To investigate the impact of preoperative serum follicle-stimulating hormone (FSH) levels on the probability of testicular sperm retrieval, we conducted a study of nonobstructive azoospermic (NOA) men with different testicular volumes (TVs) who underwent microdissection testicular sperm extraction (micro-TESE). A total of 177 NOA patients undergoing micro-TESE for the first time from April 2019 to November 2022 in Shenzhen Zhongshan Obstetrics and Gynecology Hospital (formerly Shenzhen Zhongshan Urology Hospital, Shenzhen, China) were retrospectively reviewed. The subjects were divided into four groups based on average TV quartiles. Serum hormone levels in each TV group were compared between positive and negative sperm retrieval subgroups. Overall sperm retrieval rate was 57.6%. FSH levels (median [interquartile range]) were higher in the positive sperm retrieval subgroup compared with the negative outcome subgroup when average TV was <5 ml (first quartile [Q1: TV <3 ml]: 43.32 [17.92] IU l -1 vs 32.95 [18.56] IU l -1 , P = 0.048; second quartile [Q2: 3 ml ≤ TV <5 ml]: 31.31 [15.37] IU l -1 vs 25.59 [18.40] IU l -1 , P = 0.042). Elevated serum FSH levels were associated with successful micro-TESE sperm retrieval in NOA men whose average TVs were <5 ml (adjusted odds ratio [OR]: 1.06 per unit increase; 95% confidence interval [CI]: 1.01-1.11; P = 0.011). In men with TVs ≥5 ml, larger TVs were associated with lower odds of sperm retrieval (adjusted OR: 0.84 per 1 ml increase; 95% CI: 0.71-0.98; P = 0.029). In conclusion, elevated serum FSH levels were associated with positive sperm retrieval in micro-TESE in NOA men with TVs <5 ml. In men with TV ≥5 ml, increases in average TVs were associated with lower odds of sperm retrieval.
Humans ; Male ; Azoospermia/surgery* ; Sperm Retrieval/statistics & numerical data* ; Adult ; Follicle Stimulating Hormone/blood* ; Retrospective Studies ; Testis/pathology* ; Microdissection ; Organ Size

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective To analyze the factors affecting the prognosis of patients with knee osteoarthritis,and to construct a nomogram prediction model in conjunction with multi-dimensional clinical indicators.Methods The clinical data of 234 pa-tients with knee osteoarthritis who were treated in our hospital from January 2015 to June 2021 were retrospectively analyzed,including 126 males and 108 females;age more than 60 years old for 135 cases,age less than 60 years old for 99 cases.Lysholm knee function score was used to evaluate the prognosis of the patients,and the patients were divided into good progno-sis group for 155 patients and poor prognosis group for 79 patients according to the prognosis.The clinical data of the subjects in the experimental cohort were analyzed by single factor and multiple factors.The patients were divided into experimental co-hort and verification cohort,the results of the multiple factor analysis were visualized to obtain a nomogram prediction model,the receiver operating characteristic curve(ROC),calibration curve and decision curve were used to evaluate the model's dis-crimination,accuracy and clinical benefit rate.Results The results of multivariate analysis showed that smoking,pre-treatment K-L grades of Ⅲto Ⅳ,and high levels of interleukin 6(IL-6)and matrix metallo proteinase-3(MMP-3)were risk factors for the prognosis of patients with knee osteoarthritis.ROC test results showed that the area under the curve of the nomogram model in the experimental cohort and validation cohort was 0.806[95％CI(0.742,0.866)]and 0.786[(95％CI(0.678,0.893)],re-spectively.The results of the calibration curve showed that the Brier values of the experimental cohort and verification cohort were 0.151 points and 0.134 points,respectively.When the threshold probability value in the decision curve was set to 31％,the clinical benefit rates of the experimental cohort and validation cohort were 51％and 56％,respectively.Conclusion The prognostic model of patients with knee osteoarthritis constructed based on multi-dimensional clinical data has both theoretical and practical significance,and can provide a reference for taking targeted measures to improve the prognosis of patients.

