Volume 95  ·  Issue 36  ·  2015

Male infertility, that is, the couple has normal sex for more than 1 year without using any contraceptive measures, and the woman is infertile due to the male factor. Under the interactive influence of global environmental degradation, bad lifestyle and genetic factors, the incidence of male infertility is increasing day by day. Because male infertility is caused by many factors, its etiology and pathogenesis need to be elucidated. However, at present, the diagnosis and treatment of male infertility in China is full of chaos, doctors lack standardized training, and some hospitals are out of standard diagnosis and treatment. China issued guidelines for the diagnosis and treatment of male infertility in 2013^[1]This guide explains the etiology, physical examination, auxiliary examination, treatment methods and other aspects of male infertility in detail, and summarizes a series of diagnosis and treatment strategy flow charts, which is of great significance for the standardized diagnosis and treatment of male infertility. However, with the in-depth research on the etiology and mechanism of male infertility and the development of related diagnosis and treatment methods, this guide begins to show certain limitations and cannot meet the needs of medical treatment. Therefore, we need to introduce the "three-point method" of etiology to further improve the diagnosis and treatment process of male infertility.

Y chromosome microdeletion is an important cause of severe oligozoospermia or azoospermia, and it is the second leading genetic factor leading to male infertility, and its incidence is second only to Klinefelter syndrome (Klinefelter syndrome). Since 1999, the European Association of Andrology and the European Quality Control Network of Molecular Genetic Experiments (EAA/EMQN) have published a guide for molecular diagnosis of Y chromosome microdeletions in order to improve the diagnostic quality, and provided an objective method for evaluating the experimental quality. The latest version of the laboratory guidelines was revised by EAA/EMQN in September 2013 based on 12 years of clinical accumulation and expert consensus, based on the 1999 and 2004 editions. The new guidelines focus on clarifying that the Y chromosome microdeletion regions found in oligozoospermia or azoospermia men, mainly azoospermia factor (AZF) regions, only contain AZFa, AZFb, AZFbc, AZFc and AZFabc regions, and independent AZFd regions do not exist; gr/gr deletion in AZFc region is a risk factor affecting spermatogenesis, but its clinical significance is still controversial, and it is not used as a routine examination index; The increase of detection sites does not improve the detection sensitivity, but may complicate the results; Two-tube multiplex PCR-based detection methods are still suitable for entire AZF deletion detection. The implementation of the EAA/EMQN 12-year International Quality Assessment Program (EQA Program) shows that participating laboratories can effectively reduce the diagnostic error rate by standardizing experimental operations and improving the quality of reports. The frequency of Y chromosome microdeletion in Chinese infertile men is 11.5%, which is at a high level. We recommend that AZF detection be used as a routine detection item for male severe oligozoospermia or azoospermia, and call on domestic AZF detection laboratories to join the EQA program to improve the operating specifications of Y chromosome microdeletion detection in China.

Varicocele is one of the common diseases in urology and causes male infertility, with an incidence of about 15% in the general population. Previous treatments mostly focused on scrotal symptoms and male infertility. With the research on varicocele and the improvement of surgical techniques in recent years, new understanding of varicocele has been gained.

To evaluate the correlation between chromosomal polymorphisms and male sperm quality in Jilin Province.

A total of 2 584 male patients with infertility in Center for Reproductive Medicine, First Bethune Hospital of Jilin University from 2008 to 2013 were enrolled, which semen analysis, chromosomal analysis, Y chromosome microdeletion analysis and serum hormone levels analysis were performed. A total of 602 healthy individuals, 50 fertile individuals with normal kayrotypes, 50 azoospermia patients with normal kayrotypes and 50 oligospermia patients with normal kayrotypes were selected as control groups.

There was no significant difference in the frequency of chromosome polymorphisms between infertile patients and normal control individuals(3.91%(101/2 584)vs 3.16%(19/602), P>0.05). And there was no significant difference in the frequency of autosomal polymorphisms between infertile patients and normal control individuals(allP>0.05) .The frequency of Yqh- variant was increased by the decrease of sperm count and it appeared a significantly high frequency in azoospermia patients compared with oligospermia patients and sperm count normal patients in the infertile group (57.14%(21/42) vs 24.32%(9/37), 0(0/13), bothP<0.05). There was no significant difference in the testis volume and serum hormone levels between the infertile patients with chromosomal polymorphisms and patients in control groups with normal kayrotypes (allP>0.05). The results of PCR amplication indicated that 32.14%(9/28) patients with Yqh± had Y chromosome microdeletion.

