Volume 96  ·  Issue 36  ·  2016

The seminal tract refers to the pipeline system in the male reproductive system that transports sperm. Sperm is produced by the seminiferous tubules of the testis and then excreted through the epididymis, vas deferens, seminal vesicles, ejaculatory ducts and urethra. The distal region of the seminal tract includes structures such as the ampulla of the vas deferens, the seminal vesicle, the ejaculatory duct, the prostatic vesicle, and the prostate. Structural abnormalities in this area can affect the normal discharge of sperm, thus leading to ejaculatory duct obstruction (EDO), which is one of the common causes of male infertility. EDO accounts for 1% to 5% of male infertility patients^[1]。 Common lesions in this area include local inflammation and infection, EDO due to cysts and stones, new organisms or tumors, vascular abnormalities, trauma or iatrogenic injuries, etc. The clinical manifestations of this type of patients are hematospermia, azoospermia, oligoasthenozoospermia, dull perineal pain and ejaculation pain. In the past ten years, with the continuous development of various endoscopic techniques, the use of seminal vesiculoscopy to diagnose and treat common lesions in the distal region of the seminal tract has become a vigorous new technology in the field of andrology today.

mitral stenosis is a disabling or even fatal disease. If not treated in time, progressive aggravation of mitral stenosis can lead to severe symptoms and complications (such as pulmonary edema, systemic embolism, pulmonary hypertension). The formation of mitral stenosis after acute rheumatic fever is estimated to take at least 2 years, usually more than 5 years. The asymptomatic period of most patients is more than 10 years^[1]。 According to a 20-year follow-up of 1 000 children with acute rheumatic fever in North America, clinical manifestations of valvular heart disease occur in 65% of patients after recovery from the initial rheumatic fever, and the incidence of simple mitral stenosis reaches 12% in these patients^[2]。 In China, according to the 2014 China Cardiovascular Disease Report, the number of patients with rheumatic heart disease has reached 2.5 million^[3]。 China has a vast territory and a large population. At present, there are still a large number of patients with rheumatic heart disease. The prevalence rate of rheumatic valvular heart disease in China is 1.8‰, and the prevalence rate in rural areas is higher than that in urban areas; This disease is more common in young adults, and the incidence rate of women is higher than that of men, with a male-female ratio of about 2:3^[4]。 Congenital malformations or connective tissue diseases such as systemic lupus erythematosus endocarditis are rare causes of mitral stenosis. The early manifestations of mitral stenosis are edema and exudation at the edge of the valve junction, followed by fibrin deposition to thicken the valve edge, and the valve junction gradually adheres and fuses, and then the mitral valve opening becomes smaller to form mitral stenosis. Fibrous lesions can also involve the subvalvular chordae tendineae and papillary muscles, making them shorten and adhere, which are also important factors leading to mitral stenosis^[5]。

With the rapid development of point-of-care testing (POCT) industry and the continuous advent of new testing equipment, POCT has been widely used in the medical field, which plays an important role in rapid and convenient disease diagnosis and treatment monitoring. However, in clinical practice, the operation process and quality management specification of POCT are not perfect, and the resulting inaccurate test results may affect clinical decision-making and treatment effect. In order to standardize the testing process and improve the testing quality, the Laboratory Medicine Branch of Chinese Medical Association and the Clinical Laboratory Center of National Health and Family Planning Commission organized experts in relevant fields across the country to jointly formulate the "Chinese Expert Consensus on Clinical Operation and Quality Management Standards of Portable Blood Glucose Meters".

To evaluate the efficacy and safety of microsurgical crossover vasovasostomy in treating complicated obstructive azoospermia.

The data of 14 patients with complicated obstructive azoospermia treated with microsurgical crossover vasovasostomy were reviewed from October 2012 to March 2016.Ten of them underwent microsurgical crossover vasovasostomy. Intraoperative exploration revealed that 2 patients had vas deferens injury and contralateral testicular atrophy or epididymal obstruction due to previous hernia repair; 7 patients had obstruction of intracorporeal vas deferens on one side and epididymal obstruction on the other side; the other 1 patient had unilateral vasal obstruction with contralateral epididymal obstruction. Furthermore, 4 patients underwent microsurgical crossover vasoepididymostomy, including 3 patients who had obstruction at caput epididymis on one side, and obstruction at cauda epididymis and distal vas deferens on the other side; the other patient had absence of vas deferens in the scrotum on one side, and testicular atrophy on the other side. Regular follow-up visits were conducted after the surgery.