Objective To investigate the application effect of levosimendan combined with nicorandil in the treatment of elderly patients with ischemic cardiomyopathy(ICM).Methods Elderly patients with ICM were divided into the control group and the treatment group by cohort method.The control group was treated with levosimendan at 12 μg·kg-1.7 d later,and the treatment was carried out once again.On this basis,the treatment group was given oral administration of nicorandil,5 mg per dose,tid.Patients in two groups were treated for 3 months.The two groups were compared in terms of clinical efficacy,ventricular remodeling indicators[left ventricular posterior wall thickness(LVPWT),posterior wall end systolic thickness(PWS),interventricular septum thickness in systole(IVSS)and left ventricular mass index(LVMI)],cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD)and left ventricular end diastolic diameter(LVEDD)],myocardial injury markers[cardiac troponin Ⅰ(cTn Ⅰ)and N-terminal pro-brain natriuretic peptide(NT-proBNP)],and endocrine hormones[angiotensin Ⅱ(Ang Ⅱ)and aldosterone(ALD)].Safety was evaluated.Results There were 52 cases and 46 cases in the treatment group and the control group,respectively.After 3 months of treatment,the effective rates in the treatment group and the control group were 92.31％(48 cases/52 cases)and 78.26％(36 cases/46 cases),the difference was statistically significant(P＜0.05).After 3 months of treatment,LVPWT in the treatment group and the control group were(8.17±2.25)and(9.33±2.84)mm;PWS were(10.14±2.29)and(11.32±2.90)mm;IVSS were(11.19±1.74)and(12.04±1.85)mm;LVMI were(1.93±0.21)and(2.06±0.28)mg·g-1;LVEF were(52.74±8.67)％and(49.30±7.59)％;LVESD were(43.87±5.74)and(46.66±6.48)mm;LVEDD were(51.40±8.61)and(55.25±9.58)mm;cTn Ⅰlevels were(0.25±0.03)and(0.36±0.08)μg·L-1;NT-proBNP levels were(384.58±36.06)and(401.25±42.83)ng·L-1;Ang Ⅱ levels were(56.37±10.03)and(63.25±12.46)ng·L-1;ALD levels were(50.87±13.08)and(58.36±16.54)ng·L-1.The differences were statistically significant(all P＜0.05).The total incidence rates of adverse drug reactions in the treatment group and the control group were 7.69％(4 cases/52 cases)and 4.35％(2 cases/46 cases),without statistically significant difference(P＞0.05).Conclusion Levosimendan injection combined with nicorandil tablet can effectively inhibit ventricular remodeling and myocardial injury in elderly patients with ICM.Meanwhile,it can help to improve cardiac function and endocrine hormones in the patients,with good safety.

Objective To investigate the application effect of levosimendan combined with nicorandil in the treatment of elderly patients with ischemic cardiomyopathy(ICM).Methods Elderly patients with ICM were divided into the control group and the treatment group by cohort method.The control group was treated with levosimendan at 12 μg·kg-1.7 d later,and the treatment was carried out once again.On this basis,the treatment group was given oral administration of nicorandil,5 mg per dose,tid.Patients in two groups were treated for 3 months.The two groups were compared in terms of clinical efficacy,ventricular remodeling indicators[left ventricular posterior wall thickness(LVPWT),posterior wall end systolic thickness(PWS),interventricular septum thickness in systole(IVSS)and left ventricular mass index(LVMI)],cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD)and left ventricular end diastolic diameter(LVEDD)],myocardial injury markers[cardiac troponin Ⅰ(cTn Ⅰ)and N-terminal pro-brain natriuretic peptide(NT-proBNP)],and endocrine hormones[angiotensin Ⅱ(Ang Ⅱ)and aldosterone(ALD)].Safety was evaluated.Results There were 52 cases and 46 cases in the treatment group and the control group,respectively.After 3 months of treatment,the effective rates in the treatment group and the control group were 92.31％(48 cases/52 cases)and 78.26％(36 cases/46 cases),the difference was statistically significant(P＜0.05).After 3 months of treatment,LVPWT in the treatment group and the control group were(8.17±2.25)and(9.33±2.84)mm;PWS were(10.14±2.29)and(11.32±2.90)mm;IVSS were(11.19±1.74)and(12.04±1.85)mm;LVMI were(1.93±0.21)and(2.06±0.28)mg·g-1;LVEF were(52.74±8.67)％and(49.30±7.59)％;LVESD were(43.87±5.74)and(46.66±6.48)mm;LVEDD were(51.40±8.61)and(55.25±9.58)mm;cTn Ⅰlevels were(0.25±0.03)and(0.36±0.08)μg·L-1;NT-proBNP levels were(384.58±36.06)and(401.25±42.83)ng·L-1;Ang Ⅱ levels were(56.37±10.03)and(63.25±12.46)ng·L-1;ALD levels were(50.87±13.08)and(58.36±16.54)ng·L-1.The differences were statistically significant(all P＜0.05).The total incidence rates of adverse drug reactions in the treatment group and the control group were 7.69％(4 cases/52 cases)and 4.35％(2 cases/46 cases),without statistically significant difference(P＞0.05).Conclusion Levosimendan injection combined with nicorandil tablet can effectively inhibit ventricular remodeling and myocardial injury in elderly patients with ICM.Meanwhile,it can help to improve cardiac function and endocrine hormones in the patients,with good safety.