There is no significant correlation between autosomal polymorphisms and male infertility. But Yqh± may be responsible for Y chromosome microdeletion and male infertility.

To discuss the efficacy and safety of microsurgical varicocelectomy combined with aescine in the treatment of varicocele.

A total of 120 patients with varicocele received treatments and follow up in Shanghai Renji Hospital and Shanghai General Hospital between September 2013 and April 2015, 63 patients of which were infertile and 57 patients of which were painful varicocele. A total of 106 patients were unilateral varicocele and 14 patients were bilateral varicocele. Forty-one patients were treated with varicocelectomy, and 79 patients were treated with varicocelectomy combined with aescine, 300 mg, twice a day, orally. Sperm analysis, pregnancy rate, sex hormone, and complications were recorded after six months treatments.

There was significant difference in the sperm motility improvement in infertile patients between microsurgical group (60.0%, 12/20) and combined therapy group (83.7%, 36/43) (P<0.05). There was no significant difference in levels of sexual hormones in infertile patients between microsurgical group and combined therapy group (luteinizing hormone (4.07±1.49) vs (4.29±1.32)U/L, follicule-stimulating hormone (5.64±2.70) vs (5.11±1.25)U/L, and testosterone (16.09±2.25) vs (15.98±3.79) μg/L). The pregnancy rate of infertile patients in microsurgical group and combined therapy group were 15.0% (3/20) and 18.6% (8/43), respectively, with no statistic difference between these two groups (P>0.05). The total improvement rates for the pain resolution in microsurgical group and combined therapy group were 76.2% (16/21) and 94.4% (34/36), respectively, with statistic difference between these two groups (P<0.05). In the microsurgical group, there were two cases of scrotal edema and one case of reoccurrence after treatment, while no complications were appeared in the combined therapy group.

Microsurgical varicocelectomy combined with aescine could improve sperm quality, relieve pain, and prevent complications occurrence to some extent compared with microsurgical varicocelectomy. Microsurgical varicocelectomy combined with aescine could be applied in clinical varicocele treatment.

To detect the variants in the promoter region of the CFTR gene in congenital bilateral absence of vas deferens (CBAVD).

A total of 11 CBAVD patients and 50 healthy men as control were enrolled in the study from May 2013 to January 2015. Sanger sequencing was performed in the promoter region of 3.8 kb of the CFTR gene on the PCR products. The genome sequence of the CFTR gene was compared and analyzed with the website of NCBI and Cystic Fibrosis Mutation Database. Also, Transfac and phylogenetic footprinting method was used to investigate the relationship between the promoter region variants and the transcription factors function components.

SNP of c. -8G>C(n=1) and c. -966T>G(n=7), as well as one single nucleotide variant of c. -195C>A (n=1)were identified in the promoter region of the CBAVD patients, of which c. -195C>A was in the conserved domains of the promoter region.

A single nucleotide variant within the conserved region of CFTR promoter is detected in Chinese CBAVD.And further functional study should be performed to explore the relationship between the variants in CFTR promoter and Chinese CBAVD.

To evaluate left atrial function changes inheart failure with preserved ejection fraction (HFpEF) patients by three-dimensional speckle-tracking echocardiography (3D-STE) and Real time three-dimensional echocardiograph(RT3DE).

43 HFpEF patients and a control group with 18 healthy subjectswere enrolled. According to left atrial max volume index (LAVImax), patients were grouped as A (LAVImax<34 ml/m²)and B (LAVImax≥34 ml/m²). 3D-STE deformative parameters, left atrial ventricular-systolic longitudinal peak strain(LSs%)and left atrial pre-contraction longitudinal peak strain(LSa%), from three levels (Basal, Middle and Roof) and global were measured. These parameters combined with RT3DE and Doppler parameters were analyzed between groups.

Reproducibilities of MLSs and MLSa were satisfactory (ICC>0.8). In group A, LA filling and emptying deformation reduced mainly in middle level (compared to control group: MLSs (33±6)% vs (45±9)%, MLSa (12±3)% vs (17±5)%,P<0.05), while in group B, deformation of basal and roof levels also reduced (compared to A and control group: BLSs (18±7)% vs (25±8)% vs (29±8)%, RLSs (24±9)% vs (28±8)% vs (32±10)%; compared to control group: BLSa (11±5)% vs (14±4)%, RLSa (12±5)% vs (15±5)%; allP<0.05). LA stiffness increased while LA expansion index(LAEI%), LA passive ejection fraction(LAPEF%) decreased significantly in HFpEF patients, LA active ejection fraction(LAAEF%) of group B also decreased.