Two patients were lost to follow-up; the other 12 patients were follow-up for an average of 11 (range: 2-23) months. In the 10 cases receiving microsurgical crossover vasovasostomy (including 2 patients lost to follow-up), 1 has not undergone semen re-analysis, 6 were confirmed patent, including 3 reporting spontaneous pregnancy. The patency rate in the 4 patients receiving microsurgical crosseover vasoepididymostomy was 2/4, with 1 patient reporting spontaneous pregnancy. There was no complaint of discomfort or complications following the surgery.

Microsurgical crossover anastomosis may be effective and safe for patients with complicated obstructive azoospermia, according to preoperative assessment and intraoperative exploration. It allows natural conception for patients with refractory infertility. The microsurgical crossover anastomosis could be an effective therapy to achieve satisfactory patency of vas deferens.

To analyze the effectiveness of transurethral seminal vesiculoscopy in the treatment of persistent hematospermia, and oligoasthenozoospermia and azoospermia from ejaculatory duct obstruction.

The clinical date of 56 cases of persistent hematospermia, or azoospermia/oligoasthenozoospermia from ejaculatory duct obstruction treated with transurethral seminal vesiculoscopy between November 2013 and January 2016 in the First Affiliated Hospital of Fujian Medical University were reviewed. A total of 30 cases were persistent hematospermia for 6 months to 3 years, with no response to routine antibiotic therapy for >4 weeks; 24 cases were obstructive azoospermia; and the other 2 cases were extreme oligoasthenozoospermia. Transrectal ultrasound of the prostate and seminal vesicles, and pelvic magnetic resonance imaging (MRI) were performed before the surgery, finding seminal vesicle dilation in 28 cases, ejaculatory duct dilation in 18 cases, seminal vesicle and ejaculatory duct dilation in 7 cases, seminal vesicle dilation with ejaculatory duct cyst in 2 cases, and bilateral ejaculatory duct dilation with prostatic utricle cyst in 1 case. After the transurethral seminal vesiculoscopy, follow-up examinations were performed to assess the effectiveness of the surgery for ≥3 months.

The surgery was successful in all the patients, with the duration of surgery ranging from 30 to 148 minutes. Among the 30 patients with hematospermia, calculi in ejaculatory duct or seminal vesicle was found in 20 cases, while inflammation or dark red jelly-like substances in seminal vesicle was seen in all cases. In the follow-up of 9.7 months (3.0-13.0 months), hematospermia in 26 (26/30, 86.7%)patients was relieved or cured after 1-6 times of ejaculation; the other 4 (4/30, 13.3%)cases still had hematospermia. In postoperative semen analysis for the 24 cases of azoospermia from ejaculatory duct obstruction, sperms were detected in 16(16/24, 66.7%)cases, but sperms were not found after 6 months following the surgery in 1 of the 16 case, thus re-obstruction was suspected; in the other 8 (8/24, 33.3%)cases, sperms could not be found in multiple semen analyses in >12 months after the surgery. The 2 cases of extreme oligoasthenozoospermia had obvious improvement in routine semen analysis in 1 and 3 months after the surgery. Except for 1 case of scrotum swelling after surgery, no postoperative complications (retrograde ejaculation, urinary incontinence, or rectal injury) were observed.

Transurethral seminal vesiculoscopy was an effective therapy for persistent hematospermia. More strict operation indication and careful performance are necessary for azoospermia oligoasthenozoospermia from ejaculatory duct obstruction.

To study and analyze the transcript and expression pattern of SOX5 in human semen, thus to provide evidence for exploring the role of transcription factor SOX5 in the process of spermatogenesis in testis.

A total of 61 semen samples and 3 blood samples (as controls) collected from healthy volunteer donors at Shanghai Human Sperm Bank in September 2015 were randomly selected. Expression of SOX5 in the semen samples was detected and quantified using agarose gel electrophoresis and real time-quantitative PCR (RT-qPCR) analysis.

In the human semen samples, SOX5 was found in two different transcript forms: long transcript (L-SOX5) and short transcript (S-SOX5). Moreover, the S-SOX5 was specifically expressed in human semen, not detected in the control blood samples. L-SOX5 and S-SOX5 were primarily found in seminal plasma, with low expression level in sperms. The results of RT-qPCR analysis showed obviously higher mRNA expression levels of L-SOX5 than S-SOX5 in semen (0.280±0.232 vs 0.147±0.103), however, not significantly(P=0.132).

