Objective To discuss the treatment choices of varicocele by laparoscopic. Methods Retrospective analysis clinical datas of 337 patients with primary varicocele above grade Ⅱ.All of them were treated by operation and followed-up,238 cases had scrotum pain.265 cases were infertility after married.History of diseases was between 1-13 years.249(197 patients with infertility)were treated with laparoscopic high selective ligation of spermatic veins,as Group A.88(68 patiets with infertility)were treated with laparoscopic cluster ligation,as Group B.The clinical data were compared. Results Three hundreds and thirty-seven cases were followed-up 2 years after operation.The operative times of two groups were(38.04±10.9)min、(19.04±7.5)min,the incidences of hydrocelewere 0.4%(1/249),11.3%(10/88);theincidences oftesticular atrophywere 0%(0/249),3.4%(3/88);the improving rates of semen quality in 3 months were 77.1%(192/249),62.5%(55/88);the spontaneous pregnant rates of his spouses in 2 years were 56.8%(112/197),39.7%(27/68).There were significant differences among the 2 groups(P<0.05).The recurrence rates were 5.6%(14/249),4.5%(4/88),there was no significant difference among the 2 groups(P>0.05). Conclusion Laparoscopic high selective ligation of spermatic veins in this study had less complications,higher improving rates of semen quality and pregnant rates.

ObjectiveTo observe right ventricle (RV) structure and function of New Zealand rabbits with chronic intermittent hypoxia (CIH) for short-term (0-8 weeks) by echocardiography. MethodsTwenty-four healthy male New Zealand rabbits were set up CIH animal model for 8 weeks. RV structure?s systolic and diastolic function were measured by conventional and tissue Doppler echocardiography at 0, 1, 2, 4, 6 and 8 week and one rabbit was sacriifced randomly for RV myocytes and pulmonary tissue pathology examination. RV structure and function parameters at 0, 1, 2, 4, 6 and 8 week were analyzed by mixed effects model analysis.ResultsRV structure variables: RV, RA at 8 week increased compared with those at 0 week, but had no signiifcant difference (P>0.05); RV systolic function variables:RVFAC at 8 week increased compared with those at 0 week (F=3.45, P<0.05), TAPSE at 4, 6, 8 week increased compared with that at 0 week (F=3.11, 3.41 and 3.86, all P<0.05), RVMPI at 4 week decreased compared with that at 0 week (F=3.46, P<0.05), recovered to baseline at 6, 8 week. Isovolumetric relaxation time (IRTc) corrected by heart rate at 1, 2, 4 week decreased compared with that at 0 week (F=3.15, 3.31 and 3.17, all P<0.05), recovered to baseline at 8 week, ET of PA at 1, 2 week decreased compared with that at 0 week (F=3.01 and 3.15, both P<0.05), recovered to baseline at 4, 6, 8 week, AT of PA at 1, 2, 4 week decreased compared with that at 0 week (F=3.13, 3.15 and 3.32, all P<0.05), recovered to baseline at 6, 8 week. RV diastolic function variables: isovolumetric contraction time (ICTc) corrected by heart rate at 2, 4 week decreased compared with that at 0 week (F=3.13 and 3.33,both P<0.05), E/E? at 1, 2 week decreased compared with that at 0 week (F=3.13 and 3.44,bothP<0.05), recovered to baseline at 4, 6, 8 week, E/A at 4, 6, 8 week increased compared with that at 0 week (F=4.01, 3.82 and 3.37, all P<0.05), E?/A? at 8 week increased compared with that at 0 week (F=3.81, P<0.05). The myocardial pathology showed that RV myocardial cell structure was normal at 4 week. Nuclei enlarged, stain darkened and some cytoplasms loosed when exposed to CIH for 8 weeks. The structure of lung tissues was normal when exposed to CIH for 4 weeks. Inflammatory cell inifltrated, capillary engorged as well as the wall of pulmonary arterioles thickened slightly at 8 week.ConclusionsRV diastolic and systolic function showed compensatory and structure was normal in early CIH (0-8 week). RV diastolic function compensated earlier than systolic function. IRT and ICT were sensitive indicators of RV systolic and diastolic function compensation.