3D-STE in combination with RT3DE enables the assessment of LA function effectively and comprehensively. 3D-STE strains of LA middle level were ideal parameters for LA function assessment. HFpEF patients have significantly reduced LA reservoir, conduit, pump function and left ventricular diastolic dysfunction, and these changes were more apparent in patients with LA enlarged significantly.

To explore the influence of environment factors on the migratory birds population with chronic obstructive pulmonary disease (MDCOPD).

A total of 82 stable MDCOPD patients from Beijing area, who went to Hainan Branch of PLA General Hospital and the People's Hospital of Sanya for treatment between September 2012 and May 2014, were recruited in this study.At Sanya, from October to April of the following year (wintertime), all the patients were evaluated by COPD assessment test (CAT) and modified medical research council (mMRC) questionnaire, and follow-up was performed every 2 months.From May to September (summertime), when the MDCOPD patients came back to Beijing area, the patients were evaluated by CAT and mMRC questionnaire again, and still follow-up was performed every 2 months.The scores of before and after living environment changed were compared.Acute exacerbations or hospitalizations were recorded if any occurred in the patients during the follow up period, and the patients were reevaluated by the two questionnaires 1 month later after they became stable.At the same time, the daily air quality index (AQI) from the national urban air quality publishing platform and the temperature and relative humidity from the local weather network were recorded.

The score of CAT in Sanya was significantly lower than that in Beijing ((20.0±8.0) vs (26.4±7.1) scores, P<0.001); the score of mMRC in Sanya was also significantly lower than Beijing ((1.9±0.8) vs (2.9±0.9) scores,P=0.001). Based on the latest guidelines, the classification of COPD patients changed from D (in Beijing) to C (in Sanya) according to mMRC scores, while the CAT scores from the two cities did not cause the change of classification.The difference of temperature between wintertime of Sanya and summertime of Beijing was not significant ((23.1±4.2) vs (24.3±2.3) ℃, P=0.674); the wintertime's AQI in Sanya was significantly lower than the summertime's AQI in Beijing ((49.4±8.9) vs (113.1±14.2) μg/m^3,P<0.001); the relative humidity of wintertime in Sanya was significantly higher than that of summertime in Beijing ((90.6±4.9)% vs ((58.0±10.0)%,P=0.001).

When the MDCOPDs live in the area where has a better air quality and higher relative humidity, their quality of life and activity tolerance can be improved obviously.

To analyze the relationship between 24 hours urinary sodium and renin-angiotensin-aldosterone system (RAAS) in children with postural tachycardia syndrome (POTS) and to explore low blood volume related pathogenesis of POTS.

A total of 39 POTS children who were at the clinic or admitted to the Department of Pediatrics, Peking University First Hospital from June 2012 to February 2013 and 21 healthy children (control group) were enrolled, level of RAAS in plasma, 24-hour urinary sodium and plasma sodium were detected, respectively. Baseline data, levels of RAAS and hemodynamic parameters were compared between POTS and control group, as well as groups with different 24-hour urinary sodium levels of POTS.

The angiotensin Ⅱ levels of POTS children were significantly higher than that of control group ((105±50) vs (84±28) ng/L, P=0.041), while no statistical significance was found in plasma renin and aldosterone (P>0.05 ). Pearson correlation analysis showed that 24-hour urinary sodium and angiotensin Ⅱ in children with POTS was negatively correlated (r=-0.536, P<0.001). Angiotensin Ⅱ, symptom score, upright heart rate and changes of heart rate were significantly higher in urinary sodium < 124 mmol/24 h group than that in urinary sodium ≥ 124 mmol/24 h group (P<0.05).

The regulating function disorder of RAAS may involve in the pathogenesis of POTS and cause sustained low blood volume in patients with POTS.

To investigate the efficacy of pressure support ventilation(PSV) general anesthesia in infants and premature patients undergoing ophthalmologic surgeries.

