Objective To investigate the effect of smoking on the semen quality in infertile men.Methods A total of 360 male infertility patients were enrolled and divided into the smoking group(n=190)and non-smoking group(n=170)based on whether they smoked or not.Furthermore,the smoking group was subdivided into group A(≤10 sticks/d,n=63),group B(11～20 sticks/d,n=80),and group C(>20 sticks/d group,n=47)according to the amount of smoking.Semen volume,liquefaction time,sperm concentration,motility,DNA fragmentation rate and normal morphological rate were observed and compared between and within the groups.Results There were significant differences in semen volume,liquefaction time,sperm motility,normal morphological rate and DNA fragmentation rate between the smoking group and the non-smoking group(P<0.05).The semen volume,sperm motility and normal morphological rate of the smoking group were lower than those in the non-smoking group,and the DNA fragmentation rate and semen liquefaction time were higher than those in the non-smoking group.And with the increase of smoking volume,sperm motility and normal morphological rate decreased,semen liquefaction time and DNA fragmentation rate increased,and there was no significant difference in the sperm concentration between the smoking group and non-smoking group(P>0.05).There was no significant difference in the semen volume between the three groups with different smoking amounts(P>0.05).Conclusion Smoking has a negative impact on the sperm quality parameters such as semen volume,sperm motility,normal morphological rate,sperm motility,liquefaction time and DNA fragmentation,and the effect of heavy smoking is particularly obvious.We should strengthen the comprehensive health education,promote the healthy lifestyles and reduce smoking.

Objective To explore the clinical characteristics and treatment scheme of patients with spinal infection caused by Prevotella intermedia(P.intermedia).Methods Clinical diagnosis and treatment processes of a patient with spinal infection caused by P.intermedia admitted to the spinal surgery department of a hospital were summa-rized,and relevant literature was retrieved from database for reviewing.Results The patient,a 50 year old male,was admitted to the hospital due to"lumbago pain complicated with pain in double lower extremities for 2 months".The lesion tissue was taken for metagenomic next-generation sequencing(mNGS)detection,which detected P.in-termedia,and the patient was diagnosed with P.intermedia spondylitis.After treatments with open lesion clea-rance,tube rinsing+autologous bone transplantation fusion internal fixation,intravenous drip of ceftriaxone sodium and metronidazole,as well as metronidazole rinsing,infection was under control.A total of 16 available papers were retrieved,together with this case,a total of 17 patients were included,with 7 males and 10 females.The main risk factors were diabetes and history of corticosteroid use(35.3％).The most common invasion sites were lumbar ver-tebra(n=12)and thoracic vertebra(n=6).13 cases were positive for pathogen culture,3 cases were positive for molecular detection,and 1 case was positive for staining microscopy.17 patients received anti-anaerobic bacteria treatment,with 14 cases receiving combined surgical treatment.One case died,with a mortality of 5.9％;5 cases had partial neurological impairment,with a disability rate of 29.4％.The survival rate of patients who received treatment of anti-anaerobic bacteria combined with surgery was 92.8％,3 patients only with anti-anaerobic bacteria treatment but without surgery were all cured.Conclusion P.intermedia is an opportunistic pathogeanic bacteria which often causes infection in immunocomprised individuals and is prone to be misdiagnosed.It is recommended to perform mNGS detection to identify the pathogen as early as possible and seize the opportunity for treatment to reduce mortality.

Osteoporotic proximal humeral fracture (OPHF) is one of the common osteoporotic fractures in the aged, with an incidence only lower than vertebral compression fracture, hip fracture, and distal radius fracture. OPHF, secondary to osteoporosis and characterized by poor bone quality, comminuted fracture pattern, slow healing, and severely impaired shoulder joint function, poses a big challenge to the current clinical diagnosis and treatment. In the field of diagnosis, treatment, and rehabilitation of OPHF, traditional Chinese and Western medicine have accumulated rich experience and evidence from evidence-based medicine and achieved favorable outcomes. However, there is still a lack of guidance from a relevant consensus as to how to integrate the advantages of the two medical systems and achieve the integrated diagnosis and treatment. To promote the diagnosis and treatment of OPHF with integrated traditional Chinese and Western medicine, relevant experts from Orthopedic Expert Committee of Geriatric Branch of Chinese Association of Gerontology and Geriatrics, Youth Osteoporosis Group of Orthopedic Branch of Chinese Medical Association, Osteoporosis Group of Orthopedic Surgeon Branch of Chinese Medical Doctor Association, and Osteoporosis Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine have been organized to formulate Expert consensus on the diagnosis and treatment of osteoporotic proximal humeral fracture with integrated traditional Chinese and Western medicine ( version 2024) by searching related literatures and based on the evidences from evidence-based medicine. This consensus consists of 13 recommendations about the diagnosis, treatment and rehabilitation of OPHF with integrated traditional Chinese medicine and Western medicine, aimed at standardizing, systematizing, and personalizing the diagnosis and treatment of OPHF with integrated traditional Chinse and Western medicine to improve the patients ′ function.