Objective : To understand the status of rural environmental sanitation and summer diarrhea among rural residents in Zhejiang Province,and to provide evidence for improvement of rural environmental sanitation and prevention and control of summer diarrhea. Methods : The stratified random sampling method was used. Five or six counties each were selected from the east,middle and west of Zhejiang Province;five townships（excluded Chengguan Town）were selected from each selected county;four villages were selected as field survey points from each township;five households were selected from each survey point;one family member（householder or housewife）was selected from each selected household. The information about the environmental sanitation status and prevalence of summer diarrhea were obtained by literature review,interviews,questionnaire suvey,field investigation and laboratory tests. Logistic regression model was used to analyze the influencing factors for occurrence of summer diarrhea among rural residents. Results : There were 2 000 households surveyed. In the past two weeks,108 households had families with diarrhea and the prevalence of diarrhea was 5.40%. A total of 1 828 households disposed the household waste in the garbage bins or pools,accounting for 91.40%. There were 1 926 households with organized sewage discharge,accounting for 96.30%. There were 768 households with nymphs found in the kitchen,accounting for 38.40%;404 households with live egg sheaths found,accounting for 20.20%;592 households with cockroach traces found,accounting for 29.60%;564 households with rat traces found,accounting for 28.20%;and 1 206 households with flies found,accounted for 60.30%. There were 1 314 households with disease vectors around the house,accounting for 65.70%. There were 1 944 household with sanitary toilets,accounting for 97.20%. A total of 1 915 households had habits of drinking boiled water,accounting for 96.57%. The results of multivariate logistic regression analysis showed that rat traces found in the kitchen（OR=2.026,95%CI: 1.362-3.013）were a risk factor for summer diarrhea in rural residents,while drinking boiled water（OR=0.272,95%CI: 0.091-0.811）was a protective factor. Conclusion The sanitary environment and family health habits of rural residents were related to the prevalence of diarrhea in summer. Paying attention to kitchen hygiene and drinking boiled water could prevent summer diarrhea.

Objective:To evaluate immune response of murine peritoneal macrophage challenging by methicillin-resistant S.aureus(MRSA)after pretreatment with Pam3Csk4(TLR2 agonist).Methods: Murine peritoneal macrophage was pretreated with Pam3Csk4(1 μg/ml).Following pretreatment 12 h later,heat-killed MRSA( HK-MRSA) was added and incubated for another 2 or 6 hours.The protein and mRNA level of TNF-α, IL-6 and IL-1 were determined by ELISA and Q-PCR, respectively.To estimate phagocytosis of macrophage,HK-MRSA/MSSA labeled with FITC( FITC-HK-MRSA/MSSA) were added to well and incubated for 30 min.After washing 5 times with PBS,intracellular FITC-HK-MRSA was detected by flow cytometry.To estimate antimicrobal activity of macrophage,live MRSA and MSSA were added to well and incubated at indication time,the CFU of s.aureus was estimated via a 10-fold serial dilution on agar media.cDNA was further quantitative assessed using primers for mouse FCR-Ⅰ,FCR-Ⅲ,CR-1,CR-3,iNOS and LL37 by Q-PCR .Results: Compared with saline-pretreated cell, the protein and mRNA level of TNF-α, IL-6 and IL-1 were markely reduced, respectively.However, both the phagocytosis and antimicrobal activity to S.aureus were significantly increased in macrophages pretreated with Pam3Csk4.Further study found that the macrophages had higher FCR-Ⅰ,FCR-Ⅲ,CR-1,CR-3,iNOS and LL37 expression at 6 h and 12 h post-stimulation Pam3Csk4.Conclusion: The results suggest that Pam3Csk4 could activate murine antimicrobal activity of peritoneal macrophage challenging by methicillin-resistant Saureus via increasing opsonophagocytosis in depended antibodies, complements manners.The results suggest Pam3Csk4 probably be a novel immunotherapy candidate against MRSA.

Objective: To learn the disinfection effect and its influencing factors of drinking water in rural areas of Zhejiang Province,so as to provide scientific basis for the control of microbial pollution in drinking water and prevention of waterborne diseases. Methods: A total of 5 299 samples from 879 rural water plants Zhejiang Province were collected by stratified sampling method in 2017. The disinfection effect of water samples was assessed quality according to GB 5749-2006 Hygienic Standards for Drinking Water. Logistic regression models were used to analyze the influencing factors for disinfection effect of rural drinking water. Results: There were 540 rural water plants in Zhejiang Province adopting routine process for water purification,accounting for 61.43%;771 ones using surface water,accounting for 87.72%. About 4 458 samples（84.13%）were disinfected and the qualified rate was 86.05%,22.32% of which were disinfected by chlorine dioxide and the qualified rate was 100.00%. The results of multivariate logistic regression analysis showed that scale of water plant,disinfectant residue,use frequency of disinfection equipment,disinfection,season and source water turbidity were the influencing factors for the disinfection effect of rural drinking water（P<0.05）;disinfection,disinfectant residue,use frequency of disinfection equipment and source water turbidity were the influencing factors for the disinfection effect of finished water（P<0.05）;disinfection,disinfectant residue,use frequency of disinfection equipment,source water turbidity and scale of water plant were the influencing factors for the disinfection effect of tap water（P<0.05）;disinfectant residue,use frequency of disinfection equipment,source water turbidity and scale of water plant were the influencing factors forthe disinfection effect of surface water（P<0.05）;disinfectant residue,use frequency of disinfection equipment,source water turbidity and pH were the influencing factors for the disinfection effect of groundwater（P<0.05）. Conclusion The disinfection effect of drinking water in rural areas of Zhejiang Province is associated with source water quality,scale of plants,water purification technique and so on. The disinfection process should be improved,the management of water plants should be strengthened to reduce the risk of microbial contamination.