A total of forty-two infants undergoing vitreoretinal surgeries in Peking university people's hospital from Dec. 2014 to Jul. 2015 were enrolled in the study, whose post-conceptual age (PCA, duration from the mother's last menstrual period to the date surgery was performed) were 38-92 weeks. They were divided into 3 groups according to PCA, which were group A (PCA≤44 weeks ), group B (44 weeks< PCA ≤64 weeks ) and group C (64 weeks <PCA≤92 weeks ). Anesthesia was induced with 6% sevoflurane inhalation by mask. After placement of laryngeal mask airway, patients were breathing spontaneously during the whole procedure with the inhalational maintenance concentration of sevoflurane and ventilation parameters adjusted according to clinical set. The surgical procedure begun when satisfying retrobulbar nerve block was achieved. The end-tidal concentration- of sevoflurane, hemodynamic and respirational data were recorded at the time of before surgery(T0), 15 minutes after surgery(T1) and 30 minutes after surgery(T2). The time interval from cease of sevoflurane inhalation to the laryngeal mask removal and adverse events during and after surgery were also recorded.

A total of 42 patients were enrolled in the study, with 10 cases in group A, 17 cases in group B and 15 cases in group C. The hemodynamics of all patients in three groups were stable. There was no significant difference in removal time interval among groups (all P>0.05). No significant difference was found in end-tidal concentrations of sevoflurane, minute ventilation, pressure of end-tidal carbon dioxide, lung compliance among three time points(allP>0.05). The respiration rate (per minute) of group B and group C were (33.1±5.7) and (29.4±6.4) at T1, (35.8±7.4) and (32.1±5.6) at T0, respectively, with statistical difference(F=5.087, 5.628; P<0.05) at both time points between groups. The peak airway pressure (cmH₂O) of group B and group C were (14.5±3.1) and (14.3±2.2) at T1, (14.1±2.9) and (13.1±1.5) at T0, respectively, with statistical difference(F=4.923, 12.393; P<0.05) at both time points between groups. There was no significant difference in end-tidal concentrations of sevoflurane, pressure of end-tidal carbon dioxide, expiratory tidal volume per kg, minute ventilation per kg, respiration rate and peak airway pressure among groups(allP>0.05). There was no severe adverse events during and after surgery in any group.

The application of PSV during laryngeal mask airway general anesthesia with spontaneous breathing maintained can be a choice for infants and premature patients undergoing ophthalmologic surgeries.

To identify the characteristics of blood pressure (BP) in the elderly hypertensive patients with chronic kidney disease (CKD).

We retrospectively recruited 337 CKD patients who had been admitted into our renal unit during January 2010 to December 2012 and undergone clinical blood pressure (CBP) and ambulatory blood pressure (ABP) measurement with detailed clinical data. Those with age ≥60 years old (n=94) were designated as elderly patients and their BP data were compared with those of young- and middle-aged patients (<60 years old,n=243). Logistic regression was adopted to analyze the independent risk factor for white-coat hypertension and reverse-dipper rhythm.

Compared to those <60 y, the elder CKD patients had the following characteristics: (1)Higher prevalence of white-coat hypertension (24.5% vs 12.3%, P=0.008). (2)Significantly lower diastolic blood pressure of average 24 h, daytime and nighttime by ambulatory monitoring of blood pressure (ABPM) (all P<0.001). (3)Higher BP variability with significant difference (allP<0.05) and more patients with morning surge (11.7% vs 3.7%,P=0.009). (4)Higher prevalence of reverse-dipper circadian BP rhythm (41.5% vs 25.1%, P=0.004). (5)Age was an independent predictor for white-coat hypertension (OR=1.024, 95%CI: 1.004-1.044) and reverse-dipper circadian BP rhythm (OR=1.016, 95%CI: 1.001-1.032).

The BP profile of elderly hypertensive CKD patients is different from that of young- and middle-aged patients. ABPM should be more commonly performed to improve BP treatment of elderly CKD patients.

To improve clinical testing excellence through a large scale training project targeting laboratory operators at China's county and township hospitals.

The Chinese Society of Laboratory Medicine launched the"Clinical Laboratory Standards and Training Support Project"from 2010 to 2013. The project innovatively created a model of partnership between government, professional association, individual hospitals and other social forces. A survey before training was conducted in 445 county-hospital laboratories in 31 provinces. Six months after implementation, a sampling survey was conducted among 250 participating county hospitals in 9 provinces to assess the project.

From 2010 to 2013, the project had covered 31 provinces of China, and trained technologists from 3 570 hospitals. After training, the average pass rate of assessment examination increased to 83.7% compared with 16.2% before the training. 29.6% hospitals added new biochemistry parameters, and the number of hospital with new hematology, immunology, and microbiology parameters accounted for 24.4%, 21.2% and 16.4%, respectively. The internal quality control and external quality assessment items also increased significantly. Biochemistry increased most, reaching 12.8% and 10.0%, and microbiology also reached 4.4% and 2.8% respectively. Bio-safety management capacities were also enhanced. The number of hospital implementing bio-safety risk assessment increased from 41.2% to 76.4%.

