Empfehlungen für Jungen und Männer sind nicht Inhalt dieser Publikation. Methoden Diese S2k-Leitlinie wurde durch einen strukturierten Konsens von repräsentativen Mitgliedern verschiedener Fachgesellschaften (n = 40) im Auftrag der Leitlinienkommission der DGGG, DGU und DGRM entwickelt. Empfehlungen Es werden Empfehlungen zur Beratung und dem Einsatz von fertilitätserhaltenden Maßnahmen bei Patientinnen unter Berücksichtigung der Lebensumstände, der geplanten onkologischen Therapie und des individuellen Risikoprofils dargestellt sowie über das Vorgehen bei ausgewählten Tumorentitäten.

Study question Are monkey testicular peritubular cells (MKTPCs) from the common marmoset monkey (Callithrix jacchus) a suitable translational model for the study of human testicular peritubular cells (HTPCs)? Summary answer MKTPCs can be isolated and propagated in vitro, retain characteristic markers for testicular peritubular cells and their proteome strongly (correlation coefficient of 0.78) overlaps with the proteome of HTPCs. What is known already Smooth-muscle-like peritubular cells form the wall of seminiferous tubules, transport sperm, are immunologically active, secrete a plethora of factors and may contribute to the spermatogonial stem cell niche. Mechanistic studies are hampered by heterogeneity of human samples. Study design, size, duration We established a culture method for MKTPCs and characterized these cells from six young adult animals (2-3 years). To examine whether they qualify as a translational model we also examined HTPCs from seven men and compared the proteomes of both groups. Participants/materials, setting, methods We used explant cultures to obtain MKTPCs, which express smooth muscle markers (calponin (CNN1), smooth muscle actin (ACTA2)), lack FSH-receptors (FSHR) and LH-receptors (LHCGR), but possess androgen receptors (AR). MKTPCs can be passaged at least up to eight times, without discernable phenotypic changes. Mass-spectrometry-based analyses of the MKTPC and HTPC proteomes were performed. Main results and the role of chance We established a method for isolation and cultivation of MKTPCs, and provide a comprehensive analysis of their protein repertoire. The results let us conclude that MKTPCs are suitable as a non-human primate model to study peritubular cell functions. Large scale data List of identified proteins in MKTPCs by liquid chromatography-tandem mass spectrometry is accessible at the ProteomeXchange (identifier PXD009394). Limitations, reason for caution This is an in vitro cellular non-human primate model used to provide a window into the role of these cells in the human testis. Wider implications of the findings Previous studies with HTPCs from patients revealed a degree of heterogeneity, possibly due to age, lifestyle and medical history of the individual human donors. We anticipate that the new translational model, derived from young healthy non-human primates, may allow us to circumvent these issues and may lead to a better understanding of the role of peritubular cells. Study funding and competion of interest(s) This work was supported by grants from the Deutsche Forschungsgemeinschaft (MA 1080/27-1; AR 362/9-1; BE 2296/8-1). The authors declare no competing financial interests.

Wenn ein Paar ungewollt kinderlos bleibt, liegt das in mindestens der Halfte der Falle an Fertilitatsstorungen auf Seiten des Mannes, die andrologisch abgeklart werden mussen. Durch molekulargenetische Befunde und eine detaillierte Spermienfunktionsdiagnostik lasst sich der Anteil idiopathischer Fertilitatsstorungen des Mannes reduzieren.

Befragungen von Arzten und Patienten zeigen, dass sexualmedizinische Probleme in der Hausarztpraxis noch zu selten angesprochen werden. Ein Grund dafur ist, dass sich viele Arzte auf diesem Gebiet unsicher fuhlen. Der nachfolgende Beitrag mochte dies andern. Er zeigt Grundlagen sowie wichtige Indikationsgebiete auf und gibt Ihnen einfache Screeningfragen zum Einstieg in das Thema an die Hand.

Der Genitalbefall durch den Morbus Fabry ist ein Beispiel dafur, dass relativ haufig vorkommende Hautveranderungen – in diesem Fall Angiokeratome – auch Ausdruck einer seltenen Erkrankung sein konnen.