SOX5 is expressed as different transcripts in human semen, and different transcripts may play different roles in the process of spermatogenesis in testis.

To explore the effects of varicocele on the expressions of inhibin B in rat testes and the relationship between expression of inhibin B and spermatogenesis dysfunction.

Twenty specific-pathogen-free Sprague-Dawley (SD) male rats were randomly divided into two groups with random number table: 4-week control group (C4) and 4-week experimental group(V4). Experimental varicocele was created by partial ligation of left renal vein in the V4 group; vein isolation without ligation was performed in the C4 group.Spermatogenetic function in the two groups were assessed. The expression of inhibin B in the rat testis was analyzed by immunohistochemistry, the expressions of inhibin B, Fas and Fas ligand(FasL)mRNA measured by reverse transcription-polymerase chain reaction(RT-PCR), and the inhibin B protein expression by Western blot.

In comparison of spermatogenetic function in left rat testes, the Johnsen scores in the V4 group were significantly lower than those in the C4 group (9.79±0.05 vs 9.97±0.02, P=0.023), the seminiferous epithelium in the V4 group was significantly thinner than that in the C4 group [(48.35±0.99)μm vs (57.58±1.98)μm,P=0.000], and the number of sperms in the left epididymis was significantly lower than in the right one in the V4 group [(933±161)×10⁶/(ml·g) vs(1 552±184)×10⁶/(ml·g), P=0.017]. Both Western blot and immunohistochemical assay showed that the expression of inhibin B in the rat testes was significantly lower in the V4 group than in the C4 group(0.407±0.053 vs 0.608±0.076, P=0.038; 0.161±0.004 vs 0.183±0.005, P=0.008). RT-PCR also detected reduced expression of inhibin B mRNA in the V4 group compared with the C4 group(0.522±0.050 vs 1.106±0.210, P=0.003. Compared to the C4 group, the expression of Fas mRNA in the V4 group was significantly lower, while the expression of FasL mRNA in the V4 group was significantly higher(P=0.019, 0.015).

Varicocele can lead to decreased expressions of inhibin B in rat testes and cause spermatogenesis dysfunction. There may be a close correlation between down-regulation ofinhibin B expression and spermatogenesis dysfunction.Inhibin B may play a significant rolein the mechanisms underlying male infertility due to varicocele.

To investigate the expression of microRNA 210 (miR-210) in the epididymis of rats with varicocele and changes in miR-210 expression following high spermatic vein ligation, so as to explore the significance of the surgery in treating varicocele.

A total of 21 male Sprague-Dawley (SD) rats aged 7 weeks were randomly divided into control group (n=7), experimental group (n=7), and surgical group (n=7). Varicocele model was established in both the experimental and surgical groups, while only vein isolation was performed in the control group. After 8 weeks, spermatic vein diameter were measured in the control and experimental rats, and collected the left epididymis (fixed in formaldehyde and frozen in refrigerator at -80 ℃). In the surgical group, left high spermatic vein ligation was performed, and the left epididymis was collected after 4 weeks as in the control and the experimental groups. The fixed epididymis tissues were treated with HE staining for observation of tissue injuries. The miR-210 expression in the epididymis was detected with reverse transcription-polymerase chain reaction (RT-PCR). At last every group had 5 rats.

The pathological examination showed that the number and distribution of mature sperms in epididymal duct in the experimental group were lower and less even compared to the control group, while the two indicators in the surgical group were better than those in the experimental group. The diameter of the left spermatic vein in the experimental group and pre-treatment surgical group were significantly enlarged than in the control group (P<0.01). The expression of miR-210 in the left epididymis in the experimental group was significantly higher compared with the control group(1.32±0.06 vs 0.98±0.14,P<0.01), while the expression of miR-210 in the left epididymis in the surgical group was significantly decreased compared with the experimental group (0.96±0.16 vs 1.32±0.06,P<0.01); the difference between the control group and the surgical group was not statistically significant (P>0.05).

The expression of miR-210 in the epididymis may be increased by varicocele and reduced after high ligation of the affected spermatic vein.

To analysis the correlative factors that probably affect serum leptin levels in asthmatic patients.