This project helpfully fills an important technical gap of clinical testing in China's rural healthcare infrastructure. Through training, clinical laboratory operations has been standardized, and systems of internal quality control and external quality assessment are increasingly improved.

To explore the effect of lung strain on pulmonary edema in dogs with acute respiratory distress syndrome (ARDS) preliminarily.

Twenty dogs were recruited to induct ARDS models by venous injection of oleic acid and grouped into Group S1.0, S1.5, S2.0, S2.5 randomly, the lung strain was previously designated as 1.0, 1.5, 2.0 or 2.5 for each group. The ventilation was used to support the dogs for 24 hours with tidal volume calculated from lung strain, functional residual capacity and the volume recruitment by positive end expiratory pressure. Extra vascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were tested by thermodilution technique and wet to dry ratio of lung tissue was evaluated by weighing method.

The tidal volume of Group S1.0, S1.5, S2.0, S2.5 was (7.5±1.7), (13.9± 5.8), (17.9±4.7) and (20.3±7.9) ml/kg, respectively. After ventilation for 4 h, EVLWI in Group S2.0 and Group S2.5 were higher than them in Group S1.0 and Group S1.5 ((38.9±6.5), (40.1±7.7) vs (26.6±5.2), (28.8±5.4) ml/kg; F=5.627, P=0.009). At the end of study, PVPI of Group S2.5 increased significantly versus Group S1.0, S1.5 and S2.0 (16.7±5.4 vs 7.0±2.3, 9.2±2.2, 11.5±6.0; F=4.329, P=0.022). Wet to dry ratios of lung tissue in Group S2.0 and Group S2.5 were significantly higher than Group S1.0 and Group S1.5 (10.4±1.2, 10.8±1.5 vs 8.3±1.2, 8.0±2.2; F=5.627, P=0.009) after ventilation.

Lung strain above 2.0 aggravates pulmonary edema dramatically and the effect might be slight if lung strain was smaller than 1.5.

To explore the protective effects of ulinastatin on cerebral tissue in rats following lethal burn injury and its relationship with the expression of protective protein.

A total of 40 male Sprague-Dawley rats were randomly divided into scald and ulinastatin groups (n=20 each). Both groups were subjected to 50% total body surface area third-degree burns. Immediately after scalding, 1 ml normal saline was injected intravenously in scald group while 1 ml saline containing ulinastatin (40 000 U/kg) in ulinastatin group. Then cerebral tissue was harvested for measuring the activities of neuron-specific enolase (NSE) by enzyme-linked immunosorbent assay (ELISA) at 6 h and 24 h post-injury. And the level of acetylated histone H3 was detected by Western blot and heat shock protein 70 (HSP70) by ELISA. The rates of tissue water content in heart were determined by dry/wet weight.

NSE and water content of cerebral tissue after 6 h injury in ulinastatin group were significantly lower than those in scald group ((146±11) vs (156±13)pg/ml , (77.3±1.9)% vs (79.0±2.2)%, both P<0.05), the expressions of HSP70 and histone H3 after 6 h injury in ulinastatin group was significantly higher than those in scald group ((99±19) vs (92±13) pg/ml, (1.26±0.37) vs (0.57±0.23), bothP<0.05). The NSE content of cerebral tissue after 24 h injury in ulinastatin group was significantly lower than that in scald group ((141±14) vs (159±10) pg/ml,P<0.05). And the water content of cerebral tissue, the expressions of HSP70 and histone H3 after 24 h injury had no significant inter-group differences ((75.9±1.2)% vs (76.5±1.4)%, (118±17) vs (102±16) pg/ml, (2.31±0.27) vs (1.87±0.31), bothP>0.05).

Ulinastatin significantly alleviates cerebral tissue injury in early stage of burn injury. And its protective effects may be due to the up-regulations of histone H3 and HSP70.

To investigate the effect of paraoxonase1 (PON1) overexpression on mouse diaphragmatic muscle cells injury caused by acute dichlorvos poisoning.

