[Exploring the mechanisms of Jujing pill on varicocele-associated male infertility via network pharmacology and molecular docking technology].

OBJECTIVE: To investigate the potential mechanism of treating varicocele-associated male infertility with Jujing pill using network pharmacology and molecular docking technology. METHODS: The TCMSP and BATMAN databases were used to search for the Chinese medicine components of the Jujing pill and obtain the corresponding targets. The databases GeneCards, DISGENET, OMIM, and HPO were searched for 'varicocele' and 'male infertility' to identify the potential targets of varicocele-associated male infertility. Wayne diagrams were drawn using the jvenn tool to determine the intersection targets of the Chinese medicine targets and disease targets. The intersecting targets were further analyzed to identify the components and Chinese medicine corresponding to them. A Chinese medicine-active ingredient-target network map was constructed in Cytoscape 3.8.2. The protein-protein interaction (PPI) network of the intersecting targets was constructed using the STRING platform. The intersecting targets were imported into the DAVID database for GO enrichment analysis and KEGG-based pathway enrichment analysis. The KEGG database was used to select the most relevant pathway to the topic, and a KEGG pathway map was constructed using the mapper tool. The top 15 pathways with FDR values and their related targets and components were used to draw a core ingredient-target-pathway map. Finally, molecular docking was performed to verify the protein receptors and small molecule ligands of the core genes, and the results were visualized using AutoDock and PyMol software. RESULTS: A total of 207 ingredients and 1103 predicted targets of Jujing pill were screened. Additionally, 285 targets of varicocele were also identified. By using a Venn diagram, 86 common targets were obtained. The analysis of Gene Ontology (GO) results revealed significant enrichment in various biological processes (BP) such as positive regulation of gene expression, positive regulation of transcription, positive and negative regulation of apoptotic processes, response to hypoxia, response to estradiol, and positive regulation of nitric oxide biosynthesis processes. Furthermore, significant enrichment in cellular components (CC) was observed in macromolecules, cytoplasm, nucleus, and phosphatidylinositol 3-kinase complex. In terms of molecular function (MF), enrichment was found in enzyme binding, identical protein binding, transcriptional co-activator binding, and others. KEGG analysis demonstrated enrichment in pathways related to cancer, AGE-RAGE signaling pathway in diabetic complications, HIF-1 signaling pathway, FoxO signaling pathway, and more. Molecular docking results indicated that the core ingredients exhibited a strong binding capacity with the key targets. Conclusion： The effective active ingredients of Jujing pill exert their therapeutic effects on varicocele-associated male infertility through multiple targets and pathways. These findings provide a theoretical basis for future cell and animal experiments to verify the mechanism of action of Jujing pill in treating varicocele-associated male infertility.

[Efficacy of Jujing Decoction combined with lipoic acid in the treatment of asthenospermia and teratospermia].

OBJECTIVE: To observe the clinical efficacy of Jujing Decoction combined with lipoic acid in the treatment of asthenospermia and teratospermia. METHODS: Fifty patients with asthenospermia and teratospermia meeting the inclusion criteria were randomly divided into a blank control (n = 10) and a medication group (n = 40), the former provided with fertility guidance and the latter treated with Jujing Decoction combined with lipoic acid. After 12 weeks of treatment, the clinical therapeutic effects were evaluated by comparing the semen volume, sperm concentration, percentages of progressively motile sperm (PMS) and morphologically abnormal sperm (MAS), rate of acrosome integrity, sperm DNA fragment index (DFI) and pregnancy rate between the two groups. RESULTS: Compared with the control group, the medication group achieved a significantly higher overall effectiveness rate (10% ï¼»1/10ï¼½ vs 88.89% ï¼»32/36ï¼½, P < 0.05) and pregnancy rate (0% ï¼»0/10ï¼½ vs 8.33% ï¼»3/36ï¼½, P < 0.05) after treatment. The medication group also showed remarkably increased PMS from (21.04 ± 6.49)% to (32.66 ± 7.05)%, decreased MAS from (98.31 ± 1.28)% to (96.52 ± 1.11)%, elevated acrosome integrity from (42.18 ± 16.67)% to (60.42 ± 11.61)%, and reduced sperm DFI from (21.92 ± 6.96)% to (12.37 ± 3.79)%, all with statistically significant differences compared with the blank control group. CONCLUSION: Jujing Decoction combined with lipoic acid can significantly improve sperm motility, reduce MAS and DFI and increase the pregnancy rate through antioxidant stress, and has a high clinical safety.

