【Objective】 To investigate the protective effects of aflexible sleeve penile protection device on reducing postoperative pain and wound edema in patients after circumcision. 【Methods】 A total of 54 patients who underwent circumcision at Yan’an Branch of Peking University Third Hospital during Feb.1 and May 31, 2023 were enrolled.The patients were randomly divided into the experimental group and control group, with 27 patients in either groups.Patients in the experimental group were treated with a flexible sleeve penis protection device after surgery, and patients in the control group were treated with traditional gauze bandage after surgery.Postoperative pain, wound edema and complications were compared between the two groups. 【Results】 In terms of pain, the visual analogue scale of the experimental group was significantly lower at 6 hours [(1.7±0.9) vs.(3.3±1.9), P<0.001] and 2 days [(2.0±1.3) vs.(3.3±1.3), P<0.001] after surgery than that of the control group, but there were no statistically significant differences between the two groups on the 4th and 7th postoperative days (P>0.05).In terms of edema, the edema score of the experimental group was significantly lower than that of the control group on the 2nd postoperative day [(2.0±1.0) vs.(4.0±0.8), P<0.001] , the 4th postoperative day [(1.5±1.2) vs.(2.6±0.9), P<0.001] , and the 7th postoperative day [(0.9±1.3) vs.(2.3±1.5), P<0.001] .There was no statistically significant difference in the incidence of complications between the two groups (P>0.05). 【Conclusion】 The flexible sleeve penile protection device has significant effects of reducing early postoperative pain and reducing edema in patients undergoing circumcision.

Objective:To analyze the effectiveness and safety of reoperation for obstructive azoospermia (OA) with initial microsurgical anastomosis failure.Methods:A retrospective case series was performed for OA patients who underwent reoperation after initial microsurgical anastomosis failure, in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Institute of Urology, Urologic Medical Center from March 2015 to June 2020. Totally, 21 patients were enrolled in the study, and the clinical data, patency and pregnancy outcomes were reviewed.Results:During the initial surgery, 8 cases underwent vasovasostomy and 8 cases underwent vasoepididymostomy, while the other 5 cases underwent crossover anastomosis; 19 cases underwent reoperation because of reproductive needs, and 2 for post-vasectomy chronic testicular pain. During the reoperation, anastomotic stricture was found in 14 cases, and sperm granuloma was found in 6 cases, while spermatogenic dysfunction was confirmed in 1 case. Unilateral or bilateral anastomosis was performed successfully in 19 cases. Testicular sperm extraction was performed for 1 case with non-obstructive azoospermia (NOA) and 1 case with severe adhesion respectively. Totally 19 cases was followed for 3 to 58 months [(30.21±18.43) months], and 2 cases were lost to follow-up. Chronic testicular pain was relieved completely in 1 of the 2 cases suffering from the post-vasectomy testicular pain. Overall, 11 cases achieved patency, and 4 cases concieved naturally. Furthermore, 3 cases underwent in vitro fertilization cycle (1 case with semen sperm, and the other 2 cases with frozen testicular sperm). There were no severe post-operational complications in all cases. Conclusion:Microsurgical reoperation, which allows a favorable patency rate and natural pregnancy rate, is a valid option for the treatment of OA with initial microsurgical anastomosis failure.

