In recent years, China has been facing the dual challenges of declining fertility rates and births, with male reproductive health issues, especially the decline in semen quality, identified as a pivotal contributor to this phenomenon. Meanwhile, accumulating evidence indicates that air pollutants, an increasingly severe environmental problem, can damage semen quality not only directly through their biological toxicity but also indirectly by disrupting the composition of microbial communities in the gut and semen, thereby dysregulating immune function, endocrine homeostasis, and oxidative stress responses. The gut microbiota and semen microbiota, as important components of the human microecosystem, play crucial roles in maintaining reproductive health. This article comprehensively reviewed the research progress on the potential effects of air pollutants (particulate matter and gaseous pollutants), gut microbiota, and semen microbiota on semen quality. Specifically, it elucidated the mechanisms of interaction between these factors and explored how they affect male fertility.

AIM:To appraise the bioequivalence and safety of the test preparation of ritonavir tab-lets and the reference preparation(trade name:Norvir?)in healthy adult subjects under fasting and postprandial conditions.METHODS:This study was a randomized,open-label,single-dose,four-period,fully repeated crossover design bioequivalence study protocol.Thirty-six healthy male and female volunteers were enrolled in the fasting and post-prandial conditions,and a single dose of the test preparation and reference preparation was orally administered.We used liquid chromatography-tan-dem mass spectrometry(LC-MS/MS)to finish the bioassay of the drug concentration of ritonavir in plasma.Pharmacokinetic parameters were statisti-cally analyzed using PhoenixWinNonlin8.1 software(Pharsight,USA)and a non-compartmental model.RESULTS:Under fasting conditions,the pharmacoki-netic parameters of the test and reference prepara-tions:Cmax(792.010±369.282)ng/mL and(856.939±394.427)ng/mL,AUC0-t(6 463.043±2 876.849)ng·mL-1·h and(6 907.690±3 046.132)ng·mL-1·h,AUC0-∞(6 603.617±2 916.352)ng·mL-1·h and(7 051.614±3 093.047)ng·mL-1·h.Here are the pharmacokinetic parameters for both the test prep-aration and the reference preparation in the post-prandial condition:Cmax(574.380±289.566)ng/mL and(615.796±297.382)ng/mL,AUC0-t(5 084.796±2 435.557)ng·mL-1·h and(5 414.167±2 416.952)ng·mL-1·h,AUC0-∞(5 219.144±2 487.793)ng·mL-1·h and(5 551.060±2 490.604)ng·mL-1·h.The 90%confidence interval of the geometric mean ratio of AUC0-t,AUC0-∞,and Cmax for the test preparation and reference preparation lied in the equivalent range of statistics.CONCLUSION:The tested preparation was bioequivalent to the reference preparation un-der fasting and postprandial conditions.

Objective To observe the ultrasonic manifestations of aggressive angiomyxoma(AAM).Methods Four patients with newly diagnosed AAM and 3 with recurrent AAM confirmed by pathology were retrospectively enrolled,and the ultrasonic manifestations were analyzed.Results Among 7 cases of AAM,the lesions located in subcutaneous regions of perineum in 3 cases,in both perineum and pelvic cavity in 2 cases,in pelvic cavity and in cervix each 1 case,with a median maximum diameter of 7.6 cm.The lesions mainly manifested as heterogeneous hypoechoic,scattered cord-like moderate/moderate-hyperechoic inside,regular or lobulated shape with finger-like protrusions,with clear boundary or unclear boundary with adjacent vagina/rectum.Layered structure could be observed with gray-scale ultrasound and CDFI.Conclusion AAM mainly affected pelvis and perineal region,often manifested as large lesion tended to infiltrate surrounding areas and form finger-like protrusions,most with clear boundaries and interior heterogeneous hypoechoic regions,also the characteristic stratified structures.

Objective:To explore the value of ultrasound imaging characteristics combined with clinical indicators in assessing the prognosis of patients with pancreatic ductal adenocarcinoma (PDAC).Methods:A retrospective analysis was conducted for patients who underwent pancreatic contrast-enhanced ultrasound (CEUS) from September 2017 to October 2023 at Peking Union Medical College Hospital and were diagnosed with PDAC based on pathological findings. Various parameters were recorded, including CA19-9 levels, tumor size, location, morphologic features, echogenicity, presence of internal cystic components, dilatation of the main pancreatic duct, peripheral vascular invasion, CEUS characteristics, presence or absence of liver metastasis, and treatment methods. In April 2024, patient survival information was obtained through telephone follow-up or review of medical records. Based on the results of the cox regression model analysis, a nomogram model of the risk of death was developed. The receiver operating characteristic (ROC) curves were applied to evaluate the predictive efficacy of the model. The calibration curves were plotted to evaluate the accuracy of the model, and clinical decision curves were used to evaluate the clinical benefit of the model.Results:This study included a total of 207 patients with PDAC. As of April 2024, 71 patients were alive and 136 died, with a median survival time of 14 months (95% CI: 12 -17). Multivariate analysis confirmed that the elevated CA19-9 ( HR=1.689, 95% CI: 1.102-2.588), tumor size >4 cm ( HR=1.641, 95% CI: 1.159-2.322), taller-than-wide shapes ( HR=1.450, 95% CI: 1.019-2.065), incomplete hypo-enhancement ( HR=1.618, 95% CI: 1.100-2.380), and liver metastasis ( HR=1.687, 95% CI: 1.175-2.423) were independent risk factors for survival in patients with PDAC. A nomogram model was further constructed for 6-month, 12-month and 3-year survival of patients with PDAC. The areas under the ROC curve were 0.679, 0.705 and 0.815, respectively. The calibration curves suggested that the model was more accurate, and the clinical decision curves showed that the model had a better clinical benefit. Conclusion:The combined use of ultrasound imaging characteristics and clinical indicators could effectively predict the prognosis of PDAC patients. Specifically, tumor size >4 cm, taller-than-wide shapes, incomplete hypo-enhancement, elevated CA19-9, and the presence of liver metastasis are correlated with poorer survival outcomes. The nomogram model constructed on the basis of these factors can be used to assess the survival of patients with PDAC.