Objective:To assess the trends in case-fatality rates for acute myocardial infarction (AMI) in China from 2015 to 2019.Methods:This study employed a population-based surveillance. Data from the China Registry of Acute Cardiovascular Event (China RACE) were utilized, including AMI cases reported by Grade Ⅱ and Grade Ⅲ hospitals at the disease surveillance sites across China from January 1 st 2015 to December 31 st 2019. The 28-day mortality outcome for reported AMI events was obtained by linking to the national death certificate registry system. The study analyzed the overall and age-standardized case-fatality rates, as well as their annual percent change (APC), during the study period, stratified by gender, age, and region. Results:The overall 28-day case fatality rate for AMI was 28.97% (22 532/77 764) from 2015 to 2019. The age-standardized case-fatality rate for AMI declined significantly from 37.53% in 2015 to 18.58% in 2019, with an APC of -14.33% ( P=0.018). We observed a significant downward trend in case-fatality rates of AMI in both genders (both P<0.05). Among males, the case-fatality rate decreased more steeply in younger males compared to elder counterparts. The most marked decreases were seen in males aged<35 years and 35 to 44 years, with APC of -27.63% ( P=0.007) and -22.65% ( P=0.004), respectively. In females, we observed a relatively stable decrease in case-fatality across age groups. The age-standardized case-fatality rate of AMI in eastern and central China decreased significantly from 2015 to 2019, with the APC of -19.22% ( P=0.006) and -15.62% ( P=0.032) respectively. However, the age-standardized case-fatality rate of AMI in western China remained stable ( P=0.227). Conclusions:The prognosis of AMI has considerably improved from 2015 to 2019 in China, regardless of ages and gender. Inequality in case-fatality rates among geographic regions highlights the need for targeted strategies in AMI prevention in western regions.

Noncarious lesions,a multifactorial condition encompassing tooth attrition,abrasion,and erosion,have a surge in prevalence and required increased attention in clinical practice.These nonbacterial-associated tooth de-fects can compromise aesthetics,phonetics,and mastica-tory functions.When providing full-arch fixed occlusal rehabilitation for such cases,the treatment strategy should extend beyond by restoring dentition morphology and aesthetics.This report details a complex case of erosive dental wear addressed through a fully digital,full-arch fixed occlusal rehabilitation.A 4D virtual patient was created using multiple digital data sources,including intraoral scanning,3D facial scanning,digital facebow registration,and mandibular movement tracing.With a comprehensive understanding of the masticatory system,various types of microinvasive prostheses were customized for each tooth,including labial ve-neers,buccal-occlusal veneers,occlusal veneers,overlays,inlays,and full crowns,were customized for each tooth.The reported digital workflow offered a predictable diagnostic and treatment strategy,which was facilitated by virtual visual-ization and comprehensive quality control throughout the process.

