Objective To investigate the effect of smoking on the semen quality in infertile men.Methods A total of 360 male infertility patients were enrolled and divided into the smoking group(n=190)and non-smoking group(n=170)based on whether they smoked or not.Furthermore,the smoking group was subdivided into group A(≤10 sticks/d,n=63),group B(11～20 sticks/d,n=80),and group C(>20 sticks/d group,n=47)according to the amount of smoking.Semen volume,liquefaction time,sperm concentration,motility,DNA fragmentation rate and normal morphological rate were observed and compared between and within the groups.Results There were significant differences in semen volume,liquefaction time,sperm motility,normal morphological rate and DNA fragmentation rate between the smoking group and the non-smoking group(P<0.05).The semen volume,sperm motility and normal morphological rate of the smoking group were lower than those in the non-smoking group,and the DNA fragmentation rate and semen liquefaction time were higher than those in the non-smoking group.And with the increase of smoking volume,sperm motility and normal morphological rate decreased,semen liquefaction time and DNA fragmentation rate increased,and there was no significant difference in the sperm concentration between the smoking group and non-smoking group(P>0.05).There was no significant difference in the semen volume between the three groups with different smoking amounts(P>0.05).Conclusion Smoking has a negative impact on the sperm quality parameters such as semen volume,sperm motility,normal morphological rate,sperm motility,liquefaction time and DNA fragmentation,and the effect of heavy smoking is particularly obvious.We should strengthen the comprehensive health education,promote the healthy lifestyles and reduce smoking.

Objective To observe the value of residual neural network(ResNet)-101-feature pyramid network(FPN)model based on CT for differentiating benign and malignant lung nodules.Methods Totally 2 040 lung nodules in 2 000 patients were retrospectively enrolled,including 1 150 benign and 890 malignant nodules.The nodules were divided into training set(n=1 632)and test set(n=408)at the ratio of 8∶2,the former including 881 benign and 751 malignant ones,while the latter including 269 benign and 139 malignant ones,respectively.Taken ResNet-101 as the backbone network,combined with FPN,a classification model was established based on chest CT,and the efficiency of this model alone and combined with evaluation of physicians for differentiating benign and malignant lung nodules were evaluated.Results Among 269 benign lung nodules in test set,ResNet-101-FPN model alone correctly diagnosed 214 nodules(214/269,79.55%),while combined with evaluation of physicians correctly diagnosed 230 ones(230/269,85.50%).For 139 malignant nodules in test set,ResNet-101-FPN model alone correctly diagnosed 124 nodules(124/139,89.21%),while combined with evaluation of physicians correctly diagnosed 131 ones(131/139,94.24%).The sensitivity,accuracy and precision of ResNet-101-FPN model combined with evaluation of physicians for distinguishing benign and malignant lung nodules were all higher,while the specificity of the combination was lower than those of ResNet-101-FPN model alone,but the differences were not significant(all P＞0.05).Conclusion ResNet-101-FPN model could be used to distinguish benign and malignant lung nodules based on CT.Combining with evaluation of physicians could improve diagnostic efficiency of this model.

Objective:To explore differences in clinical characteristics and hemoglobin levels between different age groups in patients with metabolic-associated fatty liver disease (MAFLD) at high and low altitude areas, so as to provide a basis for further research on the effect of chronic hypoxia on MAFLD.Methods:Liver function indexes, non-invasive fibrosis indexes, metabolic indexes, and routine blood test of 1 458 (Xining area of Qinghai province) and 1 633 cases (Huzhou area, Zhejiang province) with MAFLD who underwent physical examination were retrospectively analyzed. The total population of the two places were compared and analyzed with the hemoglobin reference limit of 180 g/L. The population of Xining was divided into high and low hemoglobin groups for comparative analysis. The population of the two places was divided into five groups according to age stratification (≤30 years old, 31-40 years old, 41-50 years old, 51-60 years old, ≥61 years old). After multivariate adjustment, the characteristics of high and low hemoglobin groups and MAFLD were compared between the two groups. Statistical analysis was performed with t-test or χ2 test. Results:The detected indexes values observed were higher in Xining than Huzhou area population [fibrosis indexes (FIB4, 1.08±0.02 vs. 1.19±0.02), erythrocyte (5.14±0.13 vs. 5.30±0.13), hemoglobin (156.82±0.37 vs. 164.19± 0.39), alanine aminotransferase (ALT, 33.70±0.66 vs. 43.68±0.70), aspartate aminotransferase (AST, 24.34±0.28 vs. 29.23±0.30), γ-glutamyltransferase (42.40±1.02 vs. 51.82±1.53), alkaline phosphatase (77.92±0.56 vs. 84.63±0.85), triglyceride (TG, 2.07±0.04 vs. 2.74±0.05), uric acid (UA, 383.42±2.15 vs. 406.44±2.36)]. The detected indexes values observed were higher in Huzhou than Xining area population [platelet count (220.54±1.32 vs. 181.62±1.40), total cholesterol (TC, 5.10±0.02 vs. 5.04±0.03), fasting blood glucose (FBG, 5.67±0.04 vs. 5.29±0.04)]. The differences were statistically significant ( P<0.01). Xining population UA and body mass index were increased in high hemoglobin group than low hemoglobin group, and the other parameters difference were not statistically significant. After the population in Xining was grouped by age, high and low FIB4, ALT, and AST and UA levels were detected in the age group of 31-40 and 51-60 years old, >61 years old, 31-40 years old, and the difference between hemoglobin groups were statistically significant ( P<0.01). Conclusion:Patients with MAFLD are more likely to develop fibrosis, liver function impairment, metabolic disorders and so on under high-altitude hypoxic environment. Additionally, there is certain correlation with disease severity and age changes, suggesting that chronic hypoxia can accelerate MAFLD progression.

