Objective:This study aims to investigate the determinants influencing the efficacy of microsurgical sperm retrieval in individuals diagnosed with idiopathic non-obstructive azoospermia (iNOA).Methods:A retrospective analysis was performed on the clinical data of 757 patients diagnosed with iNOA who underwent microsurgical sperm extraction at Peking University Third Hospital between January 2019 and December 2021. The median age of patients was 31(29, 33)years, and the duration of infertility was 3(2, 5)years. A total of 169 patients (22.3%) received preoperative pharmacological treatment with agents such as follicle-stimulating hormone, human chorionic gonadotropin, or aromatase inhibitors. Additionally, 327 patients (43.2%) underwent testicular biopsy (TESA) prior to surgery. Among these, 51 cases (15.9%) exhibited sperm presence on smear microscopy, while 57 cases (17.8%) demonstrated sperm presence on pathological examination. The pathological classifications of the biopsies included 102 cases (31.9%) of reduced spermatogenic function, 66 cases (20.6%) of delayed sperm maturation, and 63 cases (19.7%) of sertoli cell-only syndrome.Preoperative median pituitary prolactin(PRL)was 9.1(6.5, 12.5)ng/ml, follicle-stimulating hormone (FSH)20.1(14.2, 28.5)U/L, luteinizing hormone (LH)7.9(5.5, 11.3)U/L, testosterone(T)117 .0(81.3, 154.0)nmol/L, estradiol(E2)8.7(6.3, 11.8)pmol/L. Under general anesthesia, patients underwent microsurgical testicular incision for sperm retrieval.The surgical testicular volume was measured at a median of 6(5, 10) ml. Among the cases studied, 59 patients (7.7%) underwent left testicular surgery, 213 patients (28.1%) underwent right testicular surgery, and 485 patients (64.0%) underwent bilateral testicular surgery. Furthermore, 44 patients (5.8%) underwent a second microsurgical sperm retrieval procedure, while 4 patients (0.5%) underwent a third procedure.Based on the presence of sperm identified during the surgical procedure, participants were categorized into a sperm retrieval group and a non-sperm retrieval group. Clinical data of these two groups were analyzed. A subgroup analysis was performed on the observed indicators. Both univariate and multivariate logistic regression analyses were employed to examine the factors influencing the micro sperm retrieval rate.Results:Among the 757 iNOA patients, 255(33.7%) obtained sperm through micro sperm retrieval, while 502(66.3%) did not obtain sperm through micro sperm retrieval. The age of sperm-receiving group was higher than that of the non-sperm-receiving group [32(30, 35)years vs. 30(28, 33)years, P<0.01], and the course of infertility was longer than that of the non-sperm-receiving group [3.0(2.0, 5.5)years vs. 3.0(2.0, 4.0)years, P=0.004]. There was no significant difference in the sperm acquisition rate in the subgroup with or without preoperative drug treatment [38.5%(65/169)vs. 32.7%(185/566), P=0.164]. There was statistical significance in the sperm collection rate of different TESA results in subgroups [85.7%(24/28)of sperm were detected by microscopic smear and pathological examination and 75.9%(22/29)of sperm were detected by pathological examination and no sperm were detected by microscopic smear and 17% of sperm were not detected by microscopic smear and pathological examination (42/247), P<0.01). The rate of spermatogenesis in the subgroup with low spermatogenic function was significantly higher than that in the subgroup with spermatogenic maturation retardation and sercell-only syndrome [47.1%(48/112), 12.1%(8/66)vs. 11.1%(7/63), P<0.01]. There was no significant difference in testicular volume between the seminal and non-seminal groups [6.0(5.0, 10.0)ml vs. 6.0(5.0, 9.5)ml, P=0.862]. Pituitary prolactin [8.3(5.8, 12.0)ng/ml vs. 9.3(7.5, 13.0)ng/ml, P=0.001] and FSH[18.3(11.8, 27.4)U/L vs. 20.7(15.2, 28.7)U/L, P=0.005] in spermated group were lower than those in non-spermated