Objective:To explore the relationship between intestinal microbiomes and asthenospermia.Methods:This was a retrospective case control study. A total of 32 men with asthenospermia and 30 normal men (named control group) were included. The subjects were recruited from Department of Andrology of Shenyang Jinghua Hospital from January 2021 to June 2021. Basic information was collected, semen quality was tested, abundance of intestinal bacteria in feces was detected using 16S rDNA full length assembly sequencing technology (16S-FAST).Results:In patients with asthenospermia, the total sperm count [112.22×10 6 (79.13×10 6, 179.76×10 6)], forward progressive motility rate [22.93% (16.71%, 28.02%)], non-forward progressive motility rate [5.60% (3.98%, 7.62%)] were significantly lower and immobile sperm rate [72.19% (65.27%,78.92%)] was significantly higher than those of control group [166.76×10 6 (110.17×10 6, 262.79×10 6), P=0.022; 42.37% (35.21%, 57.88%), P<0.001; 8.82% (6.18%,11.14%), P=0.001; 50.88% (33.33%, 56.24%), P<0.001], and there were no significant differences in age and body mass index between the two groups (all P>0.05). The participating population can be divided into enterotype 1 (Bacteroide enterotype) and enterotype 2 (Prevotella enterotype). There was no significant difference in α diversity between asthenospermia group and control group in two enterotypes (all P>0.05). In the population with enterotype 2, β diversity analysis clearly separated the microbiome of men with asthenospermia and healthy controls, and the abundance of Proteobacteria phylum, Clostridium sp., Ruminococcus bromii, Phocea massiensis, C. disporicum, Tyzzerella sp. Marseille_P3062, Howardella ureilytica, C. perfringens, and C. sp. BG-C151 species were more abundant in men with asthenospermia compared with control group [linear discriminant analysis (LDA)>2]; while in the population with enterotype 1, β diversity analysis could not separate the microbiome of men with asthenospermia and non-asthenospermia men ( P>0.05). In addition, KEGG analysis showed that in the population with enterotype 2, thiamine metabolism PATH ko00730 pathway, which was closely related to differential bacteria, was significantly less abundant in asthenospermia group than in control group (LDA>2). Conclusion:The intestinal microbiome and KEGG functional pathways differed significantly between asthenospermia and normozoospermia in population with enterotype 2, while there was no difference in the enterotype 1 population. Changes in intestinal microbiome may have an impact on sperm motility in specific populations.

Objective:To explore the relationship between intestinal microbiomes and asthenospermia.Methods:This was a retrospective case control study. A total of 32 men with asthenospermia and 30 normal men (named control group) were included. The subjects were recruited from Department of Andrology of Shenyang Jinghua Hospital from January 2021 to June 2021. Basic information was collected, semen quality was tested, abundance of intestinal bacteria in feces was detected using 16S rDNA full length assembly sequencing technology (16S-FAST).Results:In patients with asthenospermia, the total sperm count [112.22×10 6 (79.13×10 6, 179.76×10 6)], forward progressive motility rate [22.93% (16.71%, 28.02%)], non-forward progressive motility rate [5.60% (3.98%, 7.62%)] were significantly lower and immobile sperm rate [72.19% (65.27%,78.92%)] was significantly higher than those of control group [166.76×10 6 (110.17×10 6, 262.79×10 6), P=0.022; 42.37% (35.21%, 57.88%), P<0.001; 8.82% (6.18%,11.14%), P=0.001; 50.88% (33.33%, 56.24%), P<0.001], and there were no significant differences in age and body mass index between the two groups (all P>0.05). The participating population can be divided into enterotype 1 (Bacteroide enterotype) and enterotype 2 (Prevotella enterotype). There was no significant difference in α diversity between asthenospermia group and control group in two enterotypes (all P>0.05). In the population with enterotype 2, β diversity analysis clearly separated the microbiome of men with asthenospermia and healthy controls, and the abundance of Proteobacteria phylum, Clostridium sp., Ruminococcus bromii, Phocea massiensis, C. disporicum, Tyzzerella sp. Marseille_P3062, Howardella ureilytica, C. perfringens, and C. sp. BG-C151 species were more abundant in men with asthenospermia compared with control group [linear discriminant analysis (LDA)>2]; while in the population with enterotype 1, β diversity analysis could not separate the microbiome of men with asthenospermia and non-asthenospermia men ( P>0.05). In addition, KEGG analysis showed that in the population with enterotype 2, thiamine metabolism PATH ko00730 pathway, which was closely related to differential bacteria, was significantly less abundant in asthenospermia group than in control group (LDA>2). Conclusion:The intestinal microbiome and KEGG functional pathways differed significantly between asthenospermia and normozoospermia in population with enterotype 2, while there was no difference in the enterotype 1 population. Changes in intestinal microbiome may have an impact on sperm motility in specific populations.