ObjectiveTo summarize the clinical features and prognosis of pulmonary mucormycosis （PM） in southern China， and to explore the diagnostic value of metagenomic next generation sequencing （mNGS） in PM. MethodsThe clinical manifestations， diagnosis， treatment and prognosis of patients diagnosed with PM in The First Affiliated Hospital of Sun Yat-sen University from January 1， 2019 to January 31， 2022 who had undergone mNGS detection in lung tissue or alveolar lavage fluid were collected retrospectively. A total of 14 patients with PM were included， including 4 patients with confirmed diagnosis and 10 patients with clinical diagnosis. ResultsAll patients had underlying medical conditions， with hematological malignancies and diabetes being the most common. The most common symptoms were fever （n = 10）， cough （n = 9） and shortness of breath （n = 9）. Consolidation was the most common sign of chest CT， followed by mass， mostly with cavity. On laboratory tests， decreased CD4+T lymphocytes， elevated CD8+T lymphocytes， and decreased CD4+/CD8+ ratio， and presentation with pleural effusion indicate poor prognosis. The positive rate of mNGS diagnosis was 78.5%， which was significantly higher than that of histopathology （50%）， fungus rapid fluorescence staining （61.5%） and fungal culture （23.1%） of bronchoalveolar lavage fluid. ConclusionsPulmonary mucormycosis is more likely to occur in patients with underlying diseases or who are immunocompromised. The clinical manifestations lack specificity. The low CD4/CD8 ratio and presentation of pleural effusion on CT imaging indicate poor prognosis of patients. mNGS is a rapid， convenient and sensitive method for the diagnosis of PM， which has advantages in the diagnosis of pulmonary mucormycosis.

Objective: To investigate the current situation of cell phone use and sleep quality among college students, establish a sleep quality trajectory model and explore the influence of cell phone use on the sleep quality trajectory. Methods: Based on data from the College Student Behavior and Health Cohort Study 2019-2020, a latent class growth modeling was used to establish a sleep quality trajectory model among college students. The baseline influencing factors of sleep quality trajectories among college students were analyzed by χ² test, and the effects of cell phone use on sleep quality trajectories were analyzed by binary logistic regression. Results: A total of 1 092 college students were included in the analysis. The detection rates of cell phone use and poor sleep quality were 24.5% and 13.3%. Latent class growth model identified two groups of sleep quality trend trajactories: an improved sleep quality group (86.0%) and a decreased sleep quality group (14.0%). The result of binary logistic regression showed that the cell phone use was a risk factor of sleep quality trajectories. Conclusion: The cell phone use during college period could increase the risk of poor sleep quality. Targeted intervention measures about cell phone use should be adopted to improve the sleep quality among college students.
Humans ; Sleep Quality ; Cohort Studies ; Cell Phone Use ; Surveys and Questionnaires ; Students ; Sleep Initiation and Maintenance Disorders ; Cell Phone ; Sleep