Pancreatic cancer has a concealed onset and poor prognosis,and surgical resection is the main treatment method.Neoadjuvant therapy may improve the rate of negative resection margin and prolong overall survival of patients with pancreatic cancer.Functional and quantitative imaging can non-invasively reflect tumor microenvironment characteristics related to chemotherapy resistance,providing a new perspective for evaluating and predicting the efficacy of neoadjuvant therapy for pancreatic cancer.The research progresses in functional and quantitative imaging for evaluating and predicting the efficacy of neoadjuvant therapy of pancreatic cancer were reviewed in this article.

Objective:To explore the value of ultrasound imaging characteristics combined with clinical indicators in assessing the prognosis of patients with pancreatic ductal adenocarcinoma (PDAC).Methods:A retrospective analysis was conducted for patients who underwent pancreatic contrast-enhanced ultrasound (CEUS) from September 2017 to October 2023 at Peking Union Medical College Hospital and were diagnosed with PDAC based on pathological findings. Various parameters were recorded, including CA19-9 levels, tumor size, location, morphologic features, echogenicity, presence of internal cystic components, dilatation of the main pancreatic duct, peripheral vascular invasion, CEUS characteristics, presence or absence of liver metastasis, and treatment methods. In April 2024, patient survival information was obtained through telephone follow-up or review of medical records. Based on the results of the cox regression model analysis, a nomogram model of the risk of death was developed. The receiver operating characteristic (ROC) curves were applied to evaluate the predictive efficacy of the model. The calibration curves were plotted to evaluate the accuracy of the model, and clinical decision curves were used to evaluate the clinical benefit of the model.Results:This study included a total of 207 patients with PDAC. As of April 2024, 71 patients were alive and 136 died, with a median survival time of 14 months (95% CI: 12 -17). Multivariate analysis confirmed that the elevated CA19-9 ( HR=1.689, 95% CI: 1.102-2.588), tumor size >4 cm ( HR=1.641, 95% CI: 1.159-2.322), taller-than-wide shapes ( HR=1.450, 95% CI: 1.019-2.065), incomplete hypo-enhancement ( HR=1.618, 95% CI: 1.100-2.380), and liver metastasis ( HR=1.687, 95% CI: 1.175-2.423) were independent risk factors for survival in patients with PDAC. A nomogram model was further constructed for 6-month, 12-month and 3-year survival of patients with PDAC. The areas under the ROC curve were 0.679, 0.705 and 0.815, respectively. The calibration curves suggested that the model was more accurate, and the clinical decision curves showed that the model had a better clinical benefit. Conclusion:The combined use of ultrasound imaging characteristics and clinical indicators could effectively predict the prognosis of PDAC patients. Specifically, tumor size >4 cm, taller-than-wide shapes, incomplete hypo-enhancement, elevated CA19-9, and the presence of liver metastasis are correlated with poorer survival outcomes. The nomogram model constructed on the basis of these factors can be used to assess the survival of patients with PDAC.

Pancreatic cancer has a concealed onset and poor prognosis,and surgical resection is the main treatment method.Neoadjuvant therapy may improve the rate of negative resection margin and prolong overall survival of patients with pancreatic cancer.Functional and quantitative imaging can non-invasively reflect tumor microenvironment characteristics related to chemotherapy resistance,providing a new perspective for evaluating and predicting the efficacy of neoadjuvant therapy for pancreatic cancer.The research progresses in functional and quantitative imaging for evaluating and predicting the efficacy of neoadjuvant therapy of pancreatic cancer were reviewed in this article.

