【Objective】 To investigate the sperm retrieval rate (SRR) of microdissection testicular sperm extraction (M-TESE) in patients with non-obstructive azoospermia (NOA) caused by different causes. 【Methods】 A retrospective analysis was performed on 225 NOA patients during Jan.2020 and Dec.2022. The relation between SRR and patients’ age,body mass index (BMI),testicular volume,endocrine hormones and different etiological classifications were analyzed. 【Results】 According to whether sperm was obtained by surgery,the patients were divided into two groups,including 107 cases in the sperm group and 118 cases in the non-sperm group. There were no significant differences in patients’ age,testicular volume and levels of endocrine hormones between the two groups (P>0.05). According to the different causes,NOA patients with mumps history,cryptorchidism history,AZFc deletion or Klinefelter syndrome (KS) had higher SRR,while idiopathic NOA patients had the lowest SRR (P<0.05). 【Conclusion】 M-TESE is an effective treatment of NOA. There is no correlation between SRR and patients’ age,MBI,testicular volume and levels of endocrine hormones. NOA caused by different etiological classifications may have different SRR.

【Objective】 To investigate the effects of the loss of exon 1 of TFE3 on nuclear localization of chimeric TFE3 protein in TFE3 translocation renal cell carcinoma (TFE3 tRCC). 【Methods】 The localization of TFE3 protein in TFE3 tRCC and clear cell renal cell carcinoma (ccRCC) were detected with immunochemistry. The exon retention of TFE3 gene in TFE3 tRCC was analyzed in databases and literatures. The plasmids containing TFE3 full-length and different-length of TFE3 exons which were constructed to pCDH-MCS-EGFP-Puro were transfected into HEK293T using Lipo Fiter^TM. The localization of EGFP protein in HEK293T cells were detected with confocal microscopy. The localization of TFE3 protein and truncated TFE3 protein were detected with Western blotting. The mRNA expression of the downstream genes of TFE3 protein were detected with q-PCR. 【Results】 Strong nuclear signal of TFE3 protein was observed in TFE3 tRCC, whereas TFE3 protein in ccRCC was mainly localized in cytoplasm. The results of fluorescence imaging and Western blotting showed that TFE3 full-length protein was expressed both in nucleus and cytoplasm, and the expression of truncated TFE3 protein was mainly localized in nucleus. The q-PCR analysis demonstrated that the deletion of exon 1 in TFE3 gene led to a higher transcriptional level of targeted genes of TFE3 protein. 【Conclusion】 The loss of exon 1 in TFE3 played a critical role in preventing TFE3 protein from entering the nucleus. In TFE3 tRCC, the loss of exon 1 in TFE3 gene leads to the nuclear localization of TFE3 fusion protein and activation of its downstream target genes. This mechanism promises to uncover the occurrence and development of TFE3 tRCC.