Mouse diaphragmatic muscle cells were cultured routinely and infected with overexpression lentivirus. Cells were divided into normal control group, DDVP group, LV-GFP+ DDVP group, LV-PON1+ DDVP group. Cell viability was determined by CCK-8 assay. Flow cytometry was used to detect cell apoptosis .The mRNA and protein expression of PON1 and Nrf2 in mouse diaphragmatic muscle cells was measured by RT-PCR and Western blot. Enzyme-linked immunosorbent assay was used to determine levels of acetyl cholinesterase (AchE), heme oxygenase 1(HO-1) and quinone oxidoreductase-1(NQO-1) in mouse diaphragmatic muscle cells. The activity of superoxide dismutase (SOD) and catalase (CAT) as well as malondialdehyde (MDA) content in cells was measured by chemical colorimetry.

After induced by 0, 80, 160, 320, 640 μmol/L DDVP for 24 hours, the viability of mouse diaphragmatic muscle cells was (100±3.82)%, (82.13±2.60)%, (53.57±5.05)%, (30.77±3.30)%, (14.20±2.19)% respectively, changing in a concentration-dependent manner( P<0.05). After induced by 160 μmol/L DDVP for 0, 6, 12, 24 hours, the viability of mouse diaphragmatic muscle cells was (100.17±2.74)%, (76.13±6.01)%, (66.53±3.55)%, (53.57±5.05)%, changing in a time-dependent manner(P<0.05). The PON1 protein level in LV-PON1 group was higher than that of blank control group(0.370±0.015 vs 0.232±0.004, 0.197±0.015 vs 0.037±0.003,P<0.05). The cell viability of LV-PON1 group is higher than that of DDVP group at different time point after induction of DDVP(P<0.05). After induced by DDVP for 24 hours, the cell apoptosis rate and MDA content in LV-PON1 group were lower than those of DDVP group(P<0.05). While levels of AchE, PON1 and Nrf2 protein expression, SOD and CAT, HO-1 and NQO-1 were higher than those of DDVP group(P<0.05).

The overexpression of PON1 could effectively alleviate AchE inhibition by DDVP and induce Nrf2 expression to exert antioxidant effect , thus protected the mouse diaphragmatic muscle cells.

This study explored how interferon alpha (IFN-α) influenced liver cancer SMCC-7721 cell via PI3K/Akt signaling pathway.

The effect of IFN-α on the viability of SMCC-7721 cell was measured by MTT assay. The effect of IFN-α on SMCC-7721 cell cycle was measured by flow cytometry. The activation of PI3K/Akt signaling pathway and downstream target genes expression level of glycogen synthase kinase 3 beta (GSK-3β), and cell cycle protein (Cyclin D1), p21, C-myc, Survivin were assayed by Western blot.

MTT assay indicated IFN-α (5, 10, 15 U/L) could inhibit SMCC-7721 cell viability, and the inhibitory rate was the highest at 48 h. IFN-α made SMCC-7721 cell arrested. Western blotting assays presented IFN-α could down-regulate expression of PI3K and suppress the phosphorylation of Akt, and then inhibit phosphorylation of GSK-3β. It could also reduce the expression levels of Cyclin D1, C-myc and Survivin but increase the level of p21.

These results suggested IFN-α could depress the growth and proliferation of liver cancer SMCC-7721 cell via blocking PI3K/Akt signaling pathway, and the molecular proteins Cyclin D1, p21, C-myc, Survivin were involved.

To systematically assess the efficacy and safety of oral sildenafil citrate for post bilateral nerve-sparig radical prostatectomy (post-BNSRP) erectile dysfunction(ED).

The following keywords: sildenafil, radical prostatectomy were used to search in Medline, Pubmed, Web of Science, Cochrane Library, CNKI, WanFang Database. The title, abstract and keywords of each article were independently screened by two reviewers. Randomized controlled trials (RCT) published between 1990 and 2014 were retrieved according to our inclusion and exclusion criteria. The efficacy and safety of oral sildenafil citrate for post-BNSRP ED were systematically assessed by meta-analysis.

Four RCTs with 320 cases were included after literature retrieval and filtering. The potency rates were 32.1%(35/109) and 11.3%(7/62)between sildenafil and placebo groups after meta-analysis and showed statistically significant differences(OR=4.66, 95%CI: 1.79-12.11). IIEF-5 score in sildenafil group was significant higher than that in the placebo group(WMD: 4.73, 95%CI: 3.26-6.19). In subgroup meta-analysis, the potency rates in high-dose, low-dose sildenafil groups and placebo groups were 30.4%(14/46), 25.0%(10/40) and 4.5%(2/44), respectively. There were statistically significant differences between the high-dose subgroup and placebo group(OR=9.32, 95%CI: 1.96-44.23), and the low-dose subgroup and placebo group(OR=6.99, 95%CI: 1.43-34.22). But there was no significant difference between high-dose and low-dose subgroups (OR=1.31, 95%CI: 0.51-3.40).