Objective:To investigate the risk factors associated with early hyperuricemia and gout attacks following laparoscopic sleeve gastrectomy (LSG) .Methods:This study was a retrospective observational study. Obese patients who underwent LSG surgery at Tianjin Medical University General Hospital from Jan. 2022 to Jul. 2023 were included according to inclusion and exclusion criteria. General information, body composition data, and laboratory tests were collected preoperatively and at one month postoperatively.Results:This study included a total of 300 patients. ①During the postoperative follow-up period, 216 out of 300 patients developed hyperuricemia, and 14 patients experienced gout attacks. ②Analysis of risk factors for early hyperuricemia revealed that male gender ( OR=5.32, 95% CI=1.953-14.489), postoperative creatinine ( OR=1.031, 95% CI=1.005-1.058), and preoperative uric acid levels ( OR=1.01, 95% CI=1.005-1.014) were independent risk factors for early hyperuricemia after laparoscopic sleeve gastrectomy (LSG). The area under the ROC curve (AUC) for the logistic regression model diagnosing hyperuricemia was 0.803 (95% CI=0.752-0.853), with sensitivity and specificity of 72.2% and 78.6%, respectively. ③Analysis of risk factors for early gout attacks showed that a history of gout ( OR=11.464, 95% CI=1.755-74.873), male gender ( OR=161.895, 95% CI=13.469-1946.022), postoperative fluid ratio ( OR=0.702, 95% CI=0.554-0.889), and changes in uric acid levels ( OR=1.017, 95% CI=1.006-1.028) were independent risk factors for early gout attacks after LSG. The AUC for the logistic regression model diagnosing gout was 0.921 (95% CI=0.808-1), with sensitivity and specificity of 93.4% and 92.9%, respectively. Conclusions:The incidence of early postoperative hyperuricemia is high, whereas the incidence of gout is low after LSG. Gender, preoperative uric acid, and postoperative creatinine are independent risk factors for hyperuricemia after LSG. History of gout, gender, postoperative water ratio, and change in uric acid levels are independent risk factors for gout after LSG.

Objective:To investigate the risk factors associated with early hyperuricemia and gout attacks following laparoscopic sleeve gastrectomy (LSG) .Methods:This study was a retrospective observational study. Obese patients who underwent LSG surgery at Tianjin Medical University General Hospital from Jan. 2022 to Jul. 2023 were included according to inclusion and exclusion criteria. General information, body composition data, and laboratory tests were collected preoperatively and at one month postoperatively.Results:This study included a total of 300 patients. ①During the postoperative follow-up period, 216 out of 300 patients developed hyperuricemia, and 14 patients experienced gout attacks. ②Analysis of risk factors for early hyperuricemia revealed that male gender ( OR=5.32, 95% CI=1.953-14.489), postoperative creatinine ( OR=1.031, 95% CI=1.005-1.058), and preoperative uric acid levels ( OR=1.01, 95% CI=1.005-1.014) were independent risk factors for early hyperuricemia after laparoscopic sleeve gastrectomy (LSG). The area under the ROC curve (AUC) for the logistic regression model diagnosing hyperuricemia was 0.803 (95% CI=0.752-0.853), with sensitivity and specificity of 72.2% and 78.6%, respectively. ③Analysis of risk factors for early gout attacks showed that a history of gout ( OR=11.464, 95% CI=1.755-74.873), male gender ( OR=161.895, 95% CI=13.469-1946.022), postoperative fluid ratio ( OR=0.702, 95% CI=0.554-0.889), and changes in uric acid levels ( OR=1.017, 95% CI=1.006-1.028) were independent risk factors for early gout attacks after LSG. The AUC for the logistic regression model diagnosing gout was 0.921 (95% CI=0.808-1), with sensitivity and specificity of 93.4% and 92.9%, respectively. Conclusions:The incidence of early postoperative hyperuricemia is high, whereas the incidence of gout is low after LSG. Gender, preoperative uric acid, and postoperative creatinine are independent risk factors for hyperuricemia after LSG. History of gout, gender, postoperative water ratio, and change in uric acid levels are independent risk factors for gout after LSG.