Contractile smooth muscle-like peritubular cells build the wall of seminiferous tubules in men. They are crucial for sperm transport and complement the functions of Sertoli cells by secreting factors, including glial cell line-derived neurotrophic factor. Previous studies revealed that they also secrete the chemokine C-X-C motif chemokine ligand 12 (CXCL12), which has known roles in spermatogenesis. Peritubular cells express the androgen receptor (AR), which is retained in isolated human testicular peritubular cells. We aimed to explore AR-regulated functions in human testicular peritubular cells. Bearing in mind that infertile men often have high aromatase activity, which may lower intratesticular androgen concentrations, an animal model for male infertility was studied. These mice display an age-dependent loss in spermatogenesis due to high aromatase activity. Human testicular peritubular cells were exposed to dihydrotestosterone or the antiandrogen flutamide. We studied AR, smooth muscle cell markers, glial cell line-derived neurotrophic factor and 15 secreted factors previously identified, including CXCL12. We used qPCR, Western blotting, ELISA or selected reaction monitoring (SRM). In the animal model for male infertility, we employed qPCR and immunohistochemistry. Dihydrotestosterone increased AR and flutamide prevented these actions. The smooth muscle cell markers calponin and smooth muscle actin were likewise increased, while cell size or cellular proliferation was not changed. Dihydrotestosterone did not increase glial cell line-derived neurotrophic factor or CXCL12 secretion but increased levels of serine proteinase inhibitor (SERPIN) E1. The animal model for male infertility with high aromatase activity showed reduced numbers of AR-immunoreactive testicular peritubular cells, suggesting that altered androgen and/or oestrogen levels could influence AR-mediated responses in peritubular cells. Androgens act on human testicular peritubular cells to enhance AR levels, their contractile phenotype and to modulate the secretion of some secreted factors. This study suggests that some aspects of human peritubular cell functions are regulated by androgens.

A 61-year-old woman survived resuscitation after out-of-hospital cardiac arrest. The heterogeneity of the resulting cognitive impairments and the recovery over a one-year period are presented, highlighting the need for standardized neuropsychological testing even after short cardiac arrests and for effective treatment both out of hospital and in hospital.

PURPOSE To compare the rebubbling rate and clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) with 5% sulfur hexafluoride (SF6) gas versus 100% air as a tamponade for graft attachment. METHODS Retrospective, comparative, interventional case series including 368 consecutive pseudophakic eyes with Fuchs endothelial dystrophy or pseudophakic bullous keratopathy that underwent DMEK in a tertiary referral center between October 2010 and August 2015 using either air (group 1, 191 eyes) or 5% SF6 (group 2, 177 eyes) as a tamponade. The rebubbling rate, complications, best-corrected distance visual acuity (BCVA), manifest refraction, and endothelial cell density were analyzed before and at 1 week, 1, 3, 6, 12, 24, and 36 months after surgery. RESULTS The rebubbling rate was 20.4% (39/191, group 1) versus 6.8% (12/177, group 2; P < 0.001). Complications included cystoid macular edema (n = 5, group 1, and n = 10, group 2; P = 0.14) and 1 case of presumed allograft rejection (n = 1, group 2). The follow-up period was 12 ± 8 months for group 1 and 6 ± 4 months for group 2. BCVA (logarithm of the minimum angle of resolution) had improved after 12 months from 1.43 ± 0.63 to 0.18 ± 0.26 (group 1, P < 0.001) and from 1.8 ± 0.63 to 0.18 ± 0.17 (group 2, P < 0.001). The percentage of eyes with BCVA ≥0.2 logarithm of the minimum angle of resolution at 12 months was 70.9% (90/127, group 1) and 78.4% (40/51, group 2; P = 0.3). Endothelial cell loss at 12 months after DMEK was 44 ± 18% (group 1) versus 33 ± 15% (group 2, P = 0.07). CONCLUSIONS The use of a tamponade with 5% SF6 yielded a significantly lower incidence of graft detachment requiring surgical reintervention with no detrimental effect on graft endothelial cells. Thus, routine use of 5% SF6 for a graft tamponade in DMEK is recommended.