Seventy-eight patients with asthma and 29 health controls who were admitted into outpatient clinic of Peking University Third Hospital from April 2014 to December 2015 were consecutively enrolled in our study prospectively. Serum leptin level was measured by enzyme-linked immunosorbent assay (ELISA). The sex, body mass index (BMI), onset age of asthma, allergen detection test, induced sputum cell count and classification, lung function test and asthma control level were recorded. Asthmatic patients were further divided into groups according to these factors and serum leptin levels were compared among groups.

Serum leptin levels were not different between asthmatic patients and health controls [(15.0±10.4) vs (15.2±11.7) μg/L, P=0.939]. Female asthmatic patients had significantly higher serum leptin levels than male [(18.2±10.7) vs (7.9±4.8) μg/L, P<0.001]. Asthmatic patients with obesity had significantly higher serum leptin levels than asthmatic patients with overweight, with normal BMI, with underweight and health controls [(29.7±10.8) vs (17.1±11.1), (11.8±7.7), (9.1±0.96), (15.2±11.7) μg/L, allP<0.01]. Serum leptin level was positively related to percentage of induced sputum eosinophil in female asthmatic patients (r=0.331, P=0.032). Onset age of asthma, positive allergen detection, airflow limitation or asthma control level did not affect serum leptin level.

Sex and BMI are important factors affecting serum leptin levels in patients with asthma.

To evaluate the efficacy of Bailemian capsule combined with self-help cognitive behavioral therapy (CBTI-SH) in treatment of chronic insomnia.

Approved by the Ethics Committee of the hospital, 60 patients with chronic insomnia were randomly divided into two groups, the test group (Bailemian capsule combined with CBTI-SH) and the control group (CBTI-SH alone). Each group contained 30 cases. After 4 weeks for therapy, the sleep quality, mood and adverse reactions of treatment in patients were evaluated by sleep diary, sleep severity index scale (ISI), self-rating anxiety scale (SAS), self-rating depression scale (SDS) and treatment emergent symptom scale (TESS) respectively. The data were statistically analyzed.

The total effective rate in the test group was significantly higher than that of the control group (73.3% vs 46.7%, P<0.05). Compared to the control group, the sleep onset latency was significantly shorten [(38.3±13.1) vs (27.5±9.8) min,P<0.05], while the sleep efficiency were increased markedly [(76.6±5.7)% vs (80.5±6.6)%,P<0.05] in the test group. In the test group, the sleep onset latency, the total sleep time, the time in bed and sleep efficiency both improved significantly after treatment [(27.5±9.8) vs (56.2±19.4) min, (334.4±41.6) vs (310.8±31.7) min, (415.6±38.9) vs (446.9±39.9) min, (80.5±6.6)% vs (69.6±4.9)%, allP<0.05], while in the control group, the sleep onset latency, the time in bed and sleep efficiency also improved significantly after therapy [(38.3±13.1) vs (55.2±16.2) min, (430.4±32.6) vs (452.4±34.4) min, (76.6±5.7)% vs (69.9±5.2)%, allP<0.05]. After combined treatment, the SAS and SDS scores [(51.5±6.5) vs (55.0±5.8), (52.0±5.3) vs (55.3±4.4), bothP<0.05] both decreased significantly than those of the control group, at the same time, the SAS and SDS scores decreased significantly after treatment in both the test group and the control group [(51.5±6.5) vs (61.5±4.8), (52.0±5.3) vs (60.2±4.5), (55.0±5.8) vs (62.5±3.7), (55.3±4.4) vs (62.2±3.7), allP<0.01].

The efficacy of Bailemian capsule combined with CBTI-SH in the treatment of chronic insomnia is more effective.

To analyze the predict values of pathologic complete response (pCR) rates for patient outcome according to breast cancer (BC) molecular subtypes.

Four hundred and sixteen patients with confirmed BC who received neoadjuvant chemotherapy (NCT) in The Affiliated Hospital of Military Medical Science Academy of the PLA were enrolled.The clinical and pathological characteristics of patients were collected. The primary endpoint was pCR rate and the secondary endpoint was disease free survival (DFS). We analyzed the predict values of pCR rate for patient outcome, and the predict factors for DFS by univariate and multivariate Analysis.