[Clinical efficacy of Jujing Decoction on teratospermia: An investigation based on the theory of "yin forming"].

OBJECTIVE: To study the clinical efficacy of Jujing Decoction (JJD) based on the theory of "yin forming" in the treatment of teratospermia and its effects on semen parameters, sperm morphology, sperm DNA fragmentation index (DFI) and the ultrastructure of sperm mitochondria. METHODS: We randomly divided 40 patients with teratospermia into a blank control group (n = 16) and a JJD group (n = 24), the former treated by reproductive health guidance and the latter with JJD, respectively. After 12 weeks of intervention, we observed the clinical effects and changes in the semen volume, sperm concentration, percentages of progressively motile sperm (PMS) and morphologically abnormal sperm (MAS), sperm DFI and the ultrastructure of sperm mitochondria, and analyzed the data obtained based on the "yin forming" theory. RESULTS: The total effectiveness rate was significantly higher in the JJD than in the blank control group (87.50% vs 6.66%, P < 0.05). Compared with the baseline, the patients after treated with JJD showed significant improvement in semen volume (ï¼»3.27 ± 1.14ï¼½ vs ï¼»4.16 ± 1.84ï¼½ ml, P < 0.05), sperm concentration (ï¼»38.85 ± 15.88ï¼½ vs ï¼»39.35 ± 14.58ï¼½ × 106/ml, P < 0.05), PMS (ï¼»37.47 ± 2.74ï¼½% vs ï¼»42.55 ± 7.07ï¼½%, P < 0.05), MAS (ï¼»97.43 ± 1.01ï¼½% vs ï¼»95.52 ± 0.85ï¼½%, P < 0.05), acrosomal integrity (ï¼»45.27 ± 5.14ï¼½% vs ï¼»51.88 ± 4.48ï¼½%, P < 0.05), and DFI (ï¼»25.53 ± 6.89ï¼½% vs ï¼»17.68 ± 2.38ï¼½%, P < 0.05), while the blank controls exhibited only slightly increased semen volume (ï¼»3.67 ± 1.77ï¼½ vs ï¼»4.40 ± 1.78ï¼½ ml) and sperm concentration (ï¼»37.24 ± 9.31ï¼½ vs ï¼»38.32 ± 10.54ï¼½ ×106/ml), but no significant improvement in the other parameters (P> 0.05). Before treatment, folded and discontinuous sperm acrosomal membrane was observed under the transmission electron microscope in the sperm mitochondria of the two groups of patients, the mitochondria stacked and differently sized in the neck and disorderly arranged and some obviously swollen around the tail microtubule. After treated with JJD, the ultrastructure of sperm mitochondria was significantly improved, with relative continuity and integrity of the acrosomal membrane and well-arranged and relatively intact and uniform-sized mitochondria in the neck and tail. CONCLUSION: Jujing Decoction can increase the semen volume, sperm concentration and percentage of progressively motile sperm, reduce the percentage of morphologically abnormal sperm and sperm DFI, improve sperm acrosomal integrity, maintain the stability of sperm ultrastructure and protect the structure of sperm mitochondria.

[Distribution of TCM syndrome types and their correlation semen parameters in infertility patients with varicocele].

OBJECTIVE: To explore the distribution of Traditional Chinese Medicine (TCM) syndrome types and their relationship with semen parameters in infertility male patients with varicocele (VC). METHODS: Using Questionnaire on Clinical Symptoms of Varicocele-Caused Male Infertility, we made an investigation among 147 infertility male patients with VC, determined the types of their TCM syndromes, obtained their semen parameters, and analyzed the distribution of the TCM syndrome types and their correlation with semen parameters. RESULTS: Of the TCM syndrome types identified, kidney deficiency and stagnated heat constituted the largest proportion (34.7%), and the mixed type accounted for a significantly higher percentage than the simple type (P < 0.05). The patients with kidney deficiency and stagnated heat, compared with those with other syndrome types, had a dramatically lower sperm concentration (ï¼»21.62 ± 9.25ï¼½ vs ï¼»28.88 ± 12.92ï¼½ ×106/ml, P < 0.01), but a higher percentage of morphologically abnormal sperm (ï¼»98.33 ± 0.15ï¼½% vs ï¼»96.27 ± 0.18ï¼½%, P < 0.05) and DNA fragmentation index (ï¼»19.72 ± 3.17ï¼½% vs ï¼»10.96 ± 3.82ï¼½%, P < 0.01). No statistically significant differences were observed in the percentage of progressively motile sperm among different TCM syndrome types. CONCLUSIONS: Kidney deficiency and stagnated heat is a main TCM syndrome type in infertility male patients with varicocele and correlated with sperm concentration, the percentage of morphologically abnormal sperm and DNA fragmentation index.