Objective:To analyze the effect of microRNA-506 (miR-506) on M2 macrophages polarization and immune intervention in pancreatic cancer mice.Methods:Macrophages from peripheral blood of healthy volunteers were cultured in vitro, polarized into M1 or M2 type macrophages, and transfected with miR-506 or control sequence (miR-ctrl), respectively. Polarized macrophages from M1+ miR-ctrl group, M1+ miR-506 group, M2+ miR-ctrl group and M2+ miR-506 group were collected. The relative expression of marker genes of M1 and M2 type macrophages of four groups were analyzed by qRT-PCR. The characteristic functions of M1 and M2 type macrophages of four groups were also detected, such as phagocytosis and nitric oxide (NO) synthesis (characteristic function of M1 type macrophages), arginase 1 activity and the secretion of vascular endothelial growth factor (VEGF), transforming growth factor-β (TGF-β), interleukin-10 (IL-10) (characteristic function of M2 type macrophages). Sixty healthy male C57BL/6 mice without specific pathogen, weighing 20-25 g, were randomly divided into miR-ctrl programmed death-1 (PD-1) group, miR-506 PD-1 group, miR-ctrl iso group, and miR-506 iso group. They were injected with miR-506, miR-ctrl, PD-1 antibodies, and isotype control antibodies, with 15 in each group. The tumor volume, tumor weight, Ki-67 and interferon γ expression were analyzed three weeks later. Results:Compared with M2+ miR-ctrl group, the relative expression of M1 type macrophage marker genes increased, and the relative expression of M2 type macrophage marker genes decreased in M2+ miR-506 group, with significant difference (all P<0.05). Compared with M2+ miR-ctrl group, the phagocytic function and NO synthesis of macrophages in M2+ miR-506 group increased, the activity of arginase 1 and the secretion of VEGF, TGF-β and IL-10 decreased, with significant difference (all P<0.05). There was no significant differences in tumor weight, volume, Ki-67, and interferon γ expression between miR-ctrl iso and miR-ctrl PD-1 group (all P>0.05). The tumor weight, tumor volume and Ki-67 in miR-506 PD-1 group were lower than those in miR-ctrl PD-1 group [(0.32±0.13) g vs (0.85±0.24) g; (0.72±0.23) cm 3 vs (2.03±0.21) cm 3; (25.9±10.3)% vs (55.6±12.5)%], while interferon-γ expression was significantly higher than that in miR-ctrl PD-1 group [(122.4±15.3) ng/g vs (82.4±22.2) ng/g] (all P<0.05). Conclusion:miR-506 inhibits the polarization of M2 macrophages and increases the anti PD-1 immunotherapy sensitivity in pancreatic cancer.

