Disorders of sex development (DSD) is a complex disease that involves multiple traditional professional disciplines.Multidisciplinary team(MDT) mode is a particularly advantageous treatment mode that has been developed in recent years for the diagnosis and treatment of complex diseases.This article is based on the analysis of research progress at home and abroad about DSD and MDT,and the latest advances application of MDT treatment try for DSD,probe into how to establish a DSD-MDT treatment mode in theory preliminarily.

Objective To search a new,safe and effective method to obtain semen using rectal Drobe electroejaculation(RPE).Methods RPE procedures were performed in 8 men with psychological ejaculatory failure,used the electrical stimulate instrument(CGS model,made in Italy).The average age was 26 years.Seminal vesicle was normal by B Uhrasonography or CT examination.Except for 1 case of diabetes,the other 7 cases found no hormones,blood,biochemical and nervous system abnormalities.Three cases had nocturnal emission,but no sexual intercourse ejaculation.Results Adequate sperm was successfully taken out from the 8 patients.Mean seminal fluid volume was 2.3 ml,mean total sperm count was 67×106/ml and mean total motile sperm was 21.3%.Three patients felt abdominal distension during the RPE course.Conclusion RPE is a safe,reliable,non-in-vasive,repeatable method to obtain semen.

ObjectiveTo investigate the role of CD4+ CD25+ regulatory T cells(Treg) in peripheral blood and intestinal endotoxin (ET) in liver injury of rat severe acute pancreatitis (SAP).MethodsSixty male Wistar rats were randomly allocated into sham operation group(SO group) and severe acute pancreatitis group(SAP group).The rats in SAP group recevied the injection of Sodium Taurocholate(NaTc) into their far-end of bile-pancreatic duct and were sacrificed in 3-,6-and 12-hour,serum amylase(AMY) and alanine aminotransferase(ALT) determined by full-automatic biochemistry instrument,limulus reagent method is used to determine ET content in plasma,the proportion of Treg among peripheral lymphocytes was determined by Flow Cytometry(FCM),HE stain is used to observe pathological changes in liver and pancreas,the protein of Foxp3 activity was evaluated by immunohistochemistry staining,and the relationships between these indicators were analyzed using Pearson correlation analysis test.ResultsHistopathologic examination and the level of ALT revealed the occurrence of pancreatic inflammation and pathological changes of liver in SAP group.The percentage of Treg in SAP groups significantly increased at 3 h(2.26％ ±0.32％),6 h(2.36 ％ ±0.48％)and 12 h(2.80％ ±0.35％) comparing to the SO groups(P＜0.01) ; plasma ET levels compared with the SO group was statistically significant (P＜ 0,01 ),and 12 h (0.85 ± 0.11) compared to,3 h (0.74±0.11) and 6 h (0.78-±-0.07) was no significant difference (P＞0.05).The expression of Foxp3 protein on the livers were upregulated markedly.Pearson correlation analysis teat showed that quantities of Treg were positively proportional to the levels of ET(r=0.89,P＜0.01) after liver injury of SAP.ConclusionsSAP may lead to liver injury and the high plasma levels of ET and Treg in peripheral blood may play an important role in liver injury of SAP.

Objective To evaluate the therapeutic efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of portal hypertension of patients with hepatocellular carcinoma.Methods Ninety-five portal hypertension patients with hepatic carcinoma were enrolled.TIPS was performed in 63 patients and the other 32 patients received support medical care.The data referred to survival time of the 95 patients after treatment was collected by follow-up visit.The informations about success rate of TIPS,hepatic encephalopathy,rebleeding and causes of death were assessed.The Kaplan-Meier method was used to compare the survival time between two groups.The association of survival time with Child-Pugh classification and model for end-stage liver disease (MELD) score was analyzed.Results The success rate of TIPS was 97.8% with reduction of mean portal vein pressure of 13.6 cmH2O(1 cmH2O=0.098 kPa).The incidence of hepatic encephalopathy was 20.6% and rebleeding was 26.3% six months after TIPS treatment.Fifty-six patients treated with TIPS died at the end of follow-up.Twelve of which were died of variceal bleeding complicated with portal hypertension.The median survival time of TIPS group (3.67 months) was significantly longer than that of control group (1 month). Moreover, the median survival time in patients with low MELD score (≤13) was significantly longer than that in those with high MELD seore (＞13, x2=4.71,P=0.03). Whereas the median survival time was decreasing from Child-Pugh A to C(x2=15.6,P=0.00). Conclusions TIPS is one of effective and safe therapeutic methods to control portal hypertension. However, liver function is an important factor for selcetion of TIPS.