[A clinical analysis of 15 children with systemic lupus erythematosus accompanied by pulmonary hypertension].

OBJECTIVE: To evaluate the clinical features, laboratory findings, diagnosis and treatment, and prognosis of children with systemic lupus erythematosus (SLE) accompanied by pulmonary hypertension (PH). METHODS: The clinical symptoms, laboratory findings, echocardiographic features, SLE disease activity index, and treatment outcome of 15 hospitalized children with SLE accompanied by PH were retrospectively analyzed. RESULTS: Among the 15 patients, the median interval from diagnosis of SLE to diagnosis of PH was 0.1 year (range: 0-6.5 years). Aside from PH-related symptoms, Raynaud's phenomenon was observed in 6 (40%) of the 15 patients. There was no significant difference in SLE disease activity (evaluated by complements 3 and 4 levels, erythrocyte sedimentation rate, and positive rate of anti-double-stranded DNA) between patients with mild-to-moderate PH and those with severe PH (P<0.05). As for treatment, 13 patients received immunosuppressive therapy with glucocorticoids, and among them 2 patients received PH-targeted therapy. During a median follow-up of 8.0 years (range: 0.5-18.1 years) since the diagnosis of PH, 2 deaths were noted with class III or IV cardiac function (World Health Organization), while the other patients were in a stable condition. CONCLUSIONS: Raynaud's phenomenon is a common clinical manifestation in children with SLE accompanied by pulmonary hypertension (PH). PH severity is not significantly associated with SLE disease activity, and thus greater focus should be placed upon early screening of pulmonary arterial pressure in SLE patients. Early diagnosis and early treatment can improve the prognosis of children with SLE.

[Modified Jujing No.2 Decoction for varicocele-induced male infertility].

Objective: To investigate the clinical effect of Jujing No.2 Decoction on male infertility induced by varicocele. METHODS: We equally randomized 70 male patients with varicocele-induced infertility into a treatment group and a control group, the former treated with modified Jujing No.2 Decoction (1 dose a day, bid) and the latter given Danshen Tablets (4 tablets once, tid) plus Liu Wei Di Huang Wan (8 pills once, tid), both for 3 months. We examined the spermatic veins of the patients by ultrasonography and performed seminal analysis before and after medication. RESULTS: Compared with the controls, the patients in the treatment group showed significant improvement after medication in sperm concentration (ï¼»12.35±2.12ï¼½ vs ï¼»18.56±4.16ï¼½ ×106/ml, P<0.05), progressively motile sperm (ï¼»16.18±6.34ï¼½ vs ï¼»24.63±8.51ï¼½ %, P<0.05), and morphologically normal sperm (ï¼»11.59±5.31ï¼½ vs ï¼»14.17±6.02ï¼½ %, P<0.05). In the control group, sperm concentration was increased from (12.29±2.07) ×106/ml at the baseline to (13.13±3.13) ×106/ml after medication, progressively motile sperm from (16.13±6.45) % to (20.55±7.30) % (P<0.05), and morphologically normal sperm from (11.62±5.35) % to (12.69±5.77) %. The total effectiveness rate was significantly higher in the treatment than in the control group (71.88% vs 46.67%, P<0.05). The inner diameter of the left spermatic vein was decreased from (0.32±0.05) mm at the baseline to ï¼»0.26±0.05ï¼½ mm after medication in the treatment group (P<0.05) and from (0.32±0.03) mm to (0.29±0.04) mm in the control (P<0.05), with statistically significant difference between the two groups after medication (P<0.05). CONCLUSIONS: Jujing No.2 Decoction is effective in the treatment of varicocele-induced male infertility.

Co-recycling of acrylonitrile-butadiene-styrene waste plastic and nonmetal particles from waste printed circuit boards to manufacture reproduction composites.

This study investigated the feasibility of using acrylonitrile-butadiene-styrene (ABS) waste plastic and nonmetal particles from waste printed circuit boards (WPCB) to manufacture reproduction composites (RC), with the aim of co-recycling these two waste resources. The composites were prepared in a twin-crew extruder and investigated by means of mechanical testing, in situ flexural observation, thermogravimatric analysis, and dimensional stability evaluation. The results showed that the presence of nonmetal particles significantly improved the mechanical properties and the physical performance of the RC. A loading of 30 wt% nonmetal particles could achieve a flexural strength of 72.6 MPa, a flexural modulus of 3.57 GPa, and an impact strength of 15.5 kJ/m2. Moreover, it was found that the application of maleic anhydride-grafted ABS as compatilizer could effectively promote the interfacial adhesion between the ABS plastic and the nonmetal particles. This research provides a novel method to reuse waste ABS and WPCB nonmetals for manufacturing high value-added product, which represents a promising way for waste recycling and resolving the environmental problem.