group. Luteinizing hormone [7.6(5.1, 11.0)U/L vs. 8.0(5.6, 11.5)U/L, P=0.126], testosterone [8.8(6.0, 11.8)nmol/L vs. 8.7(6.4, 11.7)nmol/L, P=0.607], estradiol [124.0(87.8, 156.0)nmol/L vs. 114.5(79.9, 151.3)nmol/L, P=0.105] had no significant difference. The recovery rate of the first operation was higher than that of the second operation [97.7%(43/44)vs. 81.8%(36/42), P=0.032]. The sperm retrieval rate of bilateral operation was significantly lower than that of unilateral operation [6.0% bilateral (29/485)vs. 86.4% left (51/59)vs. 82.2% right (175/213), P<0.01]. The proportion of no sperm on one side of bilateral operation and only 4.7%(23/485)on the opposite side were obtained. The results of multivariate analysis showed that >30 and ≤40 years old subgroup ( OR=2.226, 95% CI 1.364-3.632, P=0.001), >40 and ≤50 years old subgroup ( OR=4.282, 95% CI 1.457-12.588, P=0.008)was higher than that of >20 and ≤30 years old subgroup. The sperm acquisition rate of the sperm subgroup was significantly increased by smear microscopy and pathological examination ( OR=6.486, 95% Cl 1.444-29.127, P=0.015), while the sperm acquisition rate of the sperm subgroup was not significantly decreased by smear microscopy and pathological examination ( OR=0.420, 95% Cl 0.200-0.881, P=0.022). The pathological type of puncture was associated with lower spermatogenesis maturation block ( OR=0.099, 95% CI 0.019-0.509, P=0.006). Higher FSH (>7.6 U/L)was associated with lower sperm yield ( OR=0.324, 95% CI 0.122-0.856, P=0.023). Conclusions:Age, FSH level, results of testicular biopsy and pathologic type of biopsy are independent factors affecting the sperm retrieval rate of iNOA patients undergoing micro-TESE. The success rate of sperm retrieval diminished following multiple surgical procedures. Furthermore, for patients who did not have sperm successfully retrieved from one side, that the likelihood of sperm retrieval from contralateral surgery would also be low.

Objective:This study aims to investigate the determinants influencing the efficacy of microsurgical sperm retrieval in individuals diagnosed with idiopathic non-obstructive azoospermia (iNOA).Methods:A retrospective analysis was performed on the clinical data of 757 patients diagnosed with iNOA who underwent microsurgical sperm extraction at Peking University Third Hospital between January 2019 and December 2021. The median age of patients was 31(29, 33)years, and the duration of infertility was 3(2, 5)years. A total of 169 patients (22.3%) received preoperative pharmacological treatment with agents such as follicle-stimulating hormone, human chorionic gonadotropin, or aromatase inhibitors. Additionally, 327 patients (43.2%) underwent testicular biopsy (TESA) prior to surgery. Among these, 51 cases (15.9%) exhibited sperm presence on smear microscopy, while 57 cases (17.8%) demonstrated sperm presence on pathological examination. The pathological classifications of the biopsies included 102 cases (31.9%) of reduced spermatogenic function, 66 cases (20.6%) of delayed sperm maturation, and 63 cases (19.7%) of sertoli cell-only syndrome.Preoperative median pituitary prolactin(PRL)was 9.1(6.5, 12.5)ng/ml, follicle-stimulating hormone (FSH)20.1(14.2, 28.5)U/L, luteinizing hormone (LH)7.9(5.5, 11.3)U/L, testosterone(T)117 .0(81.3, 154.0)nmol/L, estradiol(E2)8.7(6.3, 11.8)pmol/L. Under general anesthesia, patients underwent microsurgical testicular incision for sperm retrieval.The surgical testicular volume was measured at a median of 6(5, 10) ml. Among the cases studied, 59 patients (7.7%) underwent left testicular surgery, 213 patients (28.1%) underwent right testicular surgery, and 485 patients (64.0%) underwent bilateral testicular surgery. Furthermore, 44 patients (5.8%) underwent a second microsurgical sperm retrieval procedure, while 4 patients (0.5%) underwent a third procedure.Based on the presence of sperm identified during the