OBJECTIVE: To compare the effectiveness and shoulder function of reverse total shoulder arthroplasty (RTSA) and open reduction and internal fixation (ORIF) in the treatment of Neer three/four-part proximal humeral fractures in the elderly. METHODS: Randomized controlled analysis was conducted on 68 patients over 70 years old with Neer three/four-part proximal humeral fractures treated with RTSA or ORIF between January 2020 and June 2022. The patients were randomly divided into RTSA group ( n=32) and ORIF group ( n=36). There was no significant difference ( P>0.05) in the baseline data such as age, gender, body mass index, injured side, Neer classification, and preoperative Charlson comorbidity index, visual analogue scale (VAS) score, Constant shoulder score, Oxford shoulder score (OSS), and hemoglobin (Hb). The operation time, intraoperative blood loss, reduction of Hb on the 3rd day after operation, hospital stay, total cost of hospitalization, complication incidence, range of motion of shoulder joint at 2 years after operation, VAS score before operation and at 5 days and 1 month after operation, Constant shoulder score and OSS score before operation and at 2 years after operation, and imaging results during follow-up were recorded and compared between the two groups. RESULTS: Compared with the ORIF group, the RTSA group had longer operation time, less intraoperative blood loss, and higher total cost of hospitalization ( P<0.05). There was no significant difference in Hb reduction on the 3rd day after operation between the two groups ( P>0.05). The VAS scores significantly improved in both groups at 5 days and 1 month after operation ( P<0.05), but there was no significant difference between the two groups ( P>0.05). All patients were followed up 26-35 months, with an average of 31.2 months. In the RTSA group, there were 2 cases of poor healing of superficial incision and 1 case of transient nerve injury. There was no complication such as bone resorption around the prosthesis, lucent band, prosthesis loosening, or periprosthetic fracture in all patients. In the ORIF group, there was 1 case of poor healing of superficial incision, 3 cases of nonunion of fracture, 1 case of arthritis secondary to humeral head necrosis, and 1 case of bone absorption of large tuberosity, and no displacement or fracture failure of internal fixation was found in all patients. There was no significant difference in the incidence of complications [9.4% (3/32) vs 16.7% (6/36)] between the two groups [ OR (95% CI): 0.828 (0.171, 4.014), P=0.814]. In the RTSA group, 28 cases were graded 0 and 4 cases were graded 1 at 2 years after operation. Constant and OSS scores of RTSA group were significantly better than those of ORIF group ( P<0.05). The Constant score was significantly better than ORIF group in activity and strength, range of motion, lifting, abduction, and external rotation ( P<0.05), and there was no significant difference in pain, daily function, and internal rotation between the two groups ( P>0.05). The RTSA group had a significantly greater range of motion in lifting, abduction, and external rotation than ORIF group ( P<0.05), but there was no significant difference in internal rotation between the two groups ( P>0.05). CONCLUSION Application of RTSA as the initial treatment of Neer three/four-part proximal humeral fractures in the elderly can achieve better rehabilitation of joint activity and lower risk of early reoperation, and improve the quality of life of elderly fracture patients. However, the difficulty of revision and the high cost of treatment require the surgeon to pay full attention and strictly grasp the indications.
Humans ; Fracture Fixation, Internal/instrumentation* ; Male ; Female ; Shoulder Fractures/surgery* ; Arthroplasty, Replacement, Shoulder/methods* ; Aged ; Bone Plates ; Open Fracture Reduction/methods* ; Range of Motion, Articular ; Treatment Outcome ; Shoulder Joint/physiopathology* ; Aged, 80 and over ; Operative Time ; Postoperative Complications/epidemiology* ; Length of Stay