Objective To evaluate the effect of dexmedetomidine on pulmonary function in elderly patients with mild obstructive ventilatory dysfunction under protective ventilation during laparoseopic gallbladder surgery. Methods Sixty patients were included who underwent laparoseopic gallbladder surgery with general anesthesia. For the all subjects, the age ranged from 65 to 75 years old, the body mass index range was 18.5～23.9 kg/m2, and the ASA grade wasⅡorⅢ. In the subject selection, the gender was not limited, and the included subjects were diagnosed with mild obstructive ventilation dysfunction by preoperative pulmonary function tests. All the subjects were randomly divided into 2 groups (n=30), including dexmedetomidine group (group D) and control group (group C). In the group D, dexmedetomidine was intravenously infused at a dose of 1 μg/kg 10 min before and after the general anesthesia induction, and at a rate of 0.4μg/(kg·h) after tracheal intubation until the end of operation. Group C was given an equal volume of normal saline. Airway peak pressure (Ppeak), mean airway pressure (Pmean), airway plateau pressure (Pplat), and positive end-expiratory pressure (PEEP) were measured at 5 min after intubation (before pneumoperitoneum) (T1), end of pneumoperjtoneum (T2), and 10 min after the end of pneumoperitoneum (T3). The driving pressure (DP) was calculated. The blood samples of the radial artery were collected for blood gas analysis, and PaO2 and PaCO2 were recorded. The oxygenation index (PaO2/FiO2), respiratory index (RI), dead space ventilation rate (VD/VT), and alveolar-arterial oxygen partial pressure difference (A-aDO2) were calculated. The time of removal of the tracheal tube and the occurrences of complications such as hypercapnia and hypoxemia within 48 hours after extubation were recorded. Results Compared with group C, Ppeak, Pmean, DP, RI, VD/VT and A-aDO2 at T1, T2, T3 were decreased in group D, PaO2/FiO2 was increased, postoperative extubation time was shortened, and the incidence of hypoxemia was reduced within 48 h after operation (P<0.05). Compared with T1, Ppeak, Pmean, DP, RI, VD/VT and A-aDO2 at T2 were increased, and PaO2/FiO2 was decreased(P<0.05). Conclusions Dexmedetomidine can improve the pulmonary function in elderly patients with mild obstructive ventilatory dysfunction under protective ventilation during laparoseopic gallbladder surgery.

Visual fixation is an item in the visual function subscale of the Coma Recovery Scale-Revised (CRS-R). Sometimes clinicians using the behavioral scales find it difficult to detect because of the motor impairment in patients with disorders of consciousness (DOCs). Brain-computer interface (BCI) can be used to improve clinical assessment because it directly detects the brain response to an external stimulus in the absence of behavioral expression. In this study, we designed a BCI system to assist the visual fixation assessment of DOC patients. The results from 15 patients indicated that three showed visual fixation in both CRS-R and BCI assessments and one did not show such behavior in the CRS-R assessment but achieved significant online accuracy in the BCI assessment. The results revealed that electroencephalography-based BCI can detect the brain response for visual fixation. Therefore, the proposed BCI may provide a promising method for assisting behavioral assessment using the CRS-R.
Adolescent ; Adult ; Aged ; Brain ; physiopathology ; Brain-Computer Interfaces ; Consciousness Disorders ; diagnosis ; physiopathology ; Diagnosis, Computer-Assisted ; methods ; Electroencephalography ; methods ; Evoked Potentials ; Female ; Fixation, Ocular ; physiology ; Humans ; Male ; Middle Aged ; Neurologic Examination ; Pilot Projects ; Severity of Illness Index ; User-Computer Interface