surgical procedure, participants were categorized into a sperm retrieval group and a non-sperm retrieval group. Clinical data of these two groups were analyzed. A subgroup analysis was performed on the observed indicators. Both univariate and multivariate logistic regression analyses were employed to examine the factors influencing the micro sperm retrieval rate.Results:Among the 757 iNOA patients, 255(33.7%) obtained sperm through micro sperm retrieval, while 502(66.3%) did not obtain sperm through micro sperm retrieval. The age of sperm-receiving group was higher than that of the non-sperm-receiving group [32(30, 35)years vs. 30(28, 33)years, P<0.01], and the course of infertility was longer than that of the non-sperm-receiving group [3.0(2.0, 5.5)years vs. 3.0(2.0, 4.0)years, P=0.004]. There was no significant difference in the sperm acquisition rate in the subgroup with or without preoperative drug treatment [38.5%(65/169)vs. 32.7%(185/566), P=0.164]. There was statistical significance in the sperm collection rate of different TESA results in subgroups [85.7%(24/28)of sperm were detected by microscopic smear and pathological examination and 75.9%(22/29)of sperm were detected by pathological examination and no sperm were detected by microscopic smear and 17% of sperm were not detected by microscopic smear and pathological examination (42/247), P<0.01). The rate of spermatogenesis in the subgroup with low spermatogenic function was significantly higher than that in the subgroup with spermatogenic maturation retardation and sercell-only syndrome [47.1%(48/112), 12.1%(8/66)vs. 11.1%(7/63), P<0.01]. There was no significant difference in testicular volume between the seminal and non-seminal groups [6.0(5.0, 10.0)ml vs. 6.0(5.0, 9.5)ml, P=0.862]. Pituitary prolactin [8.3(5.8, 12.0)ng/ml vs. 9.3(7.5, 13.0)ng/ml, P=0.001] and FSH[18.3(11.8, 27.4)U/L vs. 20.7(15.2, 28.7)U/L, P=0.005] in spermated group were lower than those in non-spermated group. Luteinizing hormone [7.6(5.1, 11.0)U/L vs. 8.0(5.6, 11.5)U/L, P=0.126], testosterone [8.8(6.0, 11.8)nmol/L vs. 8.7(6.4, 11.7)nmol/L, P=0.607], estradiol [124.0(87.8, 156.0)nmol/L vs. 114.5(79.9, 151.3)nmol/L, P=0.105] had no significant difference. The recovery rate of the first operation was higher than that of the second operation [97.7%(43/44)vs. 81.8%(36/42), P=0.032]. The sperm retrieval rate of bilateral operation was significantly lower than that of unilateral operation [6.0% bilateral (29/485)vs. 86.4% left (51/59)vs. 82.2% right (175/213), P<0.01]. The proportion of no sperm on one side of bilateral operation and only 4.7%(23/485)on the opposite side were obtained. The results of multivariate analysis showed that >30 and ≤40 years old subgroup ( OR=2.226, 95% CI 1.364-3.632, P=0.001), >40 and ≤50 years old subgroup ( OR=4.282, 95% CI 1.457-12.588, P=0.008)was higher than that of >20 and ≤30 years old subgroup. The sperm acquisition rate of the sperm subgroup was significantly increased by smear microscopy and pathological examination ( OR=6.486, 95% Cl 1.444-29.127, P=0.015), while the sperm acquisition rate of the sperm subgroup was not significantly decreased by smear microscopy and pathological examination ( OR=0.420, 95% Cl 0.200-0.881, P=0.022). The pathological type of puncture was associated with lower spermatogenesis maturation block ( OR=0.099, 95% CI 0.019-0.509, P=0.006). Higher FSH (>7.6 U/L)was associated with lower sperm yield ( OR=0.324, 95% CI 0.122-0.856, P=0.023). Conclusions:Age, FSH level, results of testicular biopsy and pathologic type of biopsy are independent factors affecting the sperm retrieval rate of iNOA patients undergoing micro-TESE. The success rate of sperm retrieval diminished following multiple surgical procedures. Furthermore, for patients who did not have sperm successfully retrieved from one side, that the likelihood of sperm retrieval from contralateral surgery would also be low.