[Clinical and genetic analysis of Dent disease in 4 Chinese children].

OBJECTIVE: To study the clinical features and gene mutations of 4 Chinese children with Dent disease. METHODS: The clinical and laboratory data of 4 children with Dent disease were analyzed retrospectively. Genetic testing of the 4 cases was carried out. RESULTS: All of 4 cases were boys. The first impression of Cases 1-3 was Fanconi syndrome. Proteinuria was presented as the first impression in Case 4. All 4 boys presented with low-molecular weight proteinuria (LMWP) and hypercalciuria, including 3 cases with hematuria, 1 case with kidney stones, 2 cases with nephrocalcinosis, 3 cases with hypophosphatemia, and 3 cases with rickets. Mutations of the CLCN5 gene were revealed in three patients (Cases 1, 2 and 4), including exon 6-7del, c.785_787de l(p.263del Leu) and c.1039 C>T (p.Arg347Term). The first two gene mutations had never reported before. CONCLUSIONS: Urine protein electrophoresis should be carried out for patients with proteinuria. Dent disease should be taken into consideration when patients with Fanconi syndrome have hypercalciuria, nephrocalcinosis or kindey stones. Genetic analyses are needed for a definite diagnosis.

Novel recycling of nonmetal particles from waste printed wiring boards to produce porous composite for sound absorbing application.

Nonmetal materials take up about 70 wt% of waste printed wiring boards (WPWB), which are usually recycled as low-value fillers or even directly disposed by landfill dumping and incineration. In this research, a novel reuse ofthe nonmetals to produce porous composites for sound absorbing application was demonstrated. The manufacturing process, absorbing performance and mechanical properties of the composites were studied. The results show that the high porous structure of the composites leads to an excellent sound absorption ability in broad-band frequency range. Average absorption coefficient of above 0.4 can be achievedby the composite in the frequency range from 100 to 6400 Hz. When the particle size is larger than 0.2 mm, the absorption ability of the composite is comparable to that of commercial wood-fibre board and urea-formaldehyde foam. Mechanical analysis indicates that the porous composites possess sufficient structural strength for self-sustaining applications. All the results indicate that producing sound absorbing composite with nonmetal particles from WPWB provides an efficient and profitable way for recycling this waste resource and can resolve both the environment pollution and noise pollution problems.

[Laparoscopic high uterosacral ligament suspension combined with cervical amputation in treatment of women severe uterine prolapsed at child-bearing period].

OBJECTIVE: To evaluate clinical and sexual outcomes in women with severe uterine prolapsed at child-bearing period undergoing laparoscopic high uterosacral ligament suspension combined with cervical amputation. METHODS: From November 2007 to March 2010, 34 patients ( ≤ 50 years old) with severe uterine prolapse (prolapse group) who had already given birth and underwent laparoscopic high uterosacral ligament suspension combined with cervical amputation in Peking Union Medical College Hospital were enrolled in this retrospective study. All patients were defined as Pelvic Organ Prolapse Quantification (POP-Q) stage III. Follow-up was performed at 1, 6, and 12 months, and then annually. Anatomic failure was defined as ≥ 1 pelvic compartment classified as POP-Q ≥ stage II.Sexual outcomes were assessed at baseline and 3-year follow-up according to validated Short-Form Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Thirty one age-matched women who underwent health examinations during the same time period were selected as a healthy control group. RESULTS: Mean age of women at prolapse group were (39 ± 5) years and average surgery time were (51 ± 8) minutes. No severe intraoperative complications occurred, including urethral twist, bladder and rectum injury, pelvic hemotoma. All patients were followed up for more than 3 years, the mean following up period was 40 months (36-64 months). Based on stage II of POP-Q as recurrence criteria, the anatomical success and patient satisfaction rates were both 100% (34/34). POP-Q point C and D measurements were significantly higher after surgery then those at preoperative values [C:(-5.4 ± 0.6) cm versus (2.2 ± 0.7) cm, D:(-6.7 ± 0.4) cm versus (-4.0 ± 0.7) cm; P < 0.01 for all]. Three years postoperatively, 33 patients were sexually active. Among the 94% (31/33) patients who answered the PISQ-12 questionnaire, there was significant improvement in post- and preoperative total PISQ-12 scores (38 versus 26, P < 0.01) and in all three subscale PISQ-12 domains (P < 0.01 for all). The postoperative PISQ-12 score was similar to that of the control group (38 ± 6 versus 37 ± 3, P > 0.05). CONCLUSION: Laparoscopic high uterosacral ligament suspension combined with cervical amputation conferred satisfying long-term anatomic and sexual function outcomes in women at child-bearing age.