Objective:To identify the classification characteristics and quality of life (QOL) of breast cancer (BC) patients during chemotherapy, so as to provide basis for improving the sleep and QOL of this group.Methods:A cross-sectional investigation was completed among 421 BC patients in 5 tertiary hospitals in Shanghai, Wuhan, Tangshan and Nanning in 1-12 months of 2016 using validated instruments including self-made general information questionnaire, Pittsburgh Sleep Quality Index (PSQI) and Functional Assessment of Cancer Therapy-Breast (FACT-B).Results:Four latent class of patients were identified through latent profile analysis (LPA), named by badly worse sleep quality(SQ) (C1, n=23), medium-SQ with difficulty to fall asleep (C2, n=127), medium-SQ with worse sleeping process (C3, n=30), none sleep disorders (C4, n=241). Total points of SQ among C1-C4 had significant difference ( χ2 value was 309.28, P<0.05). Age, BMI, job status, whether had surgery and course of chemotherapy between classes had statistically significant differences ( χ2 values were 9.57-25.28, all P<0.05). It had significant difference between C2 and C3, C2 and C4, C3 and C1, C3 and C4 on QOL ( χ2 values were 5.96-52.73, all P<0.05). Conclusion:SQ of BC patients during chemotherapy has heterogeneity among population. Different features of SQ of BC patients have different performance on QOL. Health professionals should keep an eye on patients with features of older age, high BMI, in job status, already received surgery and during early-stage chemotherapy, provide personal nursing intervention to improve SQ and QOL.

Objective:To explore the application and value of metagenomic next-generation sequencing (mNGS) in refractory infection after organ transplantation.Methods:A case report discussed about a patient with lumbar spine infection after kidney transplantation and the relevant literature was reviewed. The recipient was a 63-year-old man with low back pain after kidney transplantation. Lumbar spine magnetic resonance imaging showed lumbar spine infection. Multiple operations plus antibacterial and antituberculosis treatments were ineffective. Before and after treatment, numerous tests of traditional pathogenic microorganisms failed to detect any positive bacteria.Results:The detection of lumbar secretion by mNGS suggested aspergillus infection. The symptoms improved after dosing of voriconazole.Conclusions:The incidence of fungal infection of lumbar spine is low. The imaging manifestations are non-typical so that it is easy to misdiagnose. mNGS helps to timely diagnose and guide treatment. With a review of the literature, mNGS has some application value for some difficult and rare infectious diseases.

Objective:To explore the diagnostic value of synthetic magnetic resonance imaging (syMRI) quantitative parameters for benign and malignant breast lesions.Methods:From September 2018 to March 2019, a total of 43 cases of breast lesions which were confirmed by surgery and pathology in Cancer Hospital, Chinese Academy of Medical Sciences were enrolled in this study. All patients underwent syMRI sequence scans before and after enhancement except for conventional T2WI, DWI, and enhancement scans. GE AW4.7 workstation was used to generate syMRI parameter maps (T1, T2, proton density mappings), and ITK-SNAP software was used to delineate the volume of interest. The T1, T2, PD values before and after dynamic contrast enhanced (DCE) were obtained, and the change values of each parameter were calculated. Meanwhile, the apparent diffusion coefficient (ADC) and time intensity curve (TIC) of the lesions were measured. The differences of each parameter value were compared between benign and malignant breast lesions, and the receiver operating characteristic (ROC) curve was used to analyze the diagnostic performance of each parameter.Results:Among the 43 enrolled cases, 13 were benign and 30 were malignant. Among the syMRI parameters, the pre-enhancement parameters including T1pre (median 1 663.07 ms), T2pre (median 103.33 ms), post-enhancement parameters ΔT1 (median 1 022.68 ms) and ΔT2 (median 27.67 ms) of benign group, significantly higher than those of the malignant group (the medians were 1 141.74, 92.53, 664.95, and 16.19 ms, respectively, P<0.05). The ADC value of the benign group (median 1.66×10 -3mm 2/s) was significantly higher than that of the malignant group (median 1.00×10 -3mm 2/s, P<0.05). The benign group included 6 cases of TIC curve type Ⅰ, 5 cases of type Ⅱ, and 2 cases of type Ⅲ. The malignant group included 2 cases of TIC curve type Ⅰ, 17 cases of type Ⅱ, and 11 cases of type Ⅲ. The difference between the two groups was statistically significant ( P<0.05). The area under the ROC curve (AUC) of T1pre before DCE was 0.869, higher than 0.806 of ADC and 0.697 of TIC. When the best cut-off value of 1 282.94 ms was chosen, the sensitivity and specificity of diagnosis were 76.9% and 93.3%, respectively. The combination of T1pre and T2pre can further improve the diagnostic performance (AUC=0.908). Conclusions:Among the syMRI quantitative parameters, T1pre, T2pre, ΔT1 and ΔT2 have good value for the differential diagnosis of benign and malignant breast lesions. T1pre has the best diagnostic performance, and the combination of T1pre and T2pre can further improve the diagnostic performance.