Objective:To compare the advantages of high or low inferior mesenteric artery (IMA) ligation in laparoscopic anterior resection of rectum based on CT precise guidance.Methods:One hundred and twenty patients with rectal cancer who underwent laparoscopic anterior resection of rectum in Shanghai Sixth People′s Hospital South Campus from January 2016 to June 2020 were selected. Surgical protocol was selected according to the principle of voluntariness. Sixty-eight cases underwent high IMA ligation (high IMA ligation group), and 52 cases underwent low IMA ligation (low IMA ligation group). The perioperative conditions (operative time, intraoperative blood loss, postoperative anal exhaust time, abdominal drainage, hospitalization time and ileostomy), postoperative pathological data (proximal margin distance, distal margin distance, total number of dissected lymph nodes and number of positive lymph nodes) and postoperative recovery (anastomotic stoma fistula, urinary retention, sexual dysfunction and daily number of defecation) were recorded. The quality of life 6 months after surgery was evaluated by the quality of life instruments for colorectal cancer scale (QLQ-CR38). Patients were followed up for 6 to 36 months, and the local recurrence and distant metastasis were recorded.Results:The postoperative anal exhaust time in low IMA ligation group was significantly shorter than that in high IMA ligation group: (2.87 ± 1.04) d vs. (3.26 ± 1.00) d, and there was statistical difference ( P<0.05); there were no statistical differences in operative time, intraoperative blood loss, abdominal drainage, hospitalization time and rate of ileostomy between 2 groups ( P>0.05). There were no statistical difference in proximal margin distance, distal margin distance, total number of dissected lymph nodes and number of positive lymph nodes between 2 groups ( P>0.05). The incidences of anastomotic stoma fistula, urinary retention and sexual dysfunction in low IMA ligation group were significantly lower than those in high ligation group: 3.85% (2/52) vs. 13.24% (9/68), 3.85% (2/52) vs. 11.76% (8/68) and 5.77% (3/52) vs. 14.71% (10/68), the daily number of defecation was significantly less than that in high ligation group: (2.87 ± 0.98) times vs. (4.05 ± 1.56) times, and there were statistical differences ( P<0.05 or <0.01). The functional dimension, symptom dimension and aggregate score of QLQ-CR38 in low IMA ligation group were significantly higher than those in high ligation group: (15.46 ± 4.22) scores vs. (13.68 ± 3.56) scores, (51.82 ± 13.54) scores vs. (45.65 ± 12.42) scores and (67.28 ± 14.28) scores vs. (59.33 ± 12.85) scores, and there were statistical differences ( P<0.05 or <0.01). There were no statistical difference in the rates of local recurrence and distant metastasis between 2 groups ( P>0.05). Conclusions:The application of low IMA ligation based on CT precise guidance in laparoscopic anterior resection of rectum can obtain the same surgical effect as the high IMA ligation. It can promote the recovery of gastrointestinal function after surgery, reduce the risk of complications, have less effect on the defecation function, which can improve the life quality after the surgery.

Objective:To explore the effect and mechanism of hyperbaric oxygen (HBO) in alleviating infarction cerebral in rats via regulating miR-153-3p/Bcl-2 axis.Methods:A total of 32 Sprague-Dawley rats were divided into sham operation group, model group, HBO group, and HBO + mimic group according to the random number table method, with 8 rats in each group. The rat cerebral model was established by middle cerebral artery occlusion (MCAO) method. After 48 hours of reperfusion, the rats were euthanized, and their hippocampal and cortical tissues were collected to assess the brain edema and nerve function damage. The TUNEL assay was used to observe the cell apoptosis in rat hippocampus and cortex. The RT-PCR test was used to detect the expression level of miR-153-3p in the rat brain tissue. The Western blotting test was adopted to detect the protein expression level of rat brain tissue. The ELISA was used to detect the level of inflammatory factor in the rat brain tissue. The luciferase reporter assay was used to detect the transcription activity of Bcl-2. The RT-PCR test was to detect the expression level of Bcl-2 mRNA in PC-12 cells.Results:Compared with the sham operation group, the expression level of miR-153-3p in the brain tissue of rats in the model group after MCAO treatment was significantly increased, and the expression level of miR-153-3p induced by MCAO was reduced after HBO treatment, but the expression level changing of miR-153-3p in the hyperbaric oxygen + mimic group was obviously reversed after the intervention of mimic-miR-153-3p, and the differences were all statistically significant ( P<0.05). Compared with the sham operation group, the neurological damage score and brain water content in the model group increased, and the score and content decreased after HBO treatment, but the effect of HBO was significantly mitigated after miR-153-5p overexpression; and the differences were all statistically significant ( P<0.05). Compared with the model group, the levels of IL-6, CRP, and TNF-α in the brain tissue of rats in the HBO group were significantly reduced, while the up-regulation of miR-153-3p increased the expression levels of IL-6, CRP, and TNF-α; and the differences were all statistically significant ( P<0.05). When the expression of miR-153-3p in rat PC-12 cells was up-regulated, the fluorescence and transcriptional activity of Bcl-2 were significantly reduced, the expression of miR-153-3p was up-regulated, and the level of Bcl-2 mRNA was reduced; the differences were all statistically significant ( P<0.05). Conclusion:Hyperbaric oxygen can relieve brain edema by improving the brain cell apoptosis and inflammatory reaction induced by MCAO via regulating the miR-153-3p/Bcl-2 axis.