Objective To explore the current status of penile erection hardness and its influencing factors in patients with non-obstructive azoospermia.Methods From January to December 2024,450 patients with non-obstructive azoospermia were surveyed at the Reproductive Medicine Center of Hospital.A self-made general information questionnaire was used to collect their demographic data.The Erectile Hardness Scale(EHS)was employed to investigate the current status of their penile erection hardness,and a self-made questionnaire was utilized to explore the influencing factors.Results Among the 450 patients with non-obstructive azoospermia,during sexual intercourse,35.3%of the patients reported that their penile erection hardness could reach grade 4(normal state),54.5%reported that it only reached grade 3(sub-optimal state),9.3%reported that it only reached grade 2(slight penile erection),and 0.9%reported that it only reached grade 1(inability to achieve an erection).In the survey of satisfaction with sexual life quality,among the 450 patients,only 24.9%were very satisfied with their sexual life quality;57.3%were basically satisfied;9.6%considered it average;4.0%were dissatisfied;3.1%were very dissatisfied;and 1.1%had no sexual life.alcohol consumption(OR=2.393,95%CI:1.493～3.836),satisfaction with the quality of sexual life(OR=1.455,95%CI:1.118～1.894),educational attainment(OR=0.709,95%CI:0.549～0.917),and the sleep quality in the past month(OR=0.641,95%CI:0.452～0.907).Conclusions Clinical studies have shown that factors such as drinking habits,sexual life satisfaction,sleep quality,and educational attainment collectively influence the penile erection hardness in patients with non-obstructive azoospermia.Therefore,the medical team needs to customize personalized intervention plans and educational materials based on individual differences among patients.Through psychological counseling and lifestyle guidance,they can improve erectile function and the quality of sexual life,promote harmonious marital relationships,and enhance the overall life experience of the patients.

Male reproductive aging is characterized by degenerative changes in the structure and function of the testes. Testicular aging involves alterations in various types of cells, among which lysosomal dysfunction in Sertoli cells is particularly critical. Recent studies have shown that abnormal lysosomal acidification leads to impaired phagosome degradation, which fails to maintain normal nutrient cycling and thereby exacerbates damage to the testicular microenvironment. In addition, endoplasmic reticulum stress, mitochondrial dysfunction, and epigenetic changes are also important factors contributing to reproductive aging. Therefore, molecular intervention strategies targeting lysosomal dysfunction, mitochondrial oxidative stress, and endoplasmic reticulum stress, such as the use of lysosomal activators like ML-SA1 and antioxidants, may offer new therapeutic directions for alleviating male reproductive aging. Future research should further explore the interactions between these mechanisms and potential intervention targets to improve reproductive health and quality of life in middle-aged and older men.

Objective To explore the current status of penile erection hardness and its influencing factors in patients with non-obstructive azoospermia.Methods From January to December 2024,450 patients with non-obstructive azoospermia were surveyed at the Reproductive Medicine Center of Hospital.A self-made general information questionnaire was used to collect their demographic data.The Erectile Hardness Scale(EHS)was employed to investigate the current status of their penile erection hardness,and a self-made questionnaire was utilized to explore the influencing factors.Results Among the 450 patients with non-obstructive azoospermia,during sexual intercourse,35.3%of the patients reported that their penile erection hardness could reach grade 4(normal state),54.5%reported that it only reached grade 3(sub-optimal state),9.3%reported that it only reached grade 2(slight penile erection),and 0.9%reported that it only reached grade 1(inability to achieve an erection).In the survey of satisfaction with sexual life quality,among the 450 patients,only 24.9%were very satisfied with their sexual life quality;57.3%were basically satisfied;9.6%considered it average;4.0%were dissatisfied;3.1%were very dissatisfied;and 1.1%had no sexual life.alcohol consumption(OR=2.393,95%CI:1.493～3.836),satisfaction with the quality of sexual life(OR=1.455,95%CI:1.118～1.894),educational attainment(OR=0.709,95%CI:0.549～0.917),and the sleep quality in the past month(OR=0.641,95%CI:0.452～0.907).Conclusions Clinical studies have shown that factors such as drinking habits,sexual life satisfaction,sleep quality,and educational attainment collectively influence the penile erection hardness in patients with non-obstructive azoospermia.Therefore,the medical team needs to customize personalized intervention plans and educational materials based on individual differences among patients.Through psychological counseling and lifestyle guidance,they can improve erectile function and the quality of sexual life,promote harmonious marital relationships,and enhance the overall life experience of the patients.