[Therapeutic efficacy of Bushengzhuyang Fang (Yangjing Capsule) on phytoestrogen-induced erectile dysfunction: an experimental study].

OBJECTIVE: To investigate the effect of Bushengzhuyang Fang (Yangjing Capsule, YJC) on penile erectile function and its action mechanisms in rats. METHODS: Fifty-six male SD rats were randomly divided into seven groups of equal number: blank control, daidzein, daidzein + testosterone, daidzein + sildenafil, daidzein + low-dose YJC, daidzein + medium-dose YJC, and daidzein + high-dose YJC. The rats in the blank control group were treated intragastrically with normal saline and those in the other groups with daidzein at the dose of 100 mg per kg per day for 30 days. Then the last five groups received additionally testosterone (4 mg per kg per day), sildenafil (2.5 mg per kg per day), low-dose YJC, (0.315 mg per kg per day), medium-dose YJC (0.63 mg per kg per day), and high-dose YJC (1. 26 mg per kg per day), respectively. At 0, 30 and 60 days of treatment, we observed the apomorphine-induced spontaneous erectile response and pathological changes in the corpus cavernosum of the rats, recorded the number of penile erection and erectile incubation period, and determined the serum levels of testosterone (T) and luteinizing hormone (LH). RESULTS: At 30 days of treatment, the number of apomorphine-induced erections was decreased, the erectile incubation period prolonged, and the serum levels of T and LH reduced remarkably in all groups of rats (P < 0.05). Compared with the findings at 30 days, the number of penile erections was significantly decreased at 60 days in the daidzein group (1.39 ± 0.42 vs 2.67 ± 0.33, P < 0.05) and daidzein + low-dose YJC group (1.33 ± 0.49 vs 2.83 ± 0.61, P < 0.05); the erectile incubation period was markedly ex- tended ([16.33 ± 3.11] vs [8.50 ± 0.93] min and [15.50 ± 3.21] vs [8.63 ± 1.54] min, P < 0.05); and the serum levels of T ([5.34 ± 0.89] vs [1.24 ± 0.30] ng/ml and [5.28 ± 1.12] vs [2.07 ± 0.76] ng/ml, P < 0.05) and LH ([3.62 ± 0.37] vs [2.09 ± 0.12] ng/ml and [3.79 ± 0.28] vs [2.17 ± 0.33] ng/ml, P < 0.05) were significantly reduced in the daidzein and daidzein + low-dose YJC groups, respectively. Pathological examination revealed slightly decreased cavernous sinuses and blood vessels in the corpus cavernosum of the rats in the daidzein + testosterone, daidzein + sildenafil, daidzein + medium-dose YJC, and daidzein + high-dose YJC groups as compared with those in the blank control group. CONCLUSION: High-dose Yangjing Capsule is efficacious for the recovery of erectile function in rats, especially for phytoestrogen-induced erectile dysfunction.

Anatomic and sexual outcomes after vaginoplasty using tissue-engineered biomaterial graft in patients with Mayer-Rokitansky-Küster-Hauser syndrome: a new minimally invasive and effective surgery.

