Testicular histology based on testicular biopsy is an important factor for determining appropriate testicular sperm extraction surgery and predicting sperm retrieval outcomes in patients with azoospermia. Therefore, we developed a deep learning (DL) model to establish the associations between testicular grayscale ultrasound images and testicular histology. We retrospectively included two-dimensional testicular grayscale ultrasound from patients with azoospermia (353 men with 4357 images between July 2017 and December 2021 in The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China) to develop a DL model. We obtained testicular histology during conventional testicular sperm extraction. Our DL model was trained based on ultrasound images or fusion data (ultrasound images fused with the corresponding testicular volume) to distinguish spermatozoa presence in pathology (SPP) and spermatozoa absence in pathology (SAP) and to classify maturation arrest (MA) and Sertoli cell-only syndrome (SCOS) in patients with SAP. Areas under the receiver operating characteristic curve (AUCs), accuracy, sensitivity, and specificity were used to analyze model performance. DL based on images achieved an AUC of 0.922 (95% confidence interval [CI]: 0.908-0.935), a sensitivity of 80.9%, a specificity of 84.6%, and an accuracy of 83.5% in predicting SPP (including normal spermatogenesis and hypospermatogenesis) and SAP (including MA and SCOS). In the identification of SCOS and MA, DL on fusion data yielded better diagnostic performance with an AUC of 0.979 (95% CI: 0.969-0.989), a sensitivity of 89.7%, a specificity of 97.1%, and an accuracy of 92.1%. Our study provides a noninvasive method to predict testicular histology for patients with azoospermia, which would avoid unnecessary testicular biopsy.
Humans ; Male ; Azoospermia/diagnostic imaging* ; Deep Learning ; Testis/pathology* ; Retrospective Studies ; Adult ; Ultrasonography/methods* ; Sperm Retrieval ; Sertoli Cell-Only Syndrome/diagnostic imaging*

OBJECTIVES: To evaluate the efficacy of molecular targeted agents in children with progressive pediatric low-grade gliomas (pLGG). METHODS: A retrospective analysis was conducted on pLGG patients treated with oral targeted therapies at the Department of Pediatrics, Beijing Shijitan Hospital, Capital Medical University, from July 2021. Treatment responses and safety profiles were assessed. RESULTS: Among the 20 enrolled patients, the trametinib group (n=12, including 11 cases with BRAF fusions and 1 case with BRAF V600E mutation) demonstrated 4 partial responses (33%) and 2 minor responses (17%), with a median time to response of 3.0 months. In the vemurafenib group (n=6, all with BRAF V600E mutation), 5 patients achieved partial responses (83%), showing a median time to response of 1.0 month. Comparative analysis revealed no statistically significant difference in progression-free survival rates between the two treatment groups (P>0.05). The median duration of clinical benefit (defined as partial response + minor response + stable disease) was 11.0 months for vemurafenib and 18.0 months for trametinib. Two additional cases, one with ATM mutation treated with olaparib for 24 months and one with NF1 mutation receiving everolimus for 21 months, discontinued treatment due to sustained disease stability. No severe adverse events were observed in any treatment group. CONCLUSIONS Molecular targeted therapy demonstrates clinical efficacy with favorable tolerability in pLGG. Vemurafenib achieves high response rates and induces early tumor shrinkage in patients with BRAF V600E mutations, supporting its utility as a first-line therapy.
Humans ; Glioma/genetics* ; Male ; Female ; Child ; Child, Preschool ; Retrospective Studies ; Brain Neoplasms/genetics* ; Molecular Targeted Therapy/adverse effects* ; Adolescent ; Infant ; Proto-Oncogene Proteins B-raf/genetics* ; Pyrimidinones/therapeutic use* ; Mutation

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Background::The prevalence of type 2 diabetes mellitus (T2DM) has been rapidly growing in Chinese populations in recent decades, and the shift in eating habits is a key contributing factor to this increase. Eating out of home (EOH) is one of the major shifts in eating habits during this period. However, the influence of EOH on the incidence of T2DM among Chinese urban workers is unknown.Methods::The cross-sectional study involved an analysis of 13,904 urban workers recruited from 11 health examination centers in the major cities of China to explore the relationship between EOH and T2DM between 2013 September and 2016 March.Results::Average weekly EOH frequency ≥10 times was positively associated with increased incidence of T2DM in the sampled population (OR: 1.31 [1.11-1.54], p < 0.01), most notably in participants ≤45 years old (OR: 1.41[1.11-1.80], p < 0.01]) and in males (OR:1.26 [1.06-1.51], p < 0.01). An EOH frequency of 5 times/week appears as a threshold for a significant increase in the odds of T2DM. Weekly EOH frequency ≥5 times was associated with increased odds of T2DM in a dose-response manner in the total population and almost all subgroups ( poverall association < 0.05 and pnonlinearity ≤ 0.05). Conclusion::This study showed that a frequency of EOH (≥5 times/week) was associated with a frequency-dependent increase in the odds of T2DM urban workers in China. More nutrition promotion is needed to improve the eating behavior of Chinese urban workers to reduce T2DM risk.