Objective To analyze pathogenic microorganisms and related clinical features in patients with acute cholangitis.Methods The pathogenic microorganism culture results and related clinical data of 229 patients with acute cholangitis in People's Hospital of Haining from 2019 to 2022 were collected and analyzed.Results Among 229 patients,160(69.87%)patients were positive in bile culture,of which 58 patients were infected with multiple bacteria.A total of 227 strains of pathogenic bacteria were isolated from 160 positive bile specimens,of which 136(59.91%)strains were Gram-negative,79(34.80%)strains were Gram-positive and 12(5.29%)strains were fungi.Escherichia coli mixed with Enterococcus faecium was the most common infection(10/58,17.24%).The susceptibility rate of Gram-negative bacteria to amikacin and tigecycline was the highest,and Gram-positive bacteria were highly sensitive to linezolid,vancomycin and tigecycline.Previous biliary surgery history and cirrhosis were independent risk factors for biliary tract infection(P<0.05).Cirrhosis was an independent risk factor for co-infection(P<0.05).Conclusion The pathogenic microorganisms of acute cholangitis are complex in distribution and have some resistance to common antibiotics.Clinicians should pay close attention to patients with acute cholangitis who have a history of biliary tract surgery,cirrhosis and chronic renal insufficiency,and rationally select initial antibiotics.

To establish a model of inactivation adenosine A2A receptors in brain tissues of mice, we transplanted bone marrow cells (BMCs) from wild type (WT) C57BL/6 mice into A2A receptor knockout (A2A KO) C57BL/6 mice which were previously fractionated total body irradiation of 6.2 Gyx2. Six weeks later, we identified and evaluated the model. The results showed that the sexual chromagene pattern on white blood cells of recipient mice changed from female pattern to male pattern and there were 95.9% of A2AR+ cells in peripheral white blood cells of recipient mice, whereas there was no significant difference of A2AR mRNA level in brains between these recipient mice and A2AR KO mice. Furthermore, there was no significant difference of breathing frequency, brain water content and level of glutamate between the model mice and WT mice. These results indicated that we established successfully a mouse model of inactivation adenosine A2A receptors in brain tissues. This may provide a new and efficient strategy to study the effect of adenosine A2A receptors in disease and injuries of central nervous system.
Animals ; Bone Marrow Transplantation ; Brain ; metabolism ; Disease Models, Animal ; Female ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Knockout ; Receptors, Adenosine A2 ; deficiency ; genetics ; Whole-Body Irradiation

Objective To explore the incidence of tibial plateau fracture with ligament injuries and the early diagnosis and management of the condition. Methods Fifty seven cases of tibial plateau fractures which had been treated operatively from Jan. 2001 to Jun.2003 and had satisfactory reduction of the articular surface were reviewed. The stability of their knee joints was analyzed. Results The follow up lasted 6 to 30 months with an average of 15 months. The incidence of knee unstability was low. The four potential reasons for the postoperative knee stability were found to be: 1) the low prevalence of ligament injury with displaced fractures of tibial plateau; 2) incomplete ligament disruption or mild ligament injury; 3) anatomic reduction and rigid internal fixation; 4) fine and detailed plan for immobilization and functional exercise. Conclusion The prevalence of complete ligament disruption is low, and nonoperative management can result in satisfactory outcomes for tibial plateau fracture with incomplete ligament injury.

Objective:To investigate the optimal dose of dexmedetomidine combined with propofol for anesthesia in patients undergoing modified electroconvulsive therapy (MECT).Methods:One hundred and sixty patients of both sexes, aged 20-60 yr, weighing 45-80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective MECT, were allocated into 4 groups ( n=40 each) by a random number table method: different doses of dexmedetomidine combined with propofol group (D 1, D 2 and D 3 groups) and routine anesthesia group (group C). Dexmedetomidine 0.2, 0.4 and 0.6 μg/kg were intravenously injected in D 1, D 2 and D 3 groups, respectively, the equal volume of normal saline was given instead in group C, and propofol 1.0 mg/kg and succinylcholine 0.5 mg/kg were intravenously injected in turn 10 min later.Venous blood samples were collected before giving dexmedetomidine (T 0) and at 1 min after the end of MECT (T 1) for determination of the plasma epinephrine (E) and norepinephrine (NE) concentrations.Propofol consumption, occurrence of cardiovascular events, duration of epilespsy and energy suppression index were recorded. Results:Compared with group C, the plasma E and NE concentrations were significantly decreased at T 4, and the propofol consumption was reduced in D 1, D 2 and D 3 groups ( P<0.05). Compared with group D 2, the plasma E and NE concentrations were significantly increased at T 1 in group D 1 and decreased at T 1 in group D 3 ( P<0.05). The incidence of adverse cardiovascular events was significantly increased in group D 3 than in the other 3 groups ( P<0.05). There was no significant difference in duration of epilespsy or energy suppfession index among the 4 groups( P>0.05). Conclusion:The optimal dose of dexmedetomidine combined with propofol 1.0 mg/kg is 0.4 μg/kg when used for anesthesia in the patients undergoing MECT.