INTRODUCTION: Recent years have seen continuous reports about the successful reconstruction of numerous organs with the application of tissue-engineering techniques. Thus, we assess the outcomes for vagina reconstruction using tissue-engineered biological material, which we suggested previously as an ideal graft for vaginoplasty. AIM: To evaluate the anatomic and sexual outcomes in patients undergoing vaginoplasty using tissue-engineered biomaterial mesh. METHODS: This prospective study included 53 patients with Mayer-Rokitansky-Küster-Hauser syndrome admitted to our hospital. Patients underwent vaginoplasty with tissue-engineered biological material (acellular dermal matrix). Postoperatively, a silicone vaginal dilator (length: 10 cm, diameter: 3.5 cm) was advised to be used for the first 3-6 months to prevent contraction of the neovagina. Follow-up was performed at 4 weeks, 12 weeks, 12 months, and then annually. Twenty-four age-matched women who underwent health examinations during the same time period were selected as a health control group and answered Female Sexual Function Index (FSFI) questionnaires for the purpose of comparing sexuality. MAIN OUTCOME MEASURES: Anatomic success was defined by a vaginal length ≥ 8 cm and a width allowing the easy introduction of two fingers. Sexual outcomes were assessed at the 12-month follow-up according to body image perception and FSFI questionnaires validated for the Chinese-speaking population. RESULTS: No severe intra-operative complications occurred. No graft-related infection, rejection, or detachment was recorded. The cost for tissue-engineered biomaterial graft was $1,900 (¥ 12,000) per person. Postoperatively, granulomatous polyps occurred in 6/53 patients (11.3%) at the vaginal vault and were removed in an outpatient clinic. During a mean follow-up of 21.1 months, the anatomic success rate was 100%, and all of the patients were satisfied with their body image. Postoperatively, 42 patients were followed up for more than 1 year, and 32 of them were sexually active. Among the 24/32 patients (75%) who answered the FSFI questionnaire, the mean total FSFI score was 26.7 ± 3.5, which was similar to that of the control group (25.6 ± 7.4, P = 0.46). The similarity was also observed in six separate domains of the functional aspect of female sexuality. CONCLUSIONS: Vaginoplasty with tissue-engineered biomaterial graft is a safe, effective, minimally invasive cosmetic procedure that provides near normal sexual function for patients with vaginal aplasia.

Tocilizumab reduces the unmanageable inflammatory reaction of a patient with Aicardi-Goutières syndrome type 7 during treatment with ruxolitinib.

BACKGROUND: Aicardi-Goutières syndrome (AGS) is a rare hereditary early-onset encephalopathy characterized by upregulation of the type I interferon pathway, poorly responsive to conventional immunosuppression. CASE PRESENTATION: We describe a 7-year-old Chinese boy who developed symptoms at the age of 6 months. He presented with a chilblain-like rash, leukopenia, neutropenia, elevated liver enzymesgrowth retardation, microcephaly, elevated acute phase reactants, intracranial calcification and leukodystrophy. At the age of 3 years old, whole-exome sequencing confirmed a de novo heterozygous gain-of-function mutation, c.1016 C > A (p.Ala339Asp), in the IFIH1 gene, and he was diagnosed with AGS7. He was treated with ruxolitinib accompanied by steroids and thalidomide for about four years. The rash, hematological manifestations, and the liver function were all improved, but the erythrocyte sedimentation rate remained consistently elevated until the addition of tocilizumab, a monoclonal antibody against interleukin 6. CONCLUSIONS: Ruxolitinib was not successful in suppressing the inflammatory process, and tocilizumab produced highly encouraging results in reducing the inflammatory reaction of AGS. The study makes a significant contribution to the literature because we may found a potential alternative therapeutic option for AGS.

Individualized Human Milk Fortification to Improve the Growth of Hospitalized Preterm Infants.

BACKGROUND: Human milk (HM) is the first choice for preterm infants, but exclusive HM feeding is inadequate for the growth of very preterm infants. The hypothesis of this trial is that infants fed according to an individualized fortification regimen will have higher protein intake and improved weight gain velocity (WGV). METHODS: A prospective, randomized, controlled study was conducted. Infants <34 weeks of gestational age were enrolled when enteral feeding volume reached 60 mL/kg/d and were randomly allocated to the individualized fortification (IF) group or the standard fortification group. The IF group was fed using a regimen that featured modifying HM fortifier and supplemental protein powder based on the protein concentration in HM, current body weight of infants, and blood urea nitrogen (fortification level was set as L-1, L0, L1, L2, L3; the amount of HM fortifier and protein powder were determined accordingly). RESULTS: Between September 2012 and August 2016, 51 preterm infants completed the study. In the IF group, 62.5% (15/24) of preterm infants were fed with HM fortified to level 1, 29.2% (7/24) to level 2, and 12.5% (3/24) to level 3. The WGV of the third week in the IF group was greater than the standard group (20.8 ± 7.9 vs 14.9 ± 4.5 g/kg/d, P = 0.022). CONCLUSION: About two-thirds of preterm infants needed to adjust the HM fortification to a higher level. The WGV of infants in the IF group was better than that of the standard group in the third week of this study.

Single-Center Overview of Pediatric Monogenic Autoinflammatory Diseases in the Past Decade: A Summary and Beyond.

