2018年·第98卷第46期

Testicular torsion is a rare scrotal emergency, and the complications are very serious, often leading to orchiectomy. It is reported in literature that the cumulative testicular loss rate is 31.9~41.9%^[1]。 Misdiagnosis will directly lead to delayed treatment and orchiectomy. Patients with testicular loss due to misdiagnosis usually prevail in medical lawsuits, and such litigation cases rarely mention the details. This paper analyzes the medical litigation cases caused by testicular torsion, analyzes the root causes of these problems from multiple angles, and explores the influencing factors of testicular torsion litigation cases, hoping to improve the ability to identify and deal with testicular torsion, help the parties identify and avoid the occurrence of adverse events, and improve the medical safety of patients.

Azoospermia is the most serious male infertility, which refers to the complete absence of sperm in the ejaculated semen, accounting for about 5% to 20% of male infertility patients^[1]。 The diagnosis of azoospermia must have ≥2 semen specimens, more than 2 weeks apart, and no sperm was found before and after semen centrifugation^[2]。 Azoospermia does not refer to the absence of sperm production in the testicles, but rather emphasizes the absence of sperm in the semen^[3]。

In the past ten or two years, andrology has developed rapidly, and new testing items have been continuously introduced into the clinic, and have become routine testing items. However, some of these tests have obvious defects, but they are still widely used by clinical and scientific researchers. For example, the sperm DNA fragmentation index (DFI), which reflects sperm DNA damage, has been developed by a large number of andrology laboratories since its introduction into the clinic in 2002; The detection of semen elastase, which reflects recessive infection of male reproductive tract, has been gradually developed as a kit for routine clinical detection since it was reported in 1980s; Prostatosomal leakage protein (PSEP) reported in 2014 rapidly entered clinical routine testing without extensive clinical validation. These testing items have several common characteristics: (1) the clinical charges are high, up to several hundred yuan; (2) Since the promotion into clinical routine testing, although some clinicians suspect that the results are inconsistent with the clinical manifestations of patients, they have been silently used in clinical use; (3) Whether these indicators are used in clinical or scientific research, almost the same detection method comes from the same original literature, and no one seems to have ever doubted it. There may be two fundamental reasons for this phenomenon: driven by interests, high charges will inevitably bring high returns, and its clinical significance is not important; Some medical staff who have doubted these test items think that since reagent manufacturers have provided kits, they must have undergone strict verification. Coupled with a large number of repeated literature reports, they feel powerless to refute them.

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), is a common complication of hospitalized patients, and it is also the main cause of increased medical expenses and prolonged hospital stay^[1]。 Because of its insidious onset and non-specific symptoms, it has the characteristics of high morbidity, high mortality, high missed diagnosis rate and high misdiagnosis rate. It is an important cause of unexpected death and perioperative death of hospitalized patients. VTE is considered to be the most common preventable cause of hospital-related death and disability in low, middle and high-income countries^[2]。 Therefore, VTE prophylaxis is essential for hospitalized patients.

Bronchial asthma (abbreviated as asthma) is a chronic airway inflammatory disease caused by genetic and environmental factors, and its incidence is on the rise in China^[1]。 Around 30 million people in China suffer from asthma, and less than 30% of them reach asthma control^[2]Well below the long-term asthma management goals set out by the Global Asthma Initiative (GINA). Poor asthma control can lead to increased hospitalization and emergency department visits, affecting patients' study and work, and increasing medical expenditure^[3]It imposes a huge economic burden on individuals and society. The effect of asthma treatment is closely related to patient compliance, and improving patient compliance is an important measure to improve asthma control. The following are four aspects: compliance of asthma patients and its influence on disease control, methods of judging patient compliance, influencing factors of compliance of asthma patients and strategies to improve patient compliance.

Resveratrol is a polyhydric phenol antitoxin synthesized by plants to resist microbial infection. It is widely found in grapes, red wine, peanuts and other plants^[1]。 Studies have shown that resveratrol has many beneficial biological effects, such as anti-cancer, antioxidant and anti-inflammatory, cardiovascular protection, etc^[2]。 The effects of resveratrol on the reproductive function of male mammals have also been extensively studied. This paper summarizes the effects of resveratrol on the gonad function of male mammals, hoping to provide reference for the application of resveratrol in improving the reproductive function of male mammals, especially humans.

Cardiovascular disease has always been one of the main diseases that threaten human health. It is still an urgent problem in the field of cardiovascular to explore its pathogenesis and factors affecting its prognosis, and develop effective prevention and treatment measures. Myocardial ischemia-reperfusion injury (MIRI) is one of the causes of cardiac dysfunction after reperfusion and open heart surgery in different types of angina pectoris and myocardial infarction (MI); Cardiomyocyte regeneration, survival and endothelial microvascular regeneration are crucial to the prognosis of cardiovascular disease and the improvement of cardiac function; Moreover, the final outcome of cardiovascular diseases such as coronary heart disease, cardiomyopathy and valvular heart disease is a decrease in the number of cardiomyocytes with complete diastolic function, and heart failure occurs after myocardial fibrosis and cardiac remodeling. It is of great significance to prevent or delay this process. Studies have shown that different stress factors, exosomes can release different microRNAs (miRs), which regulate the occurrence and development of MIRI, myocardial regeneration and survival, microvascular genesis, myocardial fibrosis and cardiac remodeling. This article focuses on the research progress of exosome-derived miRs in the pathogenesis of cardiovascular diseases.

The common causes of primary liver cancer (HCC) are viral hepatitis, ethanol, aflatoxin or algal chemotoxins, autoimmune liver disease, etc. In recent years, Budd-Chiari syndrome (BCS) combined with HCC has been reported frequently in the literature, which shows that BCS is also one of the causes of HCC^[1]。 Of course, BCS is associated with high risk factors for HCC, such as age, sex, smoking, etc^[2]But after all, BCS is a disease that obstructs the liver outflow tract, which will cause cell damage caused by hypoxia in the local microenvironment of the liver. Persistent liver damage will cause local sustained inflammatory reaction, leading to liver fibrosis and cirrhosis, and eventually developing into HCC. By summarizing the microenvironment of liver hypoxia caused by BCS in recent years, the possible molecular mechanisms related to HCC caused by liver hypoxia in this disease were further explored.