A total of 416 BC patients confirmed by pathology were enrolled and received treatment and assessment in this study. The overall pCR rate was 23.1% (96/416). The pCR rate was 6.9% (14/204) in patients of HR+ /HER2- Subtype, 41.5% (27/65) in HR-/HER2+ Subtype, 30.9% (17/55) in HR+ /HER2+ Subtype, and 41.1% (37/91) in HR-/HER2- Subtype. The correlation of the pathological status and the patient outcome was analyzed in all patients. Compared with no pCR group, pCR group had significant higher DFS rates. In HER2+ Subtype and HR-/HER2- Subtype, DFS rates of patients who achieved pCR was higher than that of who didn′t achieved pCR. In HR+ /HER2- Subtype, DFS rates of patients who achieved pCR was higher than that of who didn′t achievced pCR, but without statistics difference. The Cox proportional hazards regression analysis revealed that ER status, T stage, pCR affected the patient outcome of BC.

So far, pCR was an established prognostic factor: reaching a pCR could predicte improved survival in HER2-enriched BC and triple-negative breast cancer (TNBC) subgroup, while data remain controversial for the luminal subtypes. Our results do not support the use of pCR as a surrogate end point of treatment efficacy in unselected patients with BC submitted to neoadjuvant systemic therapy.

To discuss the clinical safety and efficacy about off-pump coronary artery bypass grafting (OPCABG) in octogenarians.

From June 2005 to July 2014, 252 patients (male 208, female 44, with a mean age of 81.7 years old) underwent OPCABG in Beijing Anzhen Hospital who were aged 80 years or older were enrolled.

Eight (3.2%) patients were diagnosed as single vessel coronary artery disease (CAD), 29 cases (11.5%) were diagnosed as bifurcation vessel CAD, and 215 cases (85.3%) were multivessel CAD. One hundred and one cases (40.1%) were diagnosed as left main artery disease, among which 51 cases (20.2%) had old myocardial infarction. Two hundred and forty-eight patients belonged to Canadian Cardiovascular Society (CCS) classⅠ-Ⅲ and 4 cases to CCS class Ⅳ. One hundred and forty-five cases belonged to New York Heart Association (NYHA) classⅠ-Ⅱ and 107 cases to NYHA class Ⅲ-Ⅳ. Mean graft number was 3. Two hundred and six patients (81.7%) received total vein graft operation. Intra-aortic balloon pump (IABP) was used in 43 patients (17.1%). In-hospital death occurred in 15 cases (6.0%). Major in-hospital complications included reoperation (16 cases), re-intubation (16 cases), dialysis (11 cases), sternum infection (2 cases), atrial fibrillation (63 cases). The follow-up time was from 1 to 11 years (with a mean time of 6 years). All-cause mortality was 18.1% (43 cases). The major out-of-hospital complications included recurrent myocardial infarction (3 cases), stroke (3 cases), re-admission (27 cases) and recurrent angina pectoris (20 cases).

OPCABG is safe and effective for myocardial revascularization in patients aged 80 years and over.

To investigate the effects of epicanthoplasty on the trichiasis caused by the entropion of lower eyelid with epicanthus.

Epicanthoplasty was used to correct the trichiasis of lower eyelid with epicanthus from February 2010 to October 2015. Total of 72 patients were enrolled in this study, among whom 42 were male and 30 were female, and aged 8 to 58 years. Among those patients, 64 cases were found with bilateral trichiasis and 8 patients with unilateral trichiasis. And 3 cases received secondary operations for recurrence. All patients were followed-up at 1, 3 and 12 months after the operation for therapeutic evaluation.

A total of sixty-three patients completed the follow-up study with 9 withdrew. The trichiasis was corrected with the satisfied palpebral appearance. And the cure rate was 98.4%. Of the patients, 95.3%, 95.2% and 96.9% were satisfied with the effects of the operations at 1, 3 and 12 months postoperatively. Mild retraction of lower eyelid occurred in only 3 patients.

Epicanthoplasty is a simple and effective method to correct the trichiasis with epicanthus.

To study the clinical efficacy of bilateral lung transplantation treating for severe idiopathic pulmonary hypertension (IPAH).

The clinical data of 18 cases of bilateral lung transplantation for severe IPAH were retrospectively analyzed. Comparative analysis of preoperative and postoperative sets of data was performed.