Scientific reports 8(1), 1431 (2018). doi:10.1038/s41598-018-19624-3, Published by Nature Publishing Group, London

Fungi can protect themselves from host defences and antifungal drugs by the production of an extracellular hydrophobic matrix. Candida biofilms exhibit resistance to antifungal agents from all classes including the azoles, echinocandins, amphotericin B complex, and flucytosine. Although demonstrated on polystyrene and bronchial epithelia cells, until today, only indirect evidence for A. fumigatus biofilms in patients is available. The antifungals with the most activity against biofilms are the liposomal formulation of amphotericin B and agents in the echinocandin drug class. Importantly, echinocandins show excellent anti-biofilm activity against C. albicans at therapeutic concentrations. However, other biofilms formed by moulds, including A. fumigatus, are relatively resistant to echinocandins. Multiple mechanisms contribute to the intrinsic and acquired antifungal resistance during the different stages of fungal biofilm development. During the growth phase of the early biofilm various factors account for biofilm resistance. Combinational and sequential antifungal therapy as well as combination with enhancers can improve the effect of a single drug. Further studies are warranted to develop new therapeutic strategies targeting fungal biofilm-specific resistance mechanisms.

Protease activated receptor-2 (PAR-2) is the receptor for the prototype mast cell product tryptase. PAR-2 expression by cells of the human germinal epithelium was reported, but the exact cellular sites of testicular expression remained unknown. That became of interest, because mast cells, expressing tryptase, were found in the walls of seminiferous tubules of patients suffering from sub- and infertility. This location suggested that mast cells via tryptase might be able to influence PAR-2-expressing cells in the germinal epithelium. To explore these points, we used testicular paraffin-embedded sections for immunohistochemistry. PAR-2-positive cells were mostly basally located cells of the seminiferous epithelium, namely spermatogonia. Some stained for the receptor for GDNF (GFRalpha-1), and possibly represent spermatogonial stem cells (SSCs). As true human SSCs could not be examined, we turned to TCam-2 seminoma cells, expressing PAR-2 and stem cell markers, including GFRalpha-1. TCam-2 cells robustly responded to stimulation with a specific PAR-2 agonist (SLIGKV) by increased intracellular Ca(2+) levels. Recombinant tryptase and trypsin, but not a control peptide (VKGILS) evoked this response, implying functional PAR-2. Video imaging and caspase 3/7 assays showed that SLIGKV and tryptase prevented spontaneous apoptosis and increased proliferation of TCam-2 cells. The expression of the marker of pluripotency OCT3/4 was unchanged upon activation of PAR-2, suggesting that the stem cell-like character is not changed. Furthermore, human germ cell cancers were examined. A subset of seminoma and carcinoma in situ samples expressed PAR-2, indicating that yet unknown subgroups exist. Collectively, the descriptive data obtained in human testicular sections, in germ cell cancers and the functional results in TCam-2 cells imply a trophic role of mast cell-derived tryptase for human germ cells. This may be relevant for subtypes of human germ cell cancers, and possibly SSCs. It also raises the possibility that PAR-2 agonists might be useful for the in vitro propagation of human SSCs.

Bei mannlichen Neugeborenen und Jungen in der Pubertat ist die Gynakomastie meist physiologischer Natur. Bei Erwachsenen konnen aber auch Medikamente oder ernsthafte Erkrankungen wie ein Hodentumor dahinter stecken. Was mussen Sie abklaren, welche Therapieoptionen gibt es?

Die Behandlung des mannlichen Hypogonadismus ist ein wesentlicher Teil der andrologischen Weiterbildung und schliest dabei auch Aspekte der Seneszenz des Mannes ein. Kurzlich ist die deutschsprachige Version der „Leitlinie Mannlicher Hypogonadismus“ der European Association of Urology erschienen. In der vorliegenden Ubersicht sollen Ursachen, Diagnostik und Therapie des mannlichen Hypogonadismus unter Berucksichtigung dieser aktuellen Leitlinie zusammengefasst werden.

Lebensqualitat und Krankheitsbewaltigung werden bei Patienten mit einer Psoriasis vulgaris durch verschiedene Belastungsfaktoren beeintrachtigt. Die allzu oft vernachlassigten sexualmedizinischen Aspekte dieser Erkrankung werden im Folgenden aus andrologischer Sicht beleuchtet.