Compared with placebo, sildenafil has considerable efficacy for erectile function rehabilitationas as a primary treatment for post-BNSRP ED. There is no significant difference between high-dose and low-dose schedule for its efficacy. However, further studies are required to optimize treatment.

To evaluate the efficacy and safety of active vitamin D₃ treatment in maintenance hemodialysis patients(MHD).

We conducted a comprehensive search of the following databases: PubMed, Embase, Google scholar, CNKI, VIP, Wanfang data and CBM, to identify randomized controlled trials (RCTs) of active vitamin D₃ supplementation in MHD patients up to November 2014. Meanwhile, we manually searched the reference lists of identified studies. The selection of studies, assessment of methodological quality and data extraction were performed independently by two researchers. Statistical analyses were performed using RevMan software, version 5.0.

A total of 10 trials were included. There was a significant improvement in serum albumin(ALB) and an associated decline in PTH, alkaline phosphatase(ALP), C-reactive protein(CRP) and interleukin-6(IL-6) in active vitamin D₃-treated group (standardized mean difference(SMD) or weighted mean difference(95%CI): 0.47(0.06, 0.88), -2.49(-3.96, -1.02), -50.55(-83.91, -17.19), -1.53(-1.93, -1.12) and -4.71(-7.48, -1.94), respectively). There was no statistical difference in the incidence of hyperphosphatemia, adverse events and mortality between the treatment and control group(RR(95%CI): 1.31(0.96, 1.79), 0.85(0.55, 1.32), 1.49(0.80, 2.74), respectively). But there was a significant increase in serum calcium and calcium-phosphorus product in treatment group(RR(95%CI): 2.10(1.18, 3.75) and 3.65(1.45, 9.17), respectively).

Currently available evidence suggests that active vitamin D₃ is effective in treating secondary hyperparathyroidism, renal osteodystrophy, and improving malnutrition and microinflammation in MHD patients, without obvious adverse events. However, the occurrence of calcium and phosphate abnormalities should be closely monitored.

To investigate the clinical value of new kinds of urinary erythrocyte morphology parameter in discriminating different pathology types of glomerulonephritis.

All of the 52 urine samples were from glomerulonephritis patients who had been diagnosed by renal biopsy results. The change of the percentage of acanthocytes, the size of RBC, the shape of RBC between the primary glomerulonephritis(39 cases) and secondary glomerulonephritis (13 cases)urine were detected by AVE-764 fully automatic urine cell analyzer.

Acanthocytes could be found in both primary glomerulonephritis and secondary glomerulonephritis. Of the patients whose acanthocytes percentages above 10%, 94.1% had primary glomerulonephritis and 5.9% had secondary glomerulonephritis. The picture of size-shape phase were classified as strip-type, inverted triangle-type and hanging tail-type. 95.2% Strip-type cases were from primary glomerulonephritis patients. Triangle-typenormally cases were all from primary glomerulonephritis patients. Hanging tail-type cases were all from secondary glomerulonephritis.

High acanthocytes percentage is most common in primary glomerulonephritis, going with the size and shape of RBC can be useful in the differential diagnosis of different pathology types of glomerulonephritis.

A 14-year-old female was admitted to the hospital on July 11, 2014 for 9 years of pulmonary hypertension, shortness of breath, dizziness and hoarseness after activity. In 2005, the patient underwent echocardiographic examination due to recurrent pneumonia and bronchitis: left atrial diameter (LAD) 28 mm, left ventricular end-diastolic diameter (LVDD) 42 mm, right ventricular end-diastolic diameter (RVDD) 16 mm, estimated pulmonary systolic pressure 58 mmHg (1 mmHg =0.133 kPa), left atrial and right ventricular enlargement, pulmonary hypertension, in order to further examine the etiology of pulmonary hypertension and carry out corresponding treatment. In 2010, the echocardiographic results were as follows: LAD 35 mm, LVDD 48 mm, RVDD 23 mm, ejection fraction (EF) 58%, estimated pulmonary artery systolic pressure 87 mmHg, left atrium and right ventricle enlargement, pulmonary artery pressure increased progressively, but the patient did not have obvious exertion shortness of breath, and physical activity was not restricted. In 2011, I had abdominal pain after activity. Abdominal ultrasound found multiple mesenteric lymph node adhesions, with a maximum of 26 mm ×7 mm. The abdominal pain was relieved after anti-inflammatory treatment. In 2012, I went to a local hospital for pulmonary hypertension. After examination (details unknown), I was diagnosed with idiopathic pulmonary hypertension. At that time, the echocardiogram showed: LAD 37 mm, LVDD 45 mm, RVDD 39 mm, EF 60%, and the estimated pulmonary systolic pressure was 84 mmHg. Sildenafil 25 mg was given orally twice a day, and then stopped taking the drug spontaneously due to dizziness, shortness of breath and fatigue. Six months before admission to our hospital, the patient had chest tightness, shortness of breath, dizziness, hoarseness, mild abdominal pain after activity, colic, without diarrhea, fever, nausea, vomiting and other symptoms. Since the onset of the disease, the patient has normal urine and stool, no obvious change in body weight, no history of hemoptysis and hematemesis, denial of family history and genetic history, denial of drug and food allergy.