The postoperative 30-day mortality of 18 cases was 11.1%, 3 months mortality 22.2%. The survival rate of 1 year, 3 years, 5 years was 77.8%, 72.2% and 72.2%, respectively. The remaining 13 cases were able to survive for a long time which preoperative cardiac function rating of level Ⅲ, Ⅳ were improved to level Ⅰafter transplantation. Compared preoperative with postoperative, pulmonary artery systolic pressure from preoperative 128.2±25.6 mmHg dropped to postoperative 39.7±14.8 mmHg; pulmonary artery mean pressure from 75.5±13.94 mmHg to 19.61±6.43 mmHg; right atrial pressure from 21.5±2.43 mmHg to 5.22±4.18 mmHg, all P<0.000 1.

Bilateral lung transplantation is an effective treatment for severe idiopathic pulmonary arterial hypertension, which has longer survival.

To determine the effects of adipose-derived stem cells (ADSCs) on the survival rate of flaps by transplanting ADSCs into the experimental flaps pre-operatively.

ADSCs were isolated from fresh human fat and cultured in vitro. Their morphological characters were observed, and flowcytometry and differentiation test and evaluation were conducted. A total of 40 BALB/c mice were divided into 5 groups randomly with each of 8 mice. 1 cm×4 cm random skin flap was designed on the mice back, ADSCs were injected in advance into subcutaneous tissues of 3 groups, the operation was performed on the 2^nd, 5^th and 7^th day after the ADSCs injection, meanwhile skin flap operation was conducted in the immediate injection group and control group. Survival condition of the skin flaps was observed and von willebrand factor (vWF) staining was used to detect the number of micro-vessels in the skin flap. The enzyme-linked immuno sorbent assay (ELISA) method was used to detect the concentration of vascular endothelial growth factor (VEGF) in the skin flap.

The immediate injection group had a significantly higher survival rate of skin flap than the pre-injection groups and the control group [(51.5±6.3)% vs (38.3±6.7)%, (21.0±2.9)%, (30.0±3.9)% and (34.5±4.2)%, all P<0.01]. The immediate injection group had a significantly higher number of micro-vessels in the skin flap than the pre-injection groups and the control group [(21.0±4.3) vs (17.5±3.9), (9.9±2.6), (13.9±2.6) and (16.1±3.3)/LPF, allP<0.01]. The laboratory results of the concentration of VEGF in skin flap kept a consistent tendency with the flap survival rate.

Pre-injection with the ADSCs into the skin flap prevents the survival of the flap to a certain extend and does not show the function of promoting tissue angiogenesis.

To investigate the current status and influence factors of ACEI/ARB application in elderly coronary heart disease outpatients complicated with diabetes mellitus in 21 provinces of China.

In this multicenter, non-intervention and cross-sectional survey, the elderly coronary heart disease patients aged 60 years or over were recruited from 165 hospitals in 21 provinces across China from April to July 2011. Current status and influence factors of ACEI/ARB application among 1 789 cases with diabetes mellitus were investigated in the survey.

Totally, 1 069 patients used ACEI/ARB drugs (59.8%); proportion of ACEI (544 cases, 30.4%) drugs were the same as ARB drugs (533 cases, 29.8%) in terms of usage of drug types, and combination of the two drugs were taken by 28 cases (1.6%) at the same time. ACEI/ARB usage decreased with the increasing of age, and the rate of drug usage in male patients was slightly higher than that in female, however there was no statistical difference (both P>0.05); the rate of usage of ACEI/ARB drugs gradually decreased with increasing of coronary heart disease or diabetes duration (P<0.05); the rates of usage of ACEI/ARB drugs in hypertension, dyslipidemia, myocardial infarction, renal insufficiency patients and patients received revascularization therapy were significantly higher (allP<0.05). Multivariable logistic regression analysis showed that hypertension (OR=3.016, 95%CI: 1.376-4.887), dyslipidemia (OR=1.489, 95%CI: 1.114-2.031), revascularization (OR=2.291, 95%CI: 1.276-3.277), myocardial infarction (OR=2.561, 95%CI: 1.571-4.545), renal insufficiency (OR=1.337, 95%CI: 1.145-2.013), and insulin treatment (OR=1.584, 95%CI: 1.084-2.511) were positively correlated with ACEI/ARB usage (P<0.05); and coronary heart disease duration was negatively correlated with ACEI/ARB drugs usage (duration 5-10 years:OR=0.621, 95%CI: 0.416-0.823; duration >10 years, OR=0.664, 95%CI: 0.471-0.840).