Objective To investigate the relationship between folate metabolism-related gene polymorphism and fetal congenital defects,and discuss the effect of genetic factors on fetal congenital defects.Methods Retrospective analysis was used to investigate the genotype and gene frequency of 5,1O-methylenetetrahydrofolate reductase (MTHFR) C677T,A1298C gene loci and ethionine synthase reductase (MTRR) A66G gene locus in 132 cases of adverse pregnancy pregnant women (case group) and 150 cases normal pregnant women (control group) at the same period.The statistical differences were analyzed between the levels of their serum folate,vitamin B12 (Vit B12) and homocysteine (HCY).Results In the serum of case group,folate was positively correlated with Vit B12,and was negatively correlated with HCY,only HCY of skeletal system defects(6 cases) was higher (t =3.409,P ＜ 0.05).Comparing genotypes frequency of the MTHFR C677T,A1298C gene loci and MTRR A66G gene locus in case group with control group,the difference above was not statistically significant (P ＞ 0.05).In these three gene loci C/T,A/C and A/G allele frequency with the control group,the difference above was not statistically significant (all P ＞ 0.05).Different genotype combinations of MTHFR C667T and A1298C gene loci in control groups had no statistically different from the control group (P ＞ 0.05),and there was no synergy.Conclusions Maternal folate metabolism-related MTHFR and MTRR genes polymorphisms can affect the metabolic products levels accordingly.However,the correlation between the changes and the genetic mechanism of fetal congenital defects needs more large samples study in depth.

Objective To investigate the prognosis and efficiency of glucocorticoid and immunosuppressor in the treatment of idiopathic membranous nephropathy(IMN)in children. Methods A retrospective analysis of 35 cases of biopsy - proven membranous nephropathy without secondary factors was performed,who were found present with ne-phrotic proteinuria and admitted to hospital from March 2004 to July 2013,to explore the efficiency of treatment with glucocorticoid and immunosuppressor and its prognosis. Results The 35 IMN cases included 18 boys and 17 girls,and the ratio was 1. 1∶ 1. 0. The mean age at onset was(11. 3 ± 0. 5)years with a range of 3. 0 - 17. 1 years. Five cases with gross hematuria,24 cases present with microscopic hematuria,8 cases with hypertension,1 case with chronic renal insufficiency,and 2 cases were complicated with thrombosis. According to membranous nephropathy staging criteria,9 cases(25. 7% )were in stage Ⅰ,16 cases(45. 7% )in stage Ⅱ,10 cases(28. 6% )in stage Ⅲ;about 94. 3%(33 / 35 cases)had mesangial cells and mesangial matrix with mild to moderate hyperplasia. They were all treated with glucocor-ticoid initially and one of them showed sensitive to flucocorticoid but developed flucocorticoid resistance after relapse, while all the others were flucocorticoid - resistant. Cyclophosphamide A(CsA)was introduced to 17 cases and at least lasted for 3 months,in which 13 cases(76. 5% )reached complete remission and 3 cases reached partial remission, while 1 case didn't achieve remission,and the mean time for proteinuria to disappear was(4. 9 ± 3. 7)months;5 cases were treated with Mycophenolate mefetil( MMF),among which 4 cases reached complete remission in 2 months,4 months,5 months,and 9 months separately,while 1 case reached partial remission. Cyclophosphamide(CTX)was intro-duced to 6 cases,in which the mean cumulative dosage was(91. 2 ± 46. 5)mg/ kg,among them 1 case(87 mg/ kg) reached complete remission,1 case(160 mg/ kg)partial remission,but 4 cases didn't achieve remission. One case reached remission after Rituximab(RTX)was introduced. One case got partial remission after Leflunomide(LEF)was introduced,and the complete remission rate was higher in those treated with combined therapy of glucocorticoid and CsA than those treated with glucocorticoid only(76. 5% vs 12. 5% ,P = 0. 004),but the total efficacy showed no difference (94. 2% vs 62. 5% ,P = 0. 081). The complete remission rate(76. 5% vs 38. 5% ,P = 0. 042)and total efficacy (94. 1% vs 61. 5% ,P = 0. 040)were higher in those with combined therapy of steroid and CsA than those treated with steroid and other immunosuppressor. The complete remission rate(76. 5% vs 16. 7% ,P = 0. 018)and total efficacy (94. 1% vs 33. 3% ,P = 0. 008)were also higher than those treated with steroid and CTX,but the complete remission rate(76. 5% vs 80. 0% ,P = 0. 687)and total efficacy(94. 1% vs 100. 0% ,P = 0. 773)showed no difference com-pared with those treated with steroid and MMF. Conclusions IMN shows glucocorticoid resistance mostly,while CsA had definite efficiency and may be better than CTX. And the efficiency of MMF should be noted.