Objective:To analyze the effectiveness and safety of reoperation for obstructive azoospermia (OA) with initial microsurgical anastomosis failure.Methods:A retrospective case series was performed for OA patients who underwent reoperation after initial microsurgical anastomosis failure, in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Institute of Urology, Urologic Medical Center from March 2015 to June 2020. Totally, 21 patients were enrolled in the study, and the clinical data, patency and pregnancy outcomes were reviewed.Results:During the initial surgery, 8 cases underwent vasovasostomy and 8 cases underwent vasoepididymostomy, while the other 5 cases underwent crossover anastomosis; 19 cases underwent reoperation because of reproductive needs, and 2 for post-vasectomy chronic testicular pain. During the reoperation, anastomotic stricture was found in 14 cases, and sperm granuloma was found in 6 cases, while spermatogenic dysfunction was confirmed in 1 case. Unilateral or bilateral anastomosis was performed successfully in 19 cases. Testicular sperm extraction was performed for 1 case with non-obstructive azoospermia (NOA) and 1 case with severe adhesion respectively. Totally 19 cases was followed for 3 to 58 months [(30.21±18.43) months], and 2 cases were lost to follow-up. Chronic testicular pain was relieved completely in 1 of the 2 cases suffering from the post-vasectomy testicular pain. Overall, 11 cases achieved patency, and 4 cases concieved naturally. Furthermore, 3 cases underwent in vitro fertilization cycle (1 case with semen sperm, and the other 2 cases with frozen testicular sperm). There were no severe post-operational complications in all cases. Conclusion:Microsurgical reoperation, which allows a favorable patency rate and natural pregnancy rate, is a valid option for the treatment of OA with initial microsurgical anastomosis failure.

Azoospermia accounts for 10%-15% of male infertility, with the prevalence of 1% in male population. Obstructive azoospermia (OA) accounts for 40% of azoospermia and can be caused by a variety of factors, including male reproductive duct inflammation and genetic factors. Given the fact that the spermatogenesis is normal in the testis of OA patients, the OA patients can have their own offspring through testicular biopsy and sperm retrieval followed by assisted reproductive technology (ART). Therefore, the genetic etiology of OA is often overlooked. Subsequently, studies of the following ART strategies and offspring birth defects are also ignored. This article reviewed the genetic disorders of OA patients, and the animal model with OA, providing new ideas for management of OA patients, genetic counseling, and development of male contraceptives.

Azoospermia accounts for 10%-15% of male infertility, with the prevalence of 1% in male population. Obstructive azoospermia (OA) accounts for 40% of azoospermia and can be caused by a variety of factors, including male reproductive duct inflammation and genetic factors. Given the fact that the spermatogenesis is normal in the testis of OA patients, the OA patients can have their own offspring through testicular biopsy and sperm retrieval followed by assisted reproductive technology (ART). Therefore, the genetic etiology of OA is often overlooked. Subsequently, studies of the following ART strategies and offspring birth defects are also ignored. This article reviewed the genetic disorders of OA patients, and the animal model with OA, providing new ideas for management of OA patients, genetic counseling, and development of male contraceptives.

Objective To evaluate the effect of azitromycin upon the bronchiolitis obliterans and T helper (Th)17/regulatory T cell (Treg) balance after lung transplantation. Methods Twenty-four specific pathogen free(SPF) C57BL/6 mice were used as the donors and 48 Balb/c mice were utilized as the recipients. The Balb/c mice were randomly divided into the control (C group), azitromycin control (Cazm group), transplantation (T group) and transplantation + azitromycin groups (Tazm group), 12 mice in each group. In the T and Tazm groups, heterotopic tracheal transplantation models were established to simulate bronchiolitis obliterans after lung transplantation. From 1 d post-transplantation, intragastric administration of azitromycin was given at a dose of 30 mg/kg three times per week in the Cazm and Tazm groups. At 14 and 28 d after transplantation, the transplanted trachea was removed and peripheral blood was collected. The tracheal sample was prepared for hematoxylin-eosin (HE) staining for pathological observation. The expression levels of ROR-γt and Foxp3 messenger ribonucleic acid (mRNA) in the peripheral blood were quantitatively measured by reverse transcription polymerase chain reaction (RT-PCR). The variation in the related cytokines levels of Th17 cells and Treg in the plasma was detected by enzyme linked immunosorbent assay (ELISA). Results After heterotopic tracheal transplantation, compared with the C group, thetracheal occlusion accompanied with inflammatory infiltration was observed in the T and Tazm groups. The severity of relevant symptoms in the Tazm group was slighter than that in the T group. Compared with the T group, the expression level of ROR-γt mRNA in the Tazm group was significantly down-regulated (P<0.05). No statistical significance was identified in the expression of Foxp3 mRNA between two groups (P>0.05). Compared with the T group, the levels of interleukin (IL)-6 and IL-17 cytokines in the Tazm group were significantly down-regulated (all P<0.05). Conclusions Persistent therapy of azitromycin can delay the progression of bronchiolitis obliterans after transplantation, which is probably associated with inhibiting Th17 cell differentiation and inflammation.