Objective:A single-center analysis was performed to assess the significant clinical features and prognostic factors of TFE3-rearranged renal cell carcinoma (TFE3 rRCC).Methods:The clinical data of 85 confirmed cases of TFE3 rRCC patients at the Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2007 to February 2023 were analyzed retrospectively. Among these patients, there were 39 males and 46 females, with a median age of 32 (26, 45) years. All patients underwent preoperative CT scans, 21/85 cases (24.7%) of TFE3 rRCC exhibited the characteristic feature of "circular calcification" with plain CT imaging, and enhanced CT scan showed that the tumor enhancement during the arterial phase was lower than the adjacent renal cortex. Among the 85 patients in this cohort, the median tumor diameter was 4.8(3.2, 6.5). Thirty-two patients underwent partial nephrectomy (NSS), while 51 patients underwent radical nephrectomy (RN). Two patients with distant metastasis at the time of diagnosis received only sunitinib therapy. Forty-three patients received adjuvant treatment, including 14 patients who received targeted therapy. There were 29 patients in AJCC stage Ⅲ/Ⅳ, with 10 patients presenting with venous tumor thrombus and 14 patients with lymph node metastasis. Histopathology, TFE3 immunohistochemistry, and break-apart TFE3 FISH probe detection were performed on all 85 cases, while 52 patients underwent RT-PCR and/or DNA sequencing. By combining the clinical and pathological data, we summarized the diagnostic Methods for TFE3 rRCC, evaluated the impact of surgical approaches (RN and NSS) on the survival outcomes of cT 1a/b patients, and assessed the influence of genetic subtypes (ASPL, NONO, PRCC, SFPQ, and others) on the survival outcomes of all patients. Furthermore, we analyzed the risk factors for disease progression. Results:TFE3 rRCC exhibited variable histopathological features, and the presence of acinar-like structures with psammoma bodies may be a relatively typical characteristic. All 85 patients showed positive TFE3 immunohistochemical staining. In 6 cases of TFE3 rRCC, break-apart TFE3 FISH probe yielded negative results. However, final confirmation was achieved through genetic sequence, with 5 cases diagnosed as NONO-TFE3 subtype and 1 case as RBM10-TFE3 subtype. Among the 85 patients, 52 underwent RT-PCR and/or DNA sequencing, revealing a total of 8 TFE3 fusion subtypes, including 11 cases of ASPL-TFE3, 8 cases of PRCC-TFE3, 10 cases of NONO-TFE3, 15 cases of SFPQ-TFE3, 1 case of CLTC-TFE3, 2 cases of LUC7L3-TFE3, 4 cases of MED15-TFE3, and 1 case of RBM10-TFE3. The survival analysis results revealed that among the 12 patients with cT 1b stage tumors who underwent radical nephrectomy (RN), the progression-free survival (PFS) was 35 (14, 109) months, which was significantly better than the NSS group ( P=0.041). However, for the 14 patients with cT 1a stage tumors who underwent RN, there was no statistically significant difference in overall survival (OS) and PFS compared to the NSS group, with OS being 55(27, 134) months and PFS being 71(41, 134) months. Stratifying according to TFE3 fusion subtypes, it was found that patients with ASPL-TFE3 fusion had a significantly lower PFS compared to those with non-ASPL-TFE3 fusion subtypes ( P=0.029). Survival analysis revealed that tumor diameter, surgical approach, adjuvant therapy, AJCC staging, venous tumor thrombus, and lymph node metastasis were associated with OS and PFS( P<0.05). The results of the multivariate Cox regression analysis showed that AJCC stage Ⅲ/Ⅳ( HR=2.393, 95% CI 1.418-4.039, P=0.001) and venous tumor thrombus ( HR=3.543, 95% CI 1.159-10.827, P=0.026) were independent risk factors for progression-free survival (PFS). Conclusions:During the non-enhanced phase of CT scan, TFE3 rRCC tumors can exhibit a circular calcification. TFE3 immunohistochemistry is an important screening method for TFE3 rRCC.Break-apart TFE3 FISH probe detection is considered the diagnostic gold standard, and gene sequencing, if feasible, can provide the subtype diagnosis of TFE3 rRCC. For cT 1a stage TFE3 rRCC, partial nephrectomy (NSS) is a viable option, while caution should be taken in selecting NSS for cT1b stage patients. Patients with ASPL-TFE3 fusion subtype have a worse prognosis. AJCC stage Ⅲ/Ⅳ and venous tumor thrombus indicate poor prognosis in TFE3 rRCC.