Male reproductive aging is characterized by degenerative changes in the structure and function of the testes. Testicular aging involves alterations in various types of cells, among which lysosomal dysfunction in Sertoli cells is particularly critical. Recent studies have shown that abnormal lysosomal acidification leads to impaired phagosome degradation, which fails to maintain normal nutrient cycling and thereby exacerbates damage to the testicular microenvironment. In addition, endoplasmic reticulum stress, mitochondrial dysfunction, and epigenetic changes are also important factors contributing to reproductive aging. Therefore, molecular intervention strategies targeting lysosomal dysfunction, mitochondrial oxidative stress, and endoplasmic reticulum stress, such as the use of lysosomal activators like ML-SA1 and antioxidants, may offer new therapeutic directions for alleviating male reproductive aging. Future research should further explore the interactions between these mechanisms and potential intervention targets to improve reproductive health and quality of life in middle-aged and older men.

ObjectiveTo investigate the effect of Bufeitang on intestinal flora of rats with lung Qi-deficiency syndrome of chronic obstructive pulmonary disease（COPD）， and to explore the mechanism of traditional Chinese medicine in regulating intestinal flora and thus restoring the balance of lung-gut axis. MethodA total of 84 rats were randomly divided into 7 groups， including blank group， model group， fecal bacterial transplantation（FMT） group， dexamethasone group and low， medium and high dose groups of Bufeitang， 12 rats in each group. Except for the blank group， cigarette and sawdust fumigation combined with intratracheal instillation of lipopolysaccharide（LPS） were used to establish the COPD rat model with lung Qi-deficiency syndrome in all other groups. The low， medium and high dose groups of Bufeitang were intragastric administrated with Bufeitang（3.645， 7.29， 14.58 g·kg^-1）， the FMT group was given fecal bacteria liquid enema（10 mL·kg^-1）， dexamethasone group was given dexamethasone acetate tablet suspension by gavage（0.135 mg·kg^-1）， the blank group and model group were given equal amount of distilled water. Fresh feces were collected after 28 d of continuous intervention for 16S rRNA gene sequencing. Lung and colon tissues were stained with hematoxylin-eosin（HE） for pathomorphological observation， and enzyme-linked immunosorbent assay （ELISA） was performed to detect the contents of tumor necrosis factor-α（TNF-α） and interleukin-8（IL-8） in lung tissues. ResultCompared with the blank group， the model group showed severe abnormal lung tissue structure with alveolar atrophy and collapse accompanied by severe inflammatory cell infiltration. Compared with the model group， the extent of injury was significantly improved， and inflammatory cell infiltration was reduced with basically normal alveolar structure in the high dose group of Bufeitang. Compared with the blank group， the model group had severely abnormal colonic tissue structure， the epithelial cells in the mucosal layer were eroded and shed， the number of inflammatory cells increased， the submucosal layer was edematous and the gap was enlarged. Compared with the model group， the extent of damage was significantly improved in the medium and high dose groups of Bufeitang， the epithelial cells in the mucosal layer were neatly and closely arranged， with only a small amount of inflammatory cell infiltration and no significant degeneration. Compared with the blank group， the TNF-α and IL-8 levels of lung tissue in the model group were significantly increased（P<0.01）. Compared with the model group， the TNF-α and IL-8 levels of lung tissues in the low， medium and high dose groups of Bufeitang were significantly decreased（P<0.01）. Bufeitang significantly modulated the number of bacteria species as well as alpha and beta diversity of model rats， corrected the return of intestinal flora to normal abundance and diversity， and positively regulated 4 differential phyla（such as Firmicutes， Proteobacteria） and 13 differential genera（such as Turicibacter， Lactobacillus， Anaerobiospirillum， Intestinimonas） in COPD model rats with lung Qi-deficiency syndrome， and down-regulated 2 carbohydrate metabolic pathway functions， including the pentose phosphate pathway（non-oxidative branch） Ⅰ and the Calvin-Benson-Bassham cycle. ConclusionBufeitang can modulate the abundance and diversity of intestinal flora species， affect the function of metabolic pathways， repair the structure of lung and colon tissues， regulate the level of inflammatory factors， and thus improve COPD with lung Qi-deficiency syndrome. The mechanism may be related to its regulation of inflammation-related intestinal flora to restore the balance of lung-gut axis in COPD with lung Qi-deficiency syndrome.