The rate of usage of ACEI/ARB drugs in elderly coronary heart disease outpatients complicated with diabetes mellitus is still low, however, patients with hypertension, dyslipidemia, myocardial infarction, renal insufficiency and patients received revascularization therapy and insulin treatment are more likely to use ACEI/ARB drugs.

To assess the clinical outcomes of totally endoscopic coronary artery bypass grafting (TECABG).

A systematic review of studies reporting clinical outcomes of TECABG was performed. Twelve studies were included in the meta-analysis. R 3.2.3 was used to perform the statistical analysis.

Length of hospital stay of TACABG patients ranged from 3.3 to 8.6 days. The rate of recent conversion to thoracotomy was 0-28.1% (from perioperative period to 2 years after surgery); the rate of anastomotic bleeding was 1.7%-8.5%; the case fatality rate of in-hospital or 30 days after surgery was 0-3.8%; the rate of myocardial infarction was 0-3.4%; the rate of stroke was 0-2.2%; the rate of revascularization was 0-6.8%; the patency rate of recent coronary artery bypass graft (CABG) was 89.5%-100%; the mid-time survival rate of TECABG patients (from 2 to 5 years after surgery) was 92.7%-100%; the rate of revascularization was 2.0%-12.2%; the patency rate of mid-time CABG was 71.4%-97.0%.

The current data suggests that TECABG is feasible, safe and effective when proper patients are selected. However, randomized controlled trials of TECABG versus conventional CABG are still required due to lack of long-term outcomes.

The patient, a 26-year-old male, was seen in July 2015 because of "no contraception after marriage and infertility in regular sexual life for 2 years". The patient reported that his sexual desire was normal on weekdays, and his sexual life could be completed normally, about twice a week. After asking about the medical history, the patient recalled that when he was about 7 years old, his height was significantly taller than his peers and pubic hair began to appear. Considering that he had precocious puberty at that time, he had been evaluated in the local hospital and failed to make a clear diagnosis. The parents were normal and had no relevant medical history. Physical examination: Height 148 cm, weight 45 kg, body mass index 20.5 kg/m²Blood pressure is normal. The secondary sexual characteristics developed normally, and the bilateral testicles were palpated small, with a volume of about 7 ml, and no nodules were palpated. Laboratory tests: Sex hormones: prolactin 351.89 U/L (reference value 48~375 U/L), luteinizing hormone (LH)<0.07 U/L (reference 1.5-9.3 U/L), follicle stimulating hormone (FSH) 0.57 U/L (reference 1.4-18.1 U/L), estradiol 143.05 pmol/L (reference<146.1 pmol/L), testosterone 26.67 nmol/L (reference value 8.4-28.7 nmol/L), progesterone 47.49 nmol/L (reference value 0.89-3.88 nmol/L); Cortisol (8 am): 119.38 nmol/L (reference value 118.6-618.0 nmol/L); Adrenocorticotropic hormone (ACTH) 105 pmol/L (reference<10.2 pmol/L); Aldosterone: 696.75 ng/L (reference value 10-160 ng/L). Patient urinary 17 hydroxycorticosteroid, 17 ketosteroid, dehydroepiandrosterone sulfate (DHEA-SO₄), androstenedione and blood electrolytes were all within the normal range. The results of routine semen examination showed that no sperm was found after two centrifugations, the volume of semen was 0.2 ml, and the pH value was 7.5. Karyotype analysis showed 46, XY, male karyotype. Y chromosome microdeletion analysis: gr/gr large fragment deletion occurred in the AZFc region. CT scan of middle abdomen + enhancement showed diffuse hyperplasia of bilateral adrenal glands, and hypoechoic nodules about 12 mm ×8 mm in size were seen in the medial branch of right adrenal gland, which was considered to be a high possibility of adenoma (Figure 1)。 The ultrasound findings of bilateral testis and epididymis showed no abnormalities. Peripheral blood was sent to Shenzhen Huada Clinical Laboratory Center to detect the pathogenic genes, and the test results showed that there was a known pathogenic mutation c.518T>A (p.Ile173Asn, Hom) in CYP21A2 gene (Figure 2), and the pathogenicity of this site has been reported.