Objective:To study the effect of ultrasound guided transabdominal plane block (TAPB) on postoperative nausea and vomiting (PONV) in obese patients after laparoscopic sleeve gastrectomy (LSG) .Methods:From Jan. 2017 to Jan. 2022, 285 patients who underwent LSG surgery in the Department of General Surgery, Tianjin Medical University General Hospital were selected and randomly divided into two groups, including 145 patients in TAPB group and 140 patients in the control group (The TAPB group was injected with ropivacaine; the control group injected with physiological saline) . Data between TAPB group and control group were compared, including operation related data, postoperative acute pain assessment, and postoperative recovery assessment.Results:There was no significant difference between the two groups in ASA grading, operation duration, awakening time, extubation time or intraoperative hemodynamic index. The dosage of remifentanil [ (2.0±0.6) vs (2.9±0.9) mg], sufentanil [ (24.7±2.5) vs (50.0±3.2) μg], and dexmedetomidine [ (60.0±0.4) vs (65.0±0.5) μg] in TAPB group was significantly reduced compared with that in the control group, and there was no significant difference in the dosage of propofol. The VAS score and NRS score of resting state and motor state in TAPB group at 1, 3, 6, 12, 24, 48 h after operation were significantly lower than those in the control group. In TAPB group, the first use time of PCIA [ (2.0±0.8) vs (1.1±0.9) h] was significantly prolonged, the number of effective pressing of PCIA (3±1 vs 5±2) within 48 hours and the incidence of rescue analgesia in wards (19.3 % vs 31.4 %) were significantly lower than those in the control group. The frequency (3.0±1.5 vs 3.6±1.8) and severity (2.8±1.4 vs 3.4±1.8) of PONV and the incidence of additional antiemetic drugs (15.9 % vs 27.9 %) in TAPB group were significantly lower than those in the control group. The ambulation time [ (1.4±0.3) vs (1.5±0.3) h] and exhaust time [ (1.2±0.9) vs (1.4±1.0) h] in TAPB group was significantly earlier than those in the control group. There was no significant difference in postoperative length of hospitalization.Conclusion:TAPB for LSG can significantly reduce postoperative pain and PONV, reduce the use of opioid analgesics and antiemetics, and promote recovery of patients.

Objective:To explore the effect of miR-506 on the tumor associated macrophage (TAM) and tumor microenvironment (TME) of pancreatic ductal adenocarcinoma (PDAC).Methods:Panc02 cells were used to establish in situ tumorigenesis mouse model. Tumor bearing C57BL/6 mice were divided into miR-ctrl C57 group and miR-506 C57 group, with 15 mice in each group. miR-ctrl or miR-506 coated with DOPC liposomes (miR-ctrl/DOPC or miR-506/DOPC) were injected intraperitoneally. The tumor weight and volume were measured, the changes of tumor infiltrating immune cells were detected by flow cytometry and the survival time of mice was monitored. To eliminate the influence of immune system, tumor bearing nude mice were divided into miR-ctrl nude group and mir-506 nude group, with 5 mice in each group. miR-ctrl/DOPC or miR-506/DOPC were injected intraperitoneally. To eliminate the influence of macrophages, tumor bearing C57BL/6 mice were randomly divided into control group and macrophage clearance group and injected intraperitoneally with PBS or clodronate liposome (Clo), with 10 mice in each group. Then each group was randomly divided into two groups (miR-ctrl PBS group and miR-506 PBS group, miR-ctrl Clo group and miR-506 Clo group), miR-ctrl PBS group and miR-ctrl Clo group were injected with miR-ctrl/DOPC via intraperitoneal injection, miR-506 PBS group and miR-506 Clo group were injected with miR-506/DOPC. Results:In C57BL/6 mice model, the tumor volume (1.04±0.23)×10 3 mm 3 and tumor weight (0.51±0.10)g of miR-506 C57 group was lower than those in miR-ctrl C57 group (1.92±0.34)×10 3 mm 3 and (0.99±0.19) g, the overall survival of miR-506 C57 group was longer than that of miR-ctrl C57 group. The ratio of M2/M1 in miR-506 C57 group (1.19±0.46) was lower than that in miR-ctrl C57 group (2.85±0.40). In BALB/C nude mice model, the tumor volume and tumor weight showed no significant difference between miR-506 nude group and miR-ctrl nude group. Compared with the miR-ctrl PBS group, the proportion of regulatory T cells decreased [(4.70±1.86)% vs. (12.00±2.24)%], the proportion of cytotoxic T cells increased [(10.54±1.89)% vs. (4.54±1.25)%], the proportion of apoptotic cytotoxic T cells decreased [(14.00±4.00)% vs. (26.80±4.27)%] and the concentration of IFN-γ increased in miR-506 PBS group [(89.60±14.69) vs. (28.00±13.69) ng/g]. However, after clearance of macrophages by Clo, there was no significant difference in the above indexes between mir-506 Clo group and miR-ctrl Clo group. Conclusion:MiR-506 inhibits the progression of PDAC and reverses its immunosuppressive TME in a macrophage dependent manner.