OBJECTIVETo analyze the relationship between the pathological features and 64-multislice spiral computed tomography (64-MSCT) findings of pulmonary nodules in autopsies from patients with coal workers' pneumoconiosis (CWP), to investigate the optimal imaging method for the distribution of pulmonary nodules, and to provide data for the establishment of CT diagnostic criteria for CWP.

METHODSCadaveric lung specimens were collected from 7 CWP patients. All of them were men, aged 42∼77 years (mean, 60.00±13.00 years), and their dust exposure time was 5∼30 years (mean, 15.4±8.01 years). The cadaveric lung specimens were treated by aeration, sectioning, and immobilization and were then examined by coronary 64-MSCT. The primitive images were reconstructed into the maximumintensity projection (MIP) images (slice thickness: 3 mm, 5 mm, and 8 mm). The sensitivities of imaging methods with different slice thickness were evaluated based on the pathology and anatomy of local pulmonary nodules, and the correlation between pathological results and radiological findings was analyzed.

RESULTSThere were significant differences between the stages determined by pathological examination and high-kV chest radiography (before death) (χ(2) = 4.667, P < 0.05; kappa value = 0.167, P < 0.05). A total of 271 nodules were found in all pathological sections, including peribronchovascular nodules (27, 9.9%), centrilobular nodules (67, 24.6%), interlobular nodules (65, 24.3%), nodules within 5 mm from the pleura (45, 16.5%), pleural plaque-like nodules on the lateral chest wall (45, 16.5%), and nodules on the interlobar pleura (22, 8.1%). The likelihood ratio was the highest (0.981) between 5-mm MIP images and pathological results according to the chi-square test.

CONCLUSIONThe stage of pulmonary nodules determined by pathological examination is significantly different from that determined by high-kV chest radiography. The 5-mm MIP images of 64-MSCT provide a good reflection of the local pathology and anatomy of pulmonary nodules in CWP patients.

Aged ; Anthracosis ; pathology ; Coal ; Coal Mining ; Dust ; Humans ; Lung ; pathology ; Male ; Middle Aged ; Pleural Diseases ; pathology ; Tomography, Spiral Computed

OBJECTIVE: To determine the expression levels of EphA7 and MTDH and detect their clinicopathological significance in the peritumoral normal tissues and the squamous cell cancer of the tongue. METHODS: Envision immunohistochemistry was used to assay the expression levels of EphA7 and MTDH in the conventional paraffin-embedded sections from specimens of squamous cell cancer (n=45) and peritumoral normal tissues (n=10). RESULTS: The positIVe rates of EphA7 and MTDH were significantly higher in the squamous cell cancer than those in the peritumoral normal tissues ( χ(2)(EphA7)=4.14; χ(2)(MTDH)= 5.25; P < 0.05). The positIVe rates of EphA7 and MTDH expression were significantly lower in the cases of histological grade I-II,clinical stage I-II, and no-metastasis of neck lymph node than those in the histological grade III-IV, clinical stage III-IV, and metastasis of neck lymph node (P <0.05 or P <0.01). CONCLUSION The expression levels of EphA7 and/or MTDH might have important effect on the carcinogenesis and progression of tongue cancer. Overexpression of EphA7 and/or MTDH might have poor prognosis.
Adult ; Aged ; Carcinoma, Squamous Cell ; metabolism ; pathology ; Cell Adhesion Molecules ; metabolism ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Receptor, EphA7 ; metabolism ; Tongue Neoplasms ; metabolism ; pathology