Objective:To evaluate the clinical outcomes of endoscopic-assisted polyether ether ketone (PEEK) patient-specific implant (PSI) revision for over-resected mandibles caused by the mandibular angle osteotomy.Methods:A retrospective analysis was conducted on 24 patients [8 males, 16 females, aged 19-57 (32.5±9.5) years] with 39 over-resected mandibles that underwent PEEK-PSI mandibular angle revision surgery at the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University from January 2019 to December 2023. Preoperative cone-beam computed tomography (CBCT) data were used to design and fabricate customized PEEK PSIs based on individual anatomical requirements. An intraoral incision approach with endoscopic assistance was employed to meticulously dissect soft tissue attachment around the angle region, followed by the implantation of a customized PEEK PSI. Postoperative CBCT scans were performed for 3D reconstruction, with root mean square error (RMSE) and maximum deviation (MaxD) as accuracy metrics. Patients′ satisfaction was assessed preoperatively and ≥6 months postoperatively using the face questionnaire (FACE-Q) scores, which included overall facial appearance, lower face and jawline, appearance distress, psychological health and social function.Results:All 24 patients achieved satisfactory recovery with primary healing of intraoral incisions. No complications such as infection, nerve injury, or implant rejection occurred during follow-up period. Patients′ facial appearance and jaw line contouring were significantly improved. Fine anatomical fitting between PEEK-PSI and defect areas was observed: RMSE ranged from 0.117 to 0.315 mm, and MaxD was (5.485±1.300) mm. FACE-Q scores demonstrated significant improvements after surgery in overall facial appearance [(49.8±5.4) vs (65.0±5.3) scores], lower face and jawline [(42.5±5.3) vs (56.1±4.6) scores], appearance distress [(60.0±6.9) vs (70.6±6.5) scores], psychological health [(62.0±5.0) vs (70.8±5.3) scores], and social function [(60.3±4.3) vs (69.3±5.8) scores] (all P<0.001). Conclusion:Endoscopic-assisted PEEK-PSI revision for over-resected mandibles following mandibular angle osteotomy exhibits high surgical precision and safety, effectively restoring mandibular contour and significantly enhancing patients′ satisfaction.

Objective:To investigate the clinical outcomes of precapsular pocket repositioning for correcting implant malposition following augmentation mammoplasty.Methods:A retrospective analysis was conducted on 29 female patients aged 25-37 (28.8±3.4) years who underwent precapsular pocket repositioning at the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University from December 2015 to August 2024. The surgical technique involved preserving the original capsule, creating a new implant pocket anterior to the capsule, and closing the original capsular space. Postoperative complications were recorded, and breast satisfaction was evaluated preoperatively and at 6 months postoperatively using the BREAST-questionnaire (BREAST-Q).Results:All 29 patients successfully underwent precapsular pocket repositioning with primary wound healing. During the follow-up period, all patients were satisfied with the correction of implant malposition. The mean BREAST-Q score improved significantly from (43.56±3.17) scores preoperatively to (72.56±13.49) scores at 6 months postoperatively ( P<0.001). No hematoma, implant rupture, recurrent malposition, capsular contracture, or surgical site infection occurred in any patient. Conclusion:Precapsular pocket repositioning provides favorable clinical outcomes for patients with implant malposition after augmentation mammoplasty, and there are no severe complications .

Objective:To investigate the clinical effect of the divisional design in composite labia minora and clitoral hood reduction.Methods:A retrospective analysis was performed on 57 patients diagnosed with labia minora and clitoral hood hypertrophy at Department of Plastic Surgery, Nanjing Medical University Friendship Plastic Surgery Hospital between July 2018 and May 2021. The ages of the patients ranged from 24 to 45 years with an average of (31.0±8.2) years. Preoperative symptoms and surgical demands included: appearance concerns in 57 cases (100%), irritation during friction in 49 cases (86.0%), and discomfort during intercourse in 22 cases (38.6%). The complex hypertrophy was divided into simple labia minora hypertrophy and clitoral hood hypertrophy. Then the reduction of clitoris hood was performed according to the prepuce morphology, and labiaplasty was performed using edge resection. The operative effects, patient satisfaction, and postoperative complications were assessed.Results:All incisions healed primarily with no flap necrosis or marginal infections. Hematoma occurred in 1 case which recovered well after timely treatment. All patients were followed up for 3-12 months. 54 cases were satisfied with the labia minora and clitoral hood shape and reported no sensory abnormality. Bilateral asymmetry occurred in 2 cases, one of which required further surgical repair. Scar hyperplasia occurred and was gradually softened after 6 months in 1 case. Of the 57 patients with appearance concerns, 55 (96.5%) patients reported improved appearance postoperatively. Of the 49 patients with preoperative friction discomfort, 47 (95.9%) patients achieved symptom relief. Of the 22 patients reporting sexual discomfort, 15 (68.1%) patients noted enhanced sexual satisfaction postoperatively. Overall, 54 (94.7%) patients were satisfied, 2 (3.5%) patients were moderately satisfied, and 1 (1.8%) patient was unsatisfied.Conclusions:For patients with labia minora and clitoral hood hypertrophy, the application of divisional design is surgically simple and safe. It achieves satisfactory outcomes with no severe adverse reactions.