Objective:To investigate the biomechanical properties of anterior pelvic ring external fixators of two new configurations [iliac crest (IC)+anterior inferior iliac spine (AIIS), anterior superior iliac spine(ASIS)+AIIS] in the treatment of Tile type C1 pelvic fracture.Methods:A 3-dimensional finite element model of Tile type C1 pelvic ring injury (unilateral longitudinal sacral fracture and ipsilateral pubic fracture) was produced. The pelvis was fixed with external fixators of IC, AIIS, combination of IC and AIIS, combination of ASIS and AIIS, and S 1 sacroiliac screw in 5 types of models. In the simulated bipedal standing position and semi-recumbent position, the longitudinal displacement and back rotation angle displacement of the midpoint on the upper surface of S 1 were quantified and compared. Under the simulated left-right compression load state, the lateral displacements of the highest point of the lateral sacral fracture and the highest point of the lateral pubic fracture end were quantified and compared. Under the simulated anterior-posterior shear load state, the backward displacements of the highest point of the lateral sacral fracture end and the highest point of the lateral pubic fracture end were quantified and compared. Results:(1) In the simulated bipedal standing position under the vertical and longitudinal load state, the results of the longitudinal downward displacement of the midpoint on the upper surface of S 1 were consistent with the backward rotation angle displacement, and the order from largest to smallest was IC, AIIS, ASIS+AIIS, IC+AIIS and S 1 sacroiliac screw. The longitudinal downward displacement of IC was significantly larger than that of other models. The longitudinal downward displacement and backward rotation angle displacement of ASIS+AIIS and IC+AIIS were similar, and the latter was smaller. (2) In the simulated semi-recumbent position under the vertical and longitudinal load state, the results of the longitudinal downward displacement and backward rotation angle displacement of the midpoint on the upper surface of S 1 were also consistent, and the order from largest to smallest was IC, AIIS, ASIS+AIIS, IC+AIIS and S 1 sacroiliac screw. (3) Under the simulated left-right compression load state, the results of the lateral displacement of the highest point of the lateral sacral fracture end were consistent with that of the highest point of the lateral pubic fracture end, and the order from largest to smallest was S 1 sacroiliac screw, IC, AIIS, ASIS+AIIS and IC+AIIS. Among them, Among them, The lateral displacement of S 1 sacroiliac screw and IC was larger. The lateral displacement of ASIS+AIIS and IC+AIIS was similar, and the latter was smaller, significantly smaller than that of other models. (4) Under the simulated anterior-posterior shear load state, the results of the backward displacement of the highest point of the lateral sacral fracture end and the highest point of the lateral pubic fracture end were also consistent, and the order from largest to smallest was IC, AIIS, ASIS+AIIS, IC+AIIS and S 1 sacroiliac screw. Among them, the backward displacement of IC and AIIS was larger. The backward displacement of ASIS+AIIS and IC+AIIS was similar, and the latter was smaller. Conclusions:For type C1 pelvic fracture, the biomechanical stabilities of IC+AIIS and ASIS+AIIS are superior to those of IC or AIIS, with ASIS+AIIS being slightly inferior to IC+AIIS. Compared with S 1 sacroiliac screw, IC or AIIS, the lateral stabilities of IC+AIIS and ASIS+AIIS are particularly prominent. The two new external fixator configurations in this study are worthy of clinical application.

Objective To analyze the main factors affecting early using enteral nutrition and the effect of enteral nutrition within 72 h after burning on outcomes by presenting a retrospective cohort study of 11 years of hospitalization data,to provide evidence for enteral nutrition regimens for severe burn patients.Methods A retrospective study analyzed adult extensive burn patients between January 2009 and December 2020.Patients enrolled in this study who admitted to the burn department within 24 h after burning and with a burned area of more than 30%.Univariate and multiple regression were used to analyze the main factors affecting early using enteral nutrition in patients with severe burn.Non parametric Mann-Whitney U test was used to compare the main influencing factors of enteral nutrition implementation within or after 72 h,as well as the impact on the treatment outcomes such as 28-day survival rate and in hospital survival rate.Results The univariate analysis found that total burn area,full-thickness burn area,burn type,and inhalation injury were the main factors of the time to initation of enteral nutrition in patients with severe burn(P<0.05).Incorporating the above single factors into multiple regression analysis,we found that the main factors affecting enteral nutrition using in patients with severe burn were full-thickness burn area(P=0.017)and inhalation injury(P=0.001).To analysis whether enteral nutrition was started within 72 h after burning,we found that inhalation injury and larger area of full-thickness burn area in patients was the main factors for initiating enteral nutrition.After matching injury situation with pre-injury situation,we found that using enteral nutrition within or after 72 h after injury were no significant differences in the survival rate,28-day survival rate,and positive blood culture rate(P>0.05),but was associated with the lower incidence of bacteria positive in intravenous catheters(P=0.001)and the lower rate of parenteral nutrition treatment used within 7 d after burning(P= 0.001).Conclusions The main factor for influencing early implement enteral nutrition in patients with severe burn were large area of full-thickness burn and inhalation injury.Enteral nutrition using within 72 h after burning reduces the incidence of catheter infection and the use of parenteral nutrition,thereby reducing the risk of treatment in patients with severe burn.