Objective:To explore the effect and mechanism of hyperbaric oxygen (HBO) in alleviating infarction cerebral in rats via regulating miR-153-3p/Bcl-2 axis.Methods:A total of 32 Sprague-Dawley rats were divided into sham operation group, model group, HBO group, and HBO + mimic group according to the random number table method, with 8 rats in each group. The rat cerebral model was established by middle cerebral artery occlusion (MCAO) method. After 48 hours of reperfusion, the rats were euthanized, and their hippocampal and cortical tissues were collected to assess the brain edema and nerve function damage. The TUNEL assay was used to observe the cell apoptosis in rat hippocampus and cortex. The RT-PCR test was used to detect the expression level of miR-153-3p in the rat brain tissue. The Western blotting test was adopted to detect the protein expression level of rat brain tissue. The ELISA was used to detect the level of inflammatory factor in the rat brain tissue. The luciferase reporter assay was used to detect the transcription activity of Bcl-2. The RT-PCR test was to detect the expression level of Bcl-2 mRNA in PC-12 cells.Results:Compared with the sham operation group, the expression level of miR-153-3p in the brain tissue of rats in the model group after MCAO treatment was significantly increased, and the expression level of miR-153-3p induced by MCAO was reduced after HBO treatment, but the expression level changing of miR-153-3p in the hyperbaric oxygen + mimic group was obviously reversed after the intervention of mimic-miR-153-3p, and the differences were all statistically significant ( P<0.05). Compared with the sham operation group, the neurological damage score and brain water content in the model group increased, and the score and content decreased after HBO treatment, but the effect of HBO was significantly mitigated after miR-153-5p overexpression; and the differences were all statistically significant ( P<0.05). Compared with the model group, the levels of IL-6, CRP, and TNF-α in the brain tissue of rats in the HBO group were significantly reduced, while the up-regulation of miR-153-3p increased the expression levels of IL-6, CRP, and TNF-α; and the differences were all statistically significant ( P<0.05). When the expression of miR-153-3p in rat PC-12 cells was up-regulated, the fluorescence and transcriptional activity of Bcl-2 were significantly reduced, the expression of miR-153-3p was up-regulated, and the level of Bcl-2 mRNA was reduced; the differences were all statistically significant ( P<0.05). Conclusion:Hyperbaric oxygen can relieve brain edema by improving the brain cell apoptosis and inflammatory reaction induced by MCAO via regulating the miR-153-3p/Bcl-2 axis.