Dopamine is an important catecholamine neurotransmitter. It acts on the central nervous system through dopamine receptor (DRs), and plays an important role in regulating cognition, emotion and limb movement. At the same time, as a neuroendocrine hormone, it can also act on peripheral tissues, mainly regulating peripheral vascular tone and cardiorenal function. In recent years, studies have found that DRs polymorphism is related to the risk of tumorigenesis, and a variety of tumor cells, tumor vascular endothelium and immune cells can express DRs. In this paper, the research progress of peripheral dopamine and tumor is described as follows.

In recent years, the skin and soft tissue infections caused by non-tuberculous mycobacteria (NTM) have a gradual increase trend, among which fast-growing mycobacteria (RGM) are the most reported^[1]。 However, the diagnosis of RGM remains a clinical dilemma. According to the data released by the International Society of Aesthetic Surgeons, in 2013, the number of liposuction and fat transplantation surgeries reached 1.614 million and 1.054 million respectively, ranking the top 5 in the world in terms of plastic and cosmetic surgery cases^[2]。 In such a huge volume of surgery, there are many cases of postoperative RGM infection. The research on RGM infection and liposuction and fat transplantation is summarized as follows.

In recent years, the detection of sperm DNA damage has been more and more widely used in clinical practice, and there are many related literature reports. However, at present, the detection methods of sperm DNA damage in clinical practice and related literature are different, and the normal threshold is also very different, which brings a lot of confusion to clinicians and some related scientific researchers. Therefore, this paper reviews the clinical application value and current problems of sperm DNA damage detection, so that readers can correctly view the clinical application of sperm DNA damage detection.

spermatogonial stem cell (SSC) is the basis of spermatogenesis. It forms mature sperm through three stages: proliferation and differentiation of SSC, meiosis of spermatocytes and spermatogenesis. It is the only adult stem cell in which men can transmit their genetic material to their offspring^[1]。 human spermatogonial stem cells (HSSCs) are located at the basement membrane of seminiferous tubules and are developed and differentiated from primordial germ cells (PGCs). Human spermatogenesis begins around puberty. One hSSC produces about 128 spermatozoa after 8-9 mitosis and 2 meiosis, and each complete spermatogenic cycle lasts for about 70 days. On the one hand, hSSC maintains the relative stability of its number through self-renewal, on the other hand, it can proliferate and differentiate into spermatogenic cells at all levels and finally form sperm. Under normal circumstances, hSSC achieves the relative balance between the two through complex and fine regulation. In addition, recent studies suggest that hSSC can undergo transdifferentiation and gain pluripotency under in vitro culture conditions, which shows its broad application prospect in the field of regenerative medicine^[2]。 Therefore, the study of the characteristic phenotype, isolation and enrichment of hSSC, and in vitro culture (including long-term culture and induction of differentiation) will help us to better understand the biological characteristics of hSSC, reveal the fertility process of male, and lay the foundation for its application in the fields of reproductive and regenerative medicine.

Breast cancer is the most common malignant tumor in women in developed and developing countries^[1]。 Angiogenesis plays an important role in the occurrence, development, invasion and metastasis of breast cancer, and is also an independent prognostic factor of breast cancer^[2]。 The formation of tumor neovascularization is a complex process with multiple factors and steps, which is regulated by the balance between positive and negative regulators of angiogenesis. This paper mainly summarizes the characteristics of angiogenesis of breast cancer, the influence of pro-angiogenic factors and anti-angiogenic factors on the occurrence and development of breast cancer, and the current status of anti-angiogenic therapy for breast cancer.