Objective:The prognosis of cancer patients depends not only on tumor related factors, but also on host related factors, especially systemic inflammatory response. Based on the ratio of neutrophils to lymphocytes (NLR), the ratio of platelets to lymphocytes (PLR) and the ratio of lymphocytes to monocytes (LMR), we constructed a systemic inflammation model to predict the survival time of patients with gastric cancer (GC) after radical gastrectomy.Methods:Two hundred and five patients with GC who underwent radical resection from January 2011 to January 2017 were selected in Qinghai Provincial Communications Hospital and Red Cross Hospital of Qinghai Province. NLR, PLR and LMR were collected before operation. The best truncation values of NLR, PLR and LMR were obtained by ROC curve and systemic inflammatory marker score (SIMS) was constructed. The clinical value of SIMS was analyzed by single factor and multi factor Cox risk proportion model.Results:All patients were followed up for an average of (63.47 ± 10.36) months (range 20 to 65 months). The median survival time was 56 months. The one-year mortality rate was 6.3%, the three-year mortality rate was 26.2%, and the five-year mortality rate was 34.6%. The AUC of NLR, PLR and LMR were 0.745, 0.805 and 0.866 respectively, and the best truncation values were 3.11, 144 and 3.34 respectively. The mortality of patients with NLR > 3.11, PLR > 144, LMR ≤ 3.34 was higher than that of patients with NLR ≤ 3.11, PLR ≤ 114, LMR > 3.34 ( χ2 = 10.491, 14.658 and 38.765; P<0.01); there were differences in survival curves among different groups of NLR, PLR, LMR ( P < 0.05). The survival curves of different scores of SIMS were different ( P < 0.05). Age ( HR = 1.358, 95% CI 1.153 to 1.599), T stage-T 3 ( HR = 2.739, 95% CI 1.200 to 6.248), T stage-T 4 ( HR = 3.013, 95% CI 1.312 to 6.920), N stage-N 2 ( HR = 5.832, 95% CI 2.974 to 11.455), pathological stage Ⅲ ( HR = 2.962, 95% CI 1.835 to 4.646), lymphovascular invasion ( HR = 1.813, 95% CI 1.274 to 3.642), SIMS-1 ( HR = 7.065, 95% CI 4.673 to 10.692), SIMS-2 ( HR = 7.885, 95% CI 4.991 to 12.435), SIMS-3 ( HR = 8.365, 95% CI 5.635 to 3.485) were the independent risk factors of GC patients′ death ( P < 0.05). Conclusions:This study successfully constructs Sims and confirms that preoperative Sims is a relatively easy, easy to obtain and low-cost prognosis index for GC patients, which can be used to evaluate the survival time of GC patients before operation.

Objective To study the clinical efficacy of Bushen Huoxue decoction in the treatment of varicocele infertility and its influence on epididymis function and sperm vitality. Methods A total of 98 patients with varicocele infertility who were treated in our hospital from August 2016 to July 2018 were selected. The patients were randomly divided into control group of 49 cases and study group of 49 cases. The patients in the control group were treated with Maizhiling plus Wuzi Yanzong pill; the patients in the study group were treated with Bushen Huoxue decoction. After 12 weeks of treatment, the clinical efficacy of the patients was evaluated. The semen quality (including semen volume, sperm density, sperm motility, forward-moving sperm), sex hormones, and seminal plasma neutral α-glucosidase in the two groups were compared before and after treatment. After the end of treatment, the patients were followed up for 3 months to observe the pregnancy of the patients' spouse. Results After treatment, the total effective rate of the study group was87.76％, and the total effective rate of the control group was 69.39％. The semen quality, sex hormone and neutral α-glucosidase levels in the study group were better than those in the control group (P<0.05). Conclusion Bushen Huoxue decoction has a significant clinical effect in treating varicocele infertility. It can improve the semen quality, improve testosterone level and seminal plasma neutral α-glucosidase level, and improve the fertility of patients with varicocele.It is worthy of clinical promotion.