Objective: Monogenic autoinflammatory diseases (AIDs) are inborn disorders caused by innate immunity dysregulation and characterized by robust autoinflammation. We aimed to present the phenotypes and genotypes of Chinese pediatric monogenic AID patients. Methods: A total of 288 pediatric patients clinically suspected to have monogenic AIDs at the Department of Pediatrics of Peking Union Medical College Hospital between November 2008 and May 2019 were genotyped by Sanger sequencing, and/or gene panel sequencing and/or whole exome sequencing. Final definite diagnoses were made when the phenotypes and genotypes were mutually verified. Results: Of the 288 patients, 79 (27.4%) were diagnosed with 18 kinds of monogenic AIDs, including 33 patients with inflammasomopathies, 38 patients with non-inflammasome related conditions, and eight patients with type 1 interferonopathies. Main clinical features were skin disorders (76%), musculoskeletal problems (66%), fever (62%), growth retardation (33%), gastrointestinal tract abnormalities (25%), central nervous system abnormalities (15%), eye disorders (16%), ear problems (9%), and cardiopulmonary disorders (8%). The causative genes were ACP5, ADA2, ADAR1, IFIH1, LPIN2, MEFV, MVK, NLRC4, NLRP3, NLRP12, NOD2, PLCG2, PSMB8, PSTPIP1, TMEM173, TNFAIP3, TNFRSF1A, and TREX1. Conclusions: The present study summarized both clinical and genetic characteristics of 18 kinds of monogenic AIDs found in the largest pediatric AID center over the past decade, with fever, skin problems, and musculoskeletal system disorders being the most prevalent clinical features. Many of the mutations were newly discovered. This is by far the first and largest monogenic AID report in Chinese pediatric population and also a catalog of the phenotypic and genotypic features among these patients.

[A preliminary study of serum free testosterone and testosterone secreting index in men with erectile dysfunction].

OBJECTIVE: To observe the changes of serum free testosterone (FT) and testosterone secreting index (TSI) in ED patients, and to assess the contribution of these two indexes to the diagnosis of ED caused by endocrine factors. METHODS: We studied 120 ED patients and 30 healthy men undergoing pre-marital medical check-up in Jiangsu Province Hospital of TCM by analyzing the scores on erectile function and desire domain in IIEF, testing the serum total testosterone, luteinizing hormone by chemiluminescent enzyme immunoassay (CLIA), measuring free testosterone by radioimmunoassay( RIA), and calculating TSI. RESULTS: Of the 120 ED patients, 5% and 1538% were below the reference norm of TT and FT values respectively. TT, FT and TSI decreased with age, with statistical with FT and TSI, but not with TT. FT and TSI statistically declined with lower IIEF score on ED domain, but this was not the case with TT. There were no significant differences in TI, FT and TSI among different sexual desire groups the ED patients. CONCLUSION: FT is much more valuable than TF in the diagnosis of ED with hypogonadism. Both FT and TSI are important parameters in assessing the severity of ED.

[Experimental study on the effects of jujingwan on oligospermia].

OBJECTIVE: To investigate the effects of Jujingwan on the spermatozoal ultrastructure and apoptosis of germ cells in oligospermia patients. METHODS: We treated 50 oligospermia patients with Jujingwan and observed the spermatozoal ultrastructure, the apoptosis of germ cells and the changes in the DNA ploidy proportion of spermatogenic cells by electron microscopy and FCM before the treatment and 3, 6, 9 and 12 months after it. RESULTS: Jujingwan increased sperm acrosome base density 6 months after the treatment and remarkably improved the integrity of acrosome membrane 12 months after it, with no obvious pathological changes in the nuclei and tails. Three months after the treatment, cell debris and apoptotic cells decreased significantly as compared with pre-treatment (P < 0. 05) , and very significantly 12 months after the treatment (P <0. 01). The proportion of haploid spermatozoa increased very significantly (P <0.01) , and the lost primary spermatocytes decreased significantly (P <0. 05) compared with pre-treatment. CONCLUSION: Jujingwan can increase the density of sperm acrosome base and improve the pathological changes of acrosome membrane in oligospermia patients; it can improve the activity of acrosome enzyme and the integrity of acrosome membrane, decrease the apoptosis rate of germ cells and sperm and increase the percentage of haploid spermatozoa; it can also reduce the percentage of apoptotic bodies and diploid sperm cells. It is indicated that Jujingwan can inhibit the apoptosis of germ cells and sperm and improve spermatogenesis in oligospermia patients.

Effects of preoperative vaginal estrogen therapy for the incidence of mesh complication after pelvic organ prolapse surgery in postmenopausal women: is it helpful or a myth? A 1-year randomized controlled trial.