Objective To explore the application of washing fluid in the prevention of postoperative incision infection of colorectal cancer. Methods 350 patients with colorectal cancer underwent colorectal surgery from Jan. 2012 to Dec. 2015 were randomly divided into three groups: sterile saline, 0.50% metronidazole, 0.50% Povidone-iodine solution group, while part of the rinse liquid heated to 37 ~38℃ before use, then record the operation time, surgical site, postoperative incision infection, incision infection, timely delivery statistical analysis was performed by using single factor analysis and logistic multivariate regression analysis. Age, operation time, surgical site, type of irrigating fluid and temperature of flushing fluid were analyzed statistically. Results The incision infection rate of the patients ≥60 years old and the operation time ≥2 h was higher than the age <60 years, and the operation time was less than 2 h, P < 0.05, the difference was statistically significant; 0.50% metronidazole, 0.50% Povidone-iodine solution group, the infection rates of 0.50% metronidazole and 0.50% povidone-iodine group were 7.69% and 8.55%, respectively, which were significantly lower than those of the saline group 16.38% The infection rate of the rinsing fluid after heating was 7.22% and 14.71%, respectively, lower than that of the normal temperature rinsing solution (P < 0.05), the difference was statistically significant. Conclusions The risk factors of incisional infection in colorectal cancer patients with colorectal cancer were : ≥60 years of age and ≥2 h of operation, while 0.50%metronidazole, 0.50% povidone-iodine solution and heated washing fluid were protective factors. It can be applied to prevent incision infection after laparoscopic surgery.

Objective To observe the clinical effect of edaravone combined with citicoline for treatment of acute ischemic cerebral infarctio.Methods Eighty-two cases patients of acute cerebral infarction were selected from March 2012 to August 2013 in the General Hospital of XingTai Mining group.According to admission order,they were randomly divided into observation group and control group,and each group of 41 cases.Single blind studies were carried out and on the basis of conventional treatment methods,the control group was given ozagrel sodium 80 mg,2 times/d,continuous 14 days.Observation group applied 30 mg edaravone,2 times/d,continuous 14 days.Besides this,observation group were given citicoline 1 000 mg,ontinuous 14 days.Comparison of therapeutic effects were observed for 14 days.Results Before and after treatment,the national institutes of health stroke scale (NIHSS) score,Barthel index,superoxide dismutase (SOD) of observation group were (14.1±3.2) and (5.1±1.6),(51.6±13.5) and (73.1±15.9),(145.3±32.6) U/L and (226.9± 39.7) U/L,which of control group were (13.7 ± 3.3) and (10.2± 3.0),(53.4± 13.8) and (59.9±14.1),(143.6±33.8) U/L and (179.4±35.7) U/L,and there were significant difference between before and after treatment of two groups(observation group:t=16.108,6.600,10.171,P＜0.01;control group:t =5.025,2.110,4.663,P＜0.05),and between observation group and control group after treatment(t =0.605,3.977,5.697,P＜0.01).Furthermore observation group's total effective rate was 97.6％ (40/41),significantly better than that of control group,and the difference was significant (80.5％ (33/41),x2 =4.49,P ＜0.05).Conclusion It is better that edaravone combined with citicoline for the treatment of acute ischemic cerebral infarction which can effectively protect the brain tissue,improve the patients' neurologic deficits and their ability of daily life.

Objective:To observe the effects of hyperthermia on the sensitivity of gastric cancer cell lines to paclitaxel (TAX) . Methods :To establish TAX-resistant gastric cancer cell line through a method of increasing concertration gradient and named it MKN-45/TAX .Immunocytohistochemistry staining method was used to detect the expression of multi-drug resistance gene (MDR1) in MKN-45/TAX and MKN-45 .CCK-8 test was used to detect the proliferation inhibition rates in two kinds of cell lines under different temperatures and different TAX concentration .Real-time polymerase chain reaction (RT-PCR) and West-ern blotting were used to detect the expression of MDR1 mRNA and P-glycoprotein (P-gp) before and after target siRNA treat-ment .Results:Establishment of MKN-45/TAX cell line was successful .The expression level of MDR1 was high in MKN-45/TAX whereas it was low in MKN-45 .As TAX concentration increased ,the proliferation inhibition rates of both cell lines in-creased .At 42 ℃ the proliferation inhibition rate of MKN-45/TAX to TAX chemotherapy decreased ,while that of MKN-45 was the opposite .Both the expression of MDR1 mRNA and P-gp decreased after the siRNA transfection .Conclusions :Hyper-thermia combined with chemotherapy may enhance the resistance of TAX-resistant gastric cancer cell line to TAX ,while it may enhance the sensitivity of TAX-sensitive gastric cancer cell line to TAX .The mechanism may be related to the expression of MDR1 .