Objective To explore the clinical feasibility and safety of early intervention for severe stenosis of non-infarct related artery(non-IRA)in patients with acute ST-segment elevation myocardial infarction(STEMI) and multi-vessel disease(MVD)after successful primary percutaneous coronary intervention(PCI)for infarct-asso-ciated artery(IRA). Methods From May 1st,2011 to December 30th,2016,165 patients with STEMI and MVD were enrolled in our study. After the completion of primary PCI in IRA ,75 patients still in the hospital agreed to undergo a second staged PCI in severe stenosis of non-infarct arteries. We analyzed the in-hospital adverse events ,the length of hospital stay and clinical outcomes during the follow-up in the study population. Results There was no significant difference in the incidence of adverse events between the two groups during hos-pitalization. However,compared to patients treated with the IRA-only PCI,those treated with early intervention for severe stenosis of non-IRA was associated with greater benefits for clinical outcomes(including rehospitalization for heart failure,rehospitalization for ACS,recurrent angina pectoris,necessity for reintervention)during the follow-up except for the all-cause mortality. Conclusion Early intervention for severe stenosis of non-IRA is a feasible and safe procedure in patients with acute STEMI and MVD after successful primary PCI.

Objective To investigate the influence of laparoscopic radical gastrectomy for gastric cancer or colon cancer on immune indices and micrometastasis.Methods According to the treatment method,80 cases of gastric cancer or colon cancer in the Second Hospital of Shanxi Medical University from May 2016 to May 2017 were divided into observation group and control group,with 40 cases in each group.The observation group was treated with laparoscopic radical gastrectomy for gastric cancer or colon cancer,and the control group was treated with open stomach cancer or colon cancer radical operation.The changes of immune indicators of peripheral blood and micrometastasis of peritoneal lavage fluid were compared between the two groups.Results Compared with the preoperative immune indicators in peripheral blood of the two groups of IgG [(8.1 ±2.6)g/L],IgA[(1.6 ±0.9)g/L],IgM[(0.8 ± 0.2)g/L],C3[(0.7 ±0.3)g/L]and C4[(0.2 ±0.1)g/L]levels were decreased at first and then increased,and at 7d after operation,the levels[(10.5 ±2.3)g/L,(2.4 ±0.5)g/L,(1.3 ±0.6)g/L,(1.2 ±0.4)g/L,(0.5 ± 0.2)g/L]were closed to the preoperative levels.The level of IL-10[(98.8 ±32.4)g/L]increased obviously first,and then gradually decreased.The differences of C3 and IL-10 in the two groups were statistically significant at different time points,between the two groups and between different points(F=3.6786,5.769,4.668,4.625,9.375,5.354,all P<0.05).The other indicators were only statistically different among different time points(F=3.578,4.137,3.966,all P <0.05).At the end of the surgery,the CEA and DDC of the two groups were significantly increased,and the CEA[(1165.2 ±386.5)ng/L vs.(1788.6 ±725.5)ng/L]and DDC[(102.5 ±36.5)ng/L vs.(150.5 ±57.2)ng/L] levels and added value in the observation group were significantly lower than those in the control group,the differences were statistically significant(t=6.543,5.669,5.712,4.935,all P<0.05).Conclusion Laparoscopic radical gastrectomy for gastric cancer or colon cancer can improve the immune indices of the patients and reduce the index of micrometastasis in the peritoneal lavage fluid.

Objective To investigate the curative effect of benidipine hydrochloride on patients with coronary slow flow angina pectoris(CSFA).Methods Sixty cases patients with CSFA were randomly divided into two groups of 30 patients each.In the control group patients were received aspirin(100 mg,1 times/d) and atorvastatin(20 mg,1 times/d) as basic treatment;in the treatment group patients were received basic treatment plus benidipine hydrochloride(4 mg,1 times/d).Follow up for 6 mouths,the effectiveness rate of treatment(relief of angina and electrocardiogram of myocardial ischemia),the correction of thrombolysis in myocardial infarction(TIMI) frame count(CTFC) before and after the different intervention,and the incidence of adverse cardiovascular events were compared between the treatment group and the control group.Results The effectiveness rate of treatment in the treatment group(86.7%,26/30) was significantly higher than that in the control group(63.3%(19/30);χ2=4.356,P=0.037).There were significant reductions of CTFC in both groups after the different intervention(treatment group:(28.43±3.95) frames vs.(18.40±3.73) frames,t=10.254,P=0.000;control group:(27.87±4.14) frames vs.(21.87±4.17) frames,t=5.580,P=0.000).There was more significant reductions of CTFC in the treatment group as compared to the control group(t=2.138,P=0.037).The incidence of adverse cardiovascular events in the treatment group(10.0%(3/30)) was significantly lower than that in the control group(33.3%(10/30),P=0.028).Conclusion Benidipine hydrochloride is effective in the treatment of CSFA.