Objective:To explore the effect of bone marrow mesenchymal stem cell transplantation on silicosis fibrosis in different time windows in rats.Methods:BMSCs were isolated and cultured from male 3-week-old SD rats in vitro.Fifty healthy female SD rats were randomly divided into 5 groups:control group,silicosis model group,early treatment group,middle treatment group,late treatment group(n=10).The silicosis model was made by one-time infusion of silica dust suspension using the non-exposed tracheal in-tubation(50 μg/ml),and 1 d,14 d,28 d of BMSCs were given for intervention therapy (1 ×106 ml-1 ).Rats in each group were sacrificed 14 days after treatment.The BMSCs identified by flow cytometry;the morphological changes of the lung tissues were observed by HE staining;the expression of MMP-9,collagen type Ⅰ and collagen type Ⅲ were detected by immunocytochemistry and Western blot analysis.Results: BMSCs in early silicosis ( 1 d ) and the middle silicosis ( 14 d ) compared to silicosis model group can significantly alleviate the pathological process of silicosis fibrosis (P<0.05),BMSCs in late silicosis (28 d) treatment had no significant effect(P>0.05).Conclusion:Exogenous BMSCs transplantation on rat silicosis early pathological processes play a role in delaying , late treatment effect is not obvious.

Objective To observe expression of autophagy-related proteins LC-3 and Beclin-1 in alveolar macrophages in the silicosis model of rats , and to investigate the molecular mechanisms of silicosis formation from cells autophagy perspective .Methods Fifty adult male SD rats were randomly divided into control and model groups , 25 rats for each group .The silicosis model was made by one-time infusion of silica dust suspension through the trachea without exposed.The rats were sacrificed on the 1st, 3rd, 7th, 14th or 28th day after the modeling .Alveolar macrophages were obtained from bronchoalveolar lavage and used for subsequent research after culture and purification .Morphological characteristics of alveolar macrophages were observed by HE staining and transmission electron microscope ;The expression of LC-3 and Beclin-1 was detected by means of immunocytochemistry and Western blotting in each group .Results Compared with the control group , alveolar macrophages of the model group had larger volume and abundant cytoplasm , the phagocytic silica dust particles were observed in some cells , and autophagosomes were detected by transmission electron microscope .The expressions of LC-3 and Beclin-1 were increased at all time points in the model group ( P<0.05 ) .Both LC-3 and Beclin-1 began to increase at the 1st day.As the extension of time the expression gradually enhanced , peaked at the 14th day(P<0.05), and decreased at the 28th day, but higher than the basal expression .Conclusion Autophagy is activated in alveolar macrophages of the silicosis model , and alveolar macrophages autophagy is involved in the pathological process of silicosis in the rat .

ObjectiveA survey of the status quo of community nursing health resources in Shao xing countryside was carry out in order to rationally allocate medical resource,optimize quality of medical employees and construct modern rural community nursing patterns.MethodsA survey for 19 health service organizations and 381 nurses in rural communities was carried out with questionnaires.Results There existed regional differences in medical resources.The medical resources per ten thousand people were limited,only 0.7 health education room,1.2 recovery rooms,0.4 women and children′s health center.There was 1 nurse for every 1877 rural residents.The average age of nurses was (30.84±6.88) years old.Nurses on professional health education,community arevention of diseases only accountel for 43.8％.Community nuses of different ages and with different degrees had different knowledge requirements.ConclusionsThe medical resources are limited and imbalanced.The employees are too young and they have only low level of education and are not professional enough.Rational allocation of resources,optimization of personnel structure and abundance of on-the-job training is urgently needed.