OBJECTIVE: The literature advocates preoperative vaginal estrogen (VE) therapy to reduce mesh exposure in pelvic organ prolapsed (POP); however, there are no comparative studies so far. This study aims to compare the effects of preoperative VE and non-VE therapy for the incidence of mesh exposure in postmenopausal women after transvaginal pelvic reconstructive surgery (PRS) with mesh. METHODS: A randomized noninferiority single-surgeon study of 186 women with severe POP was conducted. Ninety-three women (VE group) received 0.5 g promestriene cream twice a week transvaginally for 6 weeks before PRS with mesh, and 93 women (non-VE group) underwent PRS with mesh 6 weeks after enrollment without pharmacologic preparation. The primary outcome was the occurrence of mesh exposure within 1 year. RESULTS: Overall, 173 of 186 participants (93.0%) completed 1-year follow-up. In an intention-to-treat analysis, the proportion of participants experiencing mesh exposure was 16.1% (15 of 93) in the VE group versus 12.9% (12 of 93) in the non-VE group (P = 0.024 for noninferiority). Both exposure area and time to exposure did not differ between the two groups. Similarly, no detectable differences at month 12 were found in terms of anatomic success, good response on the Patient Global Impression of Change, improvement in quality of life and sexual function, and complications. The result of per-protocol analysis agreed with that seen in the intention-to-treat analysis. CONCLUSIONS: In postmenopausal women with severe POP who underwent transvaginal PRS with mesh, non-VE therapy before surgery was noninferior to VE therapy regarding mesh exposure rate within 1 year of follow-up.

Medium-term outcomes after combined trachelectomy and uterosacral ligament suspension among young women with severe uterine prolapse.

OBJECTIVE: To evaluate anatomic and sexual outcomes among young women with severe pelvic organ prolapse undergoing combined trachelectomy and laparoscopic high uterosacral ligament suspension (LHUS). METHODS: In a prospective study in Beijing, China, patients (aged ≤50 years) with pelvic organ prolapse of stage III or higher according to the Pelvic Organ Prolapse Quantification (POP-Q) were enrolled between November 2007 and August 2011. After combined trachelectomy and LHUS, patients were followed up at 6 weeks, 6 months, 12 months, and yearly thereafter. Anatomic success was defined as POP-Q lower than stage II. Sexual outcomes were assessed at 6 months via the validated Short-Form Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and compared with a control group of 39 healthy age-matched women. RESULTS: Among 49 patients, surgical success and patient satisfaction rates were 100% after a median follow-up of 54 months. Among 48 patients who were sexually active at follow-up, 39 (81%) completed the PISQ-12 questionnaire. The 6-month PISQ-12 score was higher than the preoperative score overall (38.1 vs 26.4, P<0.001) and for all three subscale domains (P≤0.001). The PISQ-12 score of postoperative patients was similar to that of control women (36.8, P=0.52). CONCLUSION: Trachelectomy combined with LHUS produced satisfactory medium-term anatomic and functional outcomes for young women with severe uterine prolapse.

Modified laparoscopic sacrocolpopexy with mesh for severe pelvic organ prolapse.

OBJECTIVE: To evaluate anatomic and sexual outcomes among patients with severe pelvic organ prolapse, defined as stage III or higher by Pelvic Organ Prolapse Quantification (POP-Q), who underwent modified laparoscopic sacrocolpopexy. METHODS: Between March 2007 and December 2010, a prospective study in Beijing, China, enrolled 21 patients who underwent vaginal hysterectomy, followed by modified laparoscopic sacrocolpopexy with the attachment of mesh straps transvaginally and the sacral attachment of mesh laparoscopically. Patients were assessed at 6 weeks, 6 months, and yearly. Anatomic success was defined as POP-Q lower than stage II. Sexual outcomes were assessed via the short-form Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). RESULTS: During a median follow-up of 43.5 months (range 18-60 months), the surgical success rate was 100%, the patient satisfaction rate was 90.4%, and 1 patient (4.8%) experienced mesh exposure. Postoperatively, 20 patients were sexually active (95.2%). There was a significant improvement between pre- and postoperative PISQ-12 scores both for the total score (31.6 vs 38.5; P<0.001), and for 5 individual items (P<0.01). CONCLUSION: Modified laparoscopic sacrocolpopexy with mesh seemed to be safe and might simplify the surgical approach to severe POP with satisfying anatomic and functional outcomes. It did not affect sexual function negatively.