Background::The prevalence of type 2 diabetes mellitus (T2DM) has been rapidly growing in Chinese populations in recent decades, and the shift in eating habits is a key contributing factor to this increase. Eating out of home (EOH) is one of the major shifts in eating habits during this period. However, the influence of EOH on the incidence of T2DM among Chinese urban workers is unknown.Methods::The cross-sectional study involved an analysis of 13,904 urban workers recruited from 11 health examination centers in the major cities of China to explore the relationship between EOH and T2DM between 2013 September and 2016 March.Results::Average weekly EOH frequency ≥10 times was positively associated with increased incidence of T2DM in the sampled population (OR: 1.31 [1.11-1.54], p < 0.01), most notably in participants ≤45 years old (OR: 1.41[1.11-1.80], p < 0.01]) and in males (OR:1.26 [1.06-1.51], p < 0.01). An EOH frequency of 5 times/week appears as a threshold for a significant increase in the odds of T2DM. Weekly EOH frequency ≥5 times was associated with increased odds of T2DM in a dose-response manner in the total population and almost all subgroups ( poverall association < 0.05 and pnonlinearity ≤ 0.05). Conclusion::This study showed that a frequency of EOH (≥5 times/week) was associated with a frequency-dependent increase in the odds of T2DM urban workers in China. More nutrition promotion is needed to improve the eating behavior of Chinese urban workers to reduce T2DM risk.

Objective:To explore the diagnostic value and clinical application of metagenomic next-generation sequencing (mNGS) technology in pediatric urinary tract infections (UTI).Methods:In this retrospective study, the clinical data of children with UTI admitted to the Department of Nephrology, Children′s Hospital, Capital Institute of Pediatrics, from March 2023 to March 2024 were collected.The positive detection rates, timeliness, and consistency of mNGS technology were compared with those of urine culture.Measurement data were subject to test of normality.The independent sample t test, Chi-square test or Fisher′s exact probability test were used for comparison between groups. Results:A total of 193 patients were included.The positive detection rate of urine culture was 36.3% (70/193).Among 42 patients who underwent mNGS testing, 37 cases (88.1%) tested positive.The positive detection rate of mNGS was significantly higher than that of urine culture ( χ2=37.357, P<0.001).It took significantly less time to report mNGS results than to report urine culture results ( Z=3.524, P<0.001).In the 42 cases that underwent mNGS testing, 5 cases (11.9%) were negative for urine pathogens by both methods, and 21 cases (50.0%) were positive by mNGS but negative by urine culture.Among the remaining 16 cases (38.1%) positive by both mNGS and urine culture, 14 cases (33.3%) achieved fully matching results, 1 case (2.4%) was fully mismatched, and 1 case (2.4%) was partially matched.Comparison of the positive detection rate and the duration of anti-infective treatment prior to specimen collection between urine culture and mNGS showed that the median durations for urine culture and mNGS positivity were 5 and 20 days, and the difference was statistically significant ( χ2=0.537, P<0.001). Conclusions:mNGS technology has high sensitivity for diagnosing pathogens in pediatric UTI.Compared with urine culture, mNGS provides good consistency and significantly shortens the detection time.The positive detection rate is less affected by antimicrobial treatment.For children with UTI, especially those who have failed empirical anti-infective treatment and whose pathogen cannot be identified by urine culture, mNGS testing is recommended as early as possible.