Objective:To explore the diagnostic value of synthetic magnetic resonance imaging (syMRI) quantitative parameters for benign and malignant breast lesions.Methods:From September 2018 to March 2019, a total of 43 cases of breast lesions which were confirmed by surgery and pathology in Cancer Hospital, Chinese Academy of Medical Sciences were enrolled in this study. All patients underwent syMRI sequence scans before and after enhancement except for conventional T2WI, DWI, and enhancement scans. GE AW4.7 workstation was used to generate syMRI parameter maps (T1, T2, proton density mappings), and ITK-SNAP software was used to delineate the volume of interest. The T1, T2, PD values before and after dynamic contrast enhanced (DCE) were obtained, and the change values of each parameter were calculated. Meanwhile, the apparent diffusion coefficient (ADC) and time intensity curve (TIC) of the lesions were measured. The differences of each parameter value were compared between benign and malignant breast lesions, and the receiver operating characteristic (ROC) curve was used to analyze the diagnostic performance of each parameter.Results:Among the 43 enrolled cases, 13 were benign and 30 were malignant. Among the syMRI parameters, the pre-enhancement parameters including T1pre (median 1 663.07 ms), T2pre (median 103.33 ms), post-enhancement parameters ΔT1 (median 1 022.68 ms) and ΔT2 (median 27.67 ms) of benign group, significantly higher than those of the malignant group (the medians were 1 141.74, 92.53, 664.95, and 16.19 ms, respectively, P<0.05). The ADC value of the benign group (median 1.66×10 -3mm 2/s) was significantly higher than that of the malignant group (median 1.00×10 -3mm 2/s, P<0.05). The benign group included 6 cases of TIC curve type Ⅰ, 5 cases of type Ⅱ, and 2 cases of type Ⅲ. The malignant group included 2 cases of TIC curve type Ⅰ, 17 cases of type Ⅱ, and 11 cases of type Ⅲ. The difference between the two groups was statistically significant ( P<0.05). The area under the ROC curve (AUC) of T1pre before DCE was 0.869, higher than 0.806 of ADC and 0.697 of TIC. When the best cut-off value of 1 282.94 ms was chosen, the sensitivity and specificity of diagnosis were 76.9% and 93.3%, respectively. The combination of T1pre and T2pre can further improve the diagnostic performance (AUC=0.908). Conclusions:Among the syMRI quantitative parameters, T1pre, T2pre, ΔT1 and ΔT2 have good value for the differential diagnosis of benign and malignant breast lesions. T1pre has the best diagnostic performance, and the combination of T1pre and T2pre can further improve the diagnostic performance.

DNA methylation is a prevalent epigenetic modification in vertebrates, and it has been shown to be involved the regulation of gene expression and embryo development. However, it remains unclear how DNA methylation regulates sexual development, especially in species without sex chromosomes. To determine this, we utilized zebrafish to investigate DNA methylation reprogramming during juvenile germ cell development and adult female-to-male sex transition. We reveal that primordial germ cells (PGCs) undergo significant DNA methylation reprogramming during germ cell development, and the methylome of PGCs is reset to an oocyte/ovary-like pattern at 9 days post fertilization (9 dpf). When DNA methyltransferase (DNMT) activity in juveniles was blocked after 9 dpf, the zebrafish developed into females. We also show that Tet3 is involved in PGC development. Notably, we find that DNA methylome reprogramming during adult zebrafish sex transition is similar to the reprogramming during the sex differentiation from 9 dpf PGCs to sperm. Furthermore, inhibiting DNMT activity can prevent the female-to-male sex transition, sug-gesting that methylation reprogramming is required for zebrafish sex transition. In summary, DNA methylation plays important roles in zebrafish germ cell development and sexual plasticity.