Objective To analyze the clinical characteristics of type 1 autoimmune pancreatitis (AIP) in patients.Methods The clinical data of 27 patients with type 1 AIP treated at Fujian Provincial Hospital from January 2012 to October 2018 were retrospectively analyzed.Results There are 25 males (92.6％) and 2 females (7.4％) (ratio 12.5∶1).The age of disease onset was (59.5 ± 14.3) years.The most common presenting symptoms were jaundice and abdominal pain (both 59.3％).The most common complication was IgG4-related sclerosing cholangitis (63.0％).Magnetic Resonance Cholangiopancreatograhpy (MRCP) conducted on 26 patients showed the diffuse type 1 AIP was most common (53.8％),only 2 patients (7.7％) presented with a main pancreatic duct stricture.The pancreatic segment of bile duct narrowing was very common (84.6％),and most patients presented as tapered narrowings (65.4％).Standard glucocorticoid therapy was given to these 27 patients who responded well with clinical and laboratory remissions.Two patients were given maintenance glucocorticoid therapy for a high level of serum IgG4.Conclusions Type 1 AIP can present as a local manifestation of IgG4-related disease.The most common complication is IgG4-related sclerosing cholangitis.Glucocorticoid therapy was effective but some patients required maintenance therapy.

BACKGROUNDPostoperative hypocalcemia is one of the most common complications following parathyroidectomy for primary hyperparathyroidism (PHPT). The aim of this study was to analyze the predictive value of biochemical parameters as indicators for episodes of hypocalcemia in patients undergoing parathyroidectomy for PHPT.

METHODSThe patients with PHPT who underwent parathyroidectomy between February 2004 and February 2014 were studied retrospectively at a single medical center. The patients were divided into biochemical, clinical, and no postoperative hypocalcemia groups, based on different clinical manifestations. Potential risk factors for postoperative hypocalcemia were identified and investigated by univariate and multivariate Logistic regression analysis.

RESULTSOf the 139 cases, 25 patients (18.0%) were diagnosed with postoperative hypocalcemia according to the traditional criterion. Univariate analysis revealed only alkaline phosphatase (ALP) and the small area under the curve (AUC) of receiver operating characteristics (ROC) curve for ALP demonstrates low accuracy in predicting the occurrence of postoperative hypocalcemia. Based on new criteria, 22 patients were added to the postoperative hypocalcemia group and similar biochemical parameters were compared. The serum ALP was a significant independent risk factor for postoperative hypocalcemia (P = 0.000) and its AUC of ROC curve was 0.783. The optimal cutoff point was 269 U/L and the sensitivity and specificity for prediction were 89.2% and 64.3%, respectively.

CONCLUSIONSThe risk of postoperative hypocalcemia after parathyroidectomy should be emphasized for patients with typical symptoms of hypocalcemia despite their serum calcium level is in normal or a little higher range. Serum ALP is a predictive factor for the occurrence of postoperative hypocalcemia.

Adult ; Aged ; Aged, 80 and over ; Alkaline Phosphatase ; blood ; Female ; Humans ; Hyperparathyroidism, Primary ; blood ; surgery ; Hypocalcemia ; blood ; Male ; Middle Aged ; Parathyroidectomy ; Retrospective Studies ; Young Adult

Malignant obstruction of the stomach or duodenum is a preterminal event in patients with ad-vanced malignancies of the upper gastrointestinal.It severely limits the quality of life in affected patients.Most patients are in bad conditions and have an short expecting live time,so they not only can not bear but also do not need such an invasive operation.Because of this,a minimally invasive but effective palliative treatment is quite necessary.This paper makes a summary and contrastive analysis of several ways of pallia-five treatment which are widely used for malignant gastroduodenal obstruction in recent years.