Objective:To investigate the change in 25-hydroxy vitamin D (25-OHD) levels in hospitalized newborns in the neonatal intensive care unit (NICU) between baseline and vitamin D supplementation, and to explore the effect of different levels of vitamin D on the complications.Method:A prospective study was conducted on the newborns admitted to NICU at Jingzhou Hospital Affiliated to Yangtze University within 72 h after birth from January 2021 to January 2022. Vitamin D supplementation was initiated after the detection of basal 25-OHD levels within 72 h after birth. Serum 25-OHD levels were measured after 2, 4, and 6 weeks of supplementation. Newborns were categorized into four groups according to the basal 25-OHD level: sufficient, insufficient, deficient, and severely deficient groups. The analysis of variants, independent sample t-test, paired sample t-test, Chi-square test, or Fisher's exact probability method were employed to evaluate the differences in basal 25-OHD levels among newborns with different clinical conditions and gestational ages, as well as the variation in 25-OHD levels before and after supplementation among the four groups. Furthermore, differences in the morbidity and mortality among different basal status groups were analyzed. Result:(1) During the study period, 626 cases met the inclusion criteria, and after excluding seven cases, 619 infants were ultimately included in the study with serum 25-OHD level within 72 h being (21.8±10.1) ng/ml. There were 134 cases (21.6%) in the sufficient group, 208 cases (33.6%) in the insufficient group, 186 cases (30.0%) in the deficient group, and 91 cases (14.7%) in the severe deficient group. (2) No statistically significant differences were observed in the basal 25-OHD levels regardless of the genders, gestational age, birth month, number of fetuses or small for gestational age (all P>0.05). (3) Among all infants, 158 cases continued to supplement vitamin D for two weeks, 64 cases continued for four weeks, and 13 cases continued for six weeks, with all of them discharged within eight weeks. Compared with the basal 25-OHD levels, there were no statistically significant differences in the serum 25-OHD levels among the sufficient, insufficient, deficient, and severely deficient groups after two weeks of supplementation [(37.1±9.3) vs. (36.8±4.9) ng/ml, (24.7±7.2) vs. (24.7±2.9) ng/ml, (16.0±7.6) vs. (15.4±2.9) ng/ml, (8.1±5.6) vs. (7.6±1.4) ng/ml; t=0.18, 0.04, 0.65 and 0.48, respectively; all P>0.05]. After four weeks of supplementation, however, the serum 25-OHD levels in the four groups were higher than those before supplementation [(40.0±5.2) vs. (35.8±3.9) ng/ml, (29.7±6.4) vs. (24.5±2.9) ng/ml, (20.3±7.1) vs. (15.6±3.0) ng/ml, (14.9±7.3) vs. (6.5±2.3) ng/ml; t=2.13, 2.66, 5.08 and 7.64, respectively; all P<0.05]. (4) The incidence of hypocalcemia [23.1% (21/91) vs. 9.7% (18/186)] and neonatal respiratory distress syndrome [15.4% (14/91) vs. 3.2% (6/186)] were higher in the severely deficient group than those in the deficient group ( χ2=9.07 and 13.49, both P<0.008). No statistically significant differences were observed in the incidence of neonatal sepsis, neonatal necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, and mortality among the four groups (all P>0.05). Conclusions:The insufficiency of 25-OHD levels and vitamin D deficiency were prevalent in NICU neonates. Vitamin D status did not significantly differ among newborns with varying gestational ages. A prolonged period of sustained vitamin D supplementation may be required to elevate the serum 25-OHD level. The incidence of hypocalcemia and neonatal respiratory distress syndrome are higher in newborns with severe vitamin D deficiency.