The patient was a 31-year-old male who went to the doctor because he had "no birth for 2 years without contraception". Both husband and wife were primary infertility, Han nationality. The history of repeated respiratory tract infection and sinusitis was denied, and there was no visceral inversion. No obvious abnormalities were found in physical examination and ultrasound of the reproductive system. The peripheral blood karyotype is 46, XY. Serum follicle stimulating hormone (FSH) was 3.87 U/L, luteinizing hormone (LH) was 2.95 U/L, estradiol was 119.97 pmol/L, testosterone was 7.25 nmol/L, and prolactin was 131.44 mU/L. Multiple semen examinations revealed that the semen volume was 1.6~2.6 ml, the pH value was 7.4, and the sperm concentration was 17.7~22.2×10⁹/L, the rate of forward motility sperm was 0-3.1%, the rate of sperm motility was 1.8%-5.2%, and the seminal plasma anti-sperm antibody was negative. According to the criteria of multiple morphological abnormalities of the sperm flagella (MMAF)^[1]Sperm morphology was observed under light microscope after modified Pap staining, and 97.0% of MMAF phenotype sperm were observed, and 20.5%, 46.0%, 13.5%, 2.5% and 14.5% of flagella were missing, short, curly, curved and irregular, respectively. Scanning electron microscopy showed that the malformation of sperm flagellum in the patient was consistent with the diagnosis of MMAF (Figure 1)； Transmission electron microscopy showed that the assembly of sperm flagella was abnormal, the fibrous sheath was thickened, the central microtubule was missing, and the dynamic arm existed.

Male, 62 years old, was admitted to hospital in March 2015 mainly due to "left scrotal swelling and pain for 8 years, aggravated for 1 month". A family genetic history is denied. Physical examination on admission: spherical mass in the left scrotum, about 15 cm in diameter, smooth surface, cystic sensation, high tension, untouched testis and epididymis, positive light transmission test, did not disappear after lying down, no change in the size of the squeezed cyst, and no abnormalities in the contralateral scrotum and testes. After admission, routine laboratory tests, chest X-ray films and electrocardiogram showed no abnormalities. Admission diagnosis: hydrocele of the left testis.

In recent years, endoscopic submucosal dissection (ESD) has been widely used in gastric mucosal lesions such as precancerous lesions and early cancer, and has gradually become the standard method of minimally invasive surgery due to its advantages of large resection range, complete pathological specimens and low local recurrence rate. However, the wounds of ESD surgery are large, reaching the submucosa and even the muscle propria, and the probability of complications such as bleeding and perforation is relatively increased. The role of acid suppression therapy in the prevention and treatment of gastric hemorrhage caused by ESD is unquestionable, among which the efficacy of proton pump inhibitor (PPI) has also been confirmed and recognized by a large number of clinical studies. This article will explore this further in depth.

Testosterone is a steroid hormone with a relative molecular mass of 288. It is synthesized and secreted by testicular interstitial cells. A small part of androgens in the body come from the adrenal gland. Testosterone is the most secreted androgen in male body and has the most important physiological role. It runs through all male physiological activities from embryonic development to aging, and has a significant impact on male quality of life^[1]。 Therefore, a comprehensive understanding of testosterone biosynthesis and regulation pathways is of great significance for the treatment of male androgen deficiency. 95% of testosterone is synthesized and secreted by testicular interstitial cells, and testosterone is mainly regulated by the classical hypothalamic-pituitary-gonadal axis pathway. The hypothalamus secretes gonadotropin-releasing hormone, which is divided into follicle-stimulating hormone-releasing hormone and luteinizing hormone-releasing hormone, which act on the pituitary gland to secrete gonadotropin, which is divided into follicle-stimulating hormone and luteinizing hormone (LH). The latter acts on the LH receptor on the membrane of testicular interstitial cells, making testicular interstitial cells secrete testosterone. At the same time, testosterone has negative feedback regulatory effects on hypothalamus and pituitary gland^[2]。 In recent years, more and more scientists have been studying how LH affects the secretion and regulation of testicular mesenchymal cells. Therefore, this paper reviews the new targets of androgen regulation.

Medical terms are not standardized and united, which is directly related to the accurate expression, collection, use, transmission and medical insurance of medical science and technology. Standardized and unified medical science and technology terms are the basis of information exchange such as medical science and technology journals. Therefore, the author sorts out the irregularities and wrong use of medical terms in daily work and journals, hoping to attract widespread attention of readers.