OBJECTIVETo investigate the value of C-reactive protein (CRP) on transplantation day in predicting early post-transplant infections and outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODSWe retrospectively analyzed the clinical data of 78 recipients undergoing allo-HSCT. The clinical reference value of CRP on transplantation day was determined, and its sensitivity and specificity for diagnosing bacteremia was analyzed using receiver-operating characteristic curve (ROC). The incidence of transplant-related complications, overall survival, and relapse rate of the patients were analyzed with respect to the CRP level.

RESULTSThe clinical reference value of CRP for diagnosing bacteremia was 23.3 mg/L (AUC=0.735 [95% CI: 0.623-0.848], P=0.001), which had a diagnostic sensitivity and specificity of 0.793 and 0.592, respectively. Compared with the patients with low CRP levels, the patients with high CRP levels tended to have delayed neutrophil reconstitution and platelet engraftment by 0.71 days (P=0.237) and 4.09 days (P=0.048), respectively, and had a significantly higher incidence of bacteremia (17.1% vs 53.5%, P=0.001) and CMV viremia (37.1% vs 72.1%, P=0.003) within 100 days following the transplantation; the incidences of EBV viremia, pulmonary invasive fungal infection, or acute graft versus host disease (aGVHD) showed no significant difference between the two groups (41.9% vs 22.9%, P=0.094; 14.0% vs 5.7%, P=0.285; 51.2% vs 45.7, P=0.656, respectively). During the follow-up for a median of 318 (7-773) days in high-CRP group and for 299 (78-747) days in low-CRP group, the high-CRP group showed a significantly lower 2-year overall survival than the low-CRP group (42.5% vs 78.4%, P=0.022), and tended to have a higher 2-year cumulative relapse rate (52.3% vs 19.8%, P=0.235). Logistic multivariate analysis identified a high CRP level on transplantation day as the independent risk factor for post-transplant bacteremia within 100 days (OR=5.090 [95% CI: 1.115 -23.229], P=0.036).

CONCLUSIONA high CRP level on transplantation day can be indicative of a high risk of early post-transplant bacteremia and CMV viremia and also a poor prognosis following allo-HSCT.

Bacteremia ; diagnosis ; C-Reactive Protein ; chemistry ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Incidence ; Mycoses ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity ; Viremia ; diagnosis

Objective To provide references for building the medical rehabilitation system in China by learning the progress and compliance of rehabilitation departments construction at tertiary hospitals. Methods Comparative and quantitative methods were used for dynamic analysis qualitative interview to learn the index compliance of the hospitals in question in 201 1-2012.Results Compared with 201 1, average days of stay of the rehabilitation departments declined in general,yet with insufficient therapists;introduction of early rehabilitation intervention was but 57.1%,and the functional assessment rate of rehabilitation service was less than satisfactory.Conclusion Lack of manpower,varying levels of medical rehabilitation services,and neglect for functional assessment were found to be the main problems in construction of medical rehabilitation departments for the time being.

Objective To investigate the influence of early hyperbaric oxygen (HBO) therapy on cerebral edema and neural function in patients after minimally invasive surgery for intracerebral hemorrhage (ICH).Methods A random number table was used to divide 148 ICH surgery patients into a control group (n =75) and a treatment group (n =73).In the treatment group,HBO was administered in 51 cases 6-24 hours after surgery and then once a day for twenty days.Cerebral edema volume was measured by brain CT before the operation and on the 3rd,7th,14th and 21st day after the surgery.Neurological impairment was scored at the same time points.Results Average cerebral edema volume was significantly smaller in the treatment group than in the control group on the 7th,14th and 21st days,but not on the 3rd day.The neurological impairment scores (NIS) after therapy were significantly lower than that before therapy in both groups.The two groups' average scores were not significantly different before the operation or on the 3rd day,but they were significantly lower in the treatment group thereafter.Conclusion Early HBO therapy can significantly reduce cerebral edema and contribute to nerve functional recovery in patients after minimally invasive ICH surgery.