Objective To explore the network structure of anxiety,depression and sleep among individuals under long-term high-altitude exposure.Methods A total of 303 subjects who had resided at high altitudes for more than 6 months on end were selected.The insomnia severity index(ISI),patient health questionnaire(PHQ-9),and generalized anxiety disorder scale(GAD-7)were employed to assess insomnia,depression and anxiety before network analysis was conducted to identify the central and bridge nodes in the symptom network.Results The incidence of moderate or severe depression,anxiety and insomnia were 38.9％[95％confidence interval(CI):33.4％-44.5％],23.1％(95％CI:18.3％-27.9％),and 18.5％(95％CI:14.1％-22.9％),respectively."Noticeability of sleep problems by others"had the highest expected influence centrality,followed by"sleep maintenance""uncontrollable worry""restlessness"and"sleep problems".Five bridge symptoms were identified:"sad mood""sleep problems""restlessness""feeling afraid"and"trouble relaxing".Conclusion Sleep-related symptoms play a crucial role in the overall network structure,serving as both central and bridge nodes.Additionally,the"feeling down or depressed"acts as a bridge node and holds importance in the comorbidity network of anxiety and depression.Targeting these key symptoms through intervention and prevention strategies may improve the psychological well-being of individuals with long-term residence in high-altitude regions.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the consistency of domestic F-STROKE, NeuBrainCARE MRI automatic post-processing software and RAPID MRI automatic post-processing software in the output of infarction core area volume, time-to-maximum volume and ischemic penumbra volume in patients with acute ischemic stroke.Methods:The research was cross-sectional. The clinical and imaging data of patients with acute ischemic stroke from January 2016 to March 2021 were retrospectively collected, including 149 cases from Shanghai Fourth People′s Hospital Affiliated to Tongji University (Center 1), 120 cases from Langfang Changzheng Hospital of Hebei Province (Center 2), and 45 cases from Wuzhou Workers Hospital (Center 3). All patients underwent diffusion weighted imaging (DWI) and dynamic magnetic sensitivity contrast-perfusion weighted imaging (DSC-PWI). RAPID, F-STROKE and NeuBrainCARE automatic post-processing software were used to perform automatic post-processing analysis of MRI images of all patients with acute ischemic stroke. The infarct core (apparent diffusion coefficient<620×10 -6 mm 2/s) volume, time-to-maximum (T max>6 s) volume and the ischemic penumbra (PWI-DWI mismatch) volume were output. The Wilcoxon test was used to analyze the difference between F-STROKE, NeuBrainCARE, and RAPID software outputs of infarct core volume, time to maximum peak volume, and ischemic penumbra volume. Bland-Altman and intraclass correlation coefficient ( ICC) were used to analyze the consistency of the infarct core volume, time-to-maximum volume and ischemic penumbra volume output by F-STROKE, NeuBrainCARE and RAPID software. Results:There were statistically significant differences in the core infarct volume between F-STROKE and RAPID software, NeuBrainCARE and RAPID software ( Z=-10.17, -5.43, both P<0.001). There were significant differences in the time-to-maximum volume between F-STROKE and RAPID software, NeuBrainCARE and RAPID software ( Z=-3.17, -5.51, both P<0.05). There was no significant difference in the ischemic penumbra volume between F-STROKE software and RAPID software ( Z=-1.43, P=0.153), and there was significant difference in the ischemic penumbra volume between NeuBrainCARE software and RAPID software ( Z=-6.45, P<0.05). Bland-Altman analysis showed that the values within the limits of agreement accounted for more than 93.31% of all point values. ICC analysis showed high agreement between F-STROKE, NeuBrainCARE, and RAPID software outputs of infarct core volume, time to maximum peak volume, and ischemic penumbra volume ( ICC>0.6). Conclusion:Domestic F-STROKE software, NeuBrainCARE software and RAPID software have good consistency in evaluating the infarct core volume, time-to-maximum volume and ischemic penumbra volume in patients with acute ischemic stroke, which is worthy of clinical promotion.

The purpose of this study was to explore the protective effect of glycyrrhiza polysaccha-ride on oxidative stress-induced liver cell damage in broiler chickens,and to study its mechanism of action.Primary broiler liver cells cultured in vitro were divided into blank control group,H2 O2 in-duction group,glycyrrhiza polysaccharide group and H2O2+glycyrrhiza polysaccharide group;CCK-8 reagent was used to detect liver cell activity in broiler chickens,JC-1 and DAPI staining kits were used to detect cell apoptosis,relevant kits were used to detect GSH-Px,SOD,CAT,MDA content,and T-AOC levels.qRT-PCR was used to detect antioxidant genes Nrf2,Keap-1,GPx1,SOD,CAT and inflammatory genes TLR4,MyD88,NF-κB,TNF-α、IL-6,IL-1β、IL-4 and IL-10.The results showed that compared with the H2O2 induced group,glycyrrhiza polysaccharide pretreat-ment could significantly enhance liver cell activity and reduce cell apoptosis in broiler chickens;compared with the H2O2 induced group,glycyrrhiza polysaccharide pretreatment could significant-ly increase cell GSH-Px,SOD,CAT,MDA content and T-AOC levels,and inhibit MDA genera-tion;qRT-PCR detection showed that glycyrrhiza polysaccharide could significantly increase the relative expression levels of Nrf2,Keap-1,GPx1,SOD,CAT,IL-4 and IL-10,while significantly re-ducing MyD88,NF-κB,TNF-α,IL-6 and IL-1β.The results indicated that glycyrrhiza polysaccha-ride enhance the activity of antioxidant enzymes by activating the Nrf2 signaling pathway and in-hibit TLR4 signaling pathway transduction,significantly improving oxidative stress damage in broiler liver cells.

Objective To carry out rigid-body inverse dynamics modelling and analysis of a self-designed 6RSS parallel bio-inspired masticatory robot.Methods Firstly,the functions of kinematic variables including translational/rotational velocities and accelerations were derived for rigid-body inverse dynamics modelling.Secondly,the rigid-body inverse dynamics model was established with the Newton-Euler's law.Finally,the chewing motion trajectories of the oral health volunteers were tracked and numerical calculations were carried out in the case where the robot was subjected to a chewing reaction force.Results Numerical calculations showed that the driving torque and the constraint force of the robot peaked when the chewing reaction force was at its maximum.Conclusion The external force has a large impact on the inverse dynamics of the robot,and theoretical references are provided for the motion control and optimal design of the robot.[Chinese Medical Equipment Journal,2024,45(3):16-22]