Objective:To explore the diagnostic value and clinical application of metagenomic next-generation sequencing (mNGS) technology in pediatric urinary tract infections (UTI).Methods:In this retrospective study, the clinical data of children with UTI admitted to the Department of Nephrology, Children′s Hospital, Capital Institute of Pediatrics, from March 2023 to March 2024 were collected.The positive detection rates, timeliness, and consistency of mNGS technology were compared with those of urine culture.Measurement data were subject to test of normality.The independent sample t test, Chi-square test or Fisher′s exact probability test were used for comparison between groups. Results:A total of 193 patients were included.The positive detection rate of urine culture was 36.3% (70/193).Among 42 patients who underwent mNGS testing, 37 cases (88.1%) tested positive.The positive detection rate of mNGS was significantly higher than that of urine culture ( χ2=37.357, P<0.001).It took significantly less time to report mNGS results than to report urine culture results ( Z=3.524, P<0.001).In the 42 cases that underwent mNGS testing, 5 cases (11.9%) were negative for urine pathogens by both methods, and 21 cases (50.0%) were positive by mNGS but negative by urine culture.Among the remaining 16 cases (38.1%) positive by both mNGS and urine culture, 14 cases (33.3%) achieved fully matching results, 1 case (2.4%) was fully mismatched, and 1 case (2.4%) was partially matched.Comparison of the positive detection rate and the duration of anti-infective treatment prior to specimen collection between urine culture and mNGS showed that the median durations for urine culture and mNGS positivity were 5 and 20 days, and the difference was statistically significant ( χ2=0.537, P<0.001). Conclusions:mNGS technology has high sensitivity for diagnosing pathogens in pediatric UTI.Compared with urine culture, mNGS provides good consistency and significantly shortens the detection time.The positive detection rate is less affected by antimicrobial treatment.For children with UTI, especially those who have failed empirical anti-infective treatment and whose pathogen cannot be identified by urine culture, mNGS testing is recommended as early as possible.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To evaluate the efficacy and safety of rituximab (RTX) in children with steroid resistant nephrotic syndrome (SRNS).Methods:The was a retrospective observational study. A retrospective analysis was conducted on the clinical data of 14 children with SRNS who received RTX treatment in the Department of Nephrology, Children's Hospital Affiliated to Capital Institute of Pediatrics from July 2021 to August 2023. The changes in urinary protein content, renal function, serum albumin, immunoglobulin and other indicators before and after RTX medication were compared to evaluate the clinical efficacy and safety of RTX treatment for SRNS.Results:A total of 14 children with SRNS were selected for this study, with a male to female ratio of 6:8. The age of onset of kidney disease was (4.36±3.12) years, and 8 of them underwent kidney biopsy. Among them, 6 cases showed focal segmental glomerulosclerosis in renal pathology, and 2 cases showed minimal change disease. The age of 14 children who first used RTX was (8.45±3.98) years old, with a dose of 375 mg/m 2 and a maximum dose of 500 mg. The number of children who had used 2, 3, 4, and 5 doses of RTX was 6, 6, 1, and 1, respectively. RTX was administered orally with compound sulfamethoxazole to prevent infection. Glucocorticoids and immunosuppressants were discontinued 4.0(2.5, 6.5) months after the first dose of RTX. The median follow-up time was 10.5(6.0, 18.3) months. By the end of the 3-month, 6-month, and follow-up endpoints, the complete remission rates of kidney disease in the children were 100.0%(14/14), 85.7%(12/14), and 64.3%(9/14), respectively. Five children experienced kidney disease recurrence. Compared with before the first dose of RTX treatment, the serum albumin and height significantly increased, while body mass index significantly decreased at the end of follow-up (all P<0.05). There was no statistically significant difference in urinary protein content, renal function, and IgG (all P>0.05). During the RTX treatment, all 14 children did not experience any infusion reaction, and there were no serious infections during follow-up. One case was diagnosed with hypogammaglobulinemia. Conclusions:RTX can improve the remission rate and recurrence rate of SRNS children, reduce the dosage of glucocorticoids and related drug untoward reaction, significantly improve patient height and BMI, with minimal side effects. Especially for SRNS patients who cannot be relieved by the combination of glucocorticoids and immunosuppressants, RTX may be considered.

Objective:To analyze the clinical characteristics of renal abscess in children and provide suggestions for early diagnosis and treatment.Methods:The clinical data including general information, laboratory data, imaging results, treatment and prognosis of 20 pediatric patients with renal abscess admitted to the Department of Nephrology, Capital Center for Children's Health Capital Medical University were analyzed retrospectively.Results:A total of 8 males and 12 females were enrolled. The age of onset was 3.0 (0.8, 9.0) years. All cases had fever. Six cases presented with abdominal pain, 6 cases had poor appetite, 5 cases had vomiting and 5 cases urinary tract irritation symptoms. Laboratory data showed elevated white blood cells 20.4 (17.4,26.3)×10 9/L, C-reactive protein 126 (77, 154)mg/L, erythrocyte sedimentation rate 60 (41,73) mm/1 h in 20 cases and procalcitonin 4.7 (1.2,33.5)μg/L in 10 cases. Totally 18 cases had pyuria. Urine culture was positive in 8 cases. Enterococcus faecium and Pseudomonas aeruginosa was detected in 2 cases. Klebsiella pneumoniae was found in 1 case after performing blood culture. Renal abscess was confirmed in all cases by doing contrast-enhanced CT scan, while only 9 cases with abscesses were identified by using renal ultrasound. There were 14 cases with renal abscess formation confirmed at onset by performing magnetic resonance imaging. Nine cases were accompanied with congenital anomalies of the kidney and urinary tract. All cases received conservative medical treatment. Intravenous broad-spectrum antibiotics were administered for 23 (14, 39) d initially, while the medication in 11 cases were upgraded to meropenem or imipenem. Oral antibiotics were continued for 23 (14, 28) d after discharge in all cases. Within 1 year of follow-up, except for 1 case of recurrence, the others had a favorable prognosis. Conclusions:Renal abscess should be suspected for children presenting with unexplained fever, vomiting, abdominal pain, elevated white blood cell count, C-reactive protein, erythrocyte sedimentation rate and pyuria. Ultrasonography is suitable for screening and follow-up, while CT or magnetic resonance imaging can be used to confirm the diagnosis. Conservative management with broad-spectrum antibiotics is effective and can be considered the first